Cooking with Care A toolkit to support healthy eating for unpaid older carers Introduction We know healthy eating plays an important role in keeping our bodies healthy and strong, as well as preventing illness. This is particularly important for older adults, because as we age we are at a higher risk of health issues associated with poor nutrition. Caring in later life can be a rewarding role, but it is not without its challenges and stresses. Therefore, eating well and being active are great ways to ensure we stay healthy, meaning we can fulfil a good quality of live and provide the best level of care we can for our loved one or family member. The Cooking with Care toolkit provides simple information on how to eat healthy in later life whilst managing the role of a carer and useful tips and advice on cooking and food skills. The toolkit also provides some useful information on looking out for symptoms of malnutrition and how a range of barriers (i.e. medical, emotional, physical) can affect our appetite and the food we eat as we age. This toolkit is aimed at older adults (defined as 65 years and older) in an unpaid caring role for another member of their household. However, it may also be of interest to any older adult looking improve their diet and skills in the kitchen, or anyone who cares for an older adult. The toolkit has been written by Public Health Nutritionists at Food Active (a healthy weight programme delivered by charity Health Equalities Group), as part of the ‘Cooking and Company’ project delivered in partnership with the Liverpool Carers Centre (part of Local Solutions) in 2019-20, which was kindly funded by BUPA UK Foundation. Contents Page no Healthy eating for older adults 3 Food skills: top tips and tricks 14 Healthy recipe ideas and inspiration 16 Nutrition and disease 22 Malnutrition: what are the risks? 24 Further information and support 27 p.2 COOKING WITH CARE TOOLKIT Healthy Eating for Older Adults As we get older, it’s important that we continue to eat well. Changes in our body as we age can affect how and what we eat, including lower energy (calorie) requirements. As we age, eating well can help to improve mental sharpness and increase our resistance to illness. It can also make sure we stay strong and healthy, providing enough energy to support our day to day life as well as our role as a carer. Healthy eating isn’t about cutting out foods, dieting or sacrifice – it’s about enjoying a wide variety of foods in the right amounts to give your body what it needs. It's also about getting the right balance. Our nutritional needs can change as we get older, general healthy eating advice may not always be appropriate, dependent on requirements. Please see Section 5 for more information. However, we may face several barriers faced in providing a healthy diet for yourself and the person you care for. Caring for our partner, child or relative can be fulfilling, but also stressful and tiring at the same time. The daily challenges of a carer often include a busy and demanding lifestyle, meaning healthy eating and our own health needs are pushed down the priority list. But it does not need to be this way. No matter what our age is or our previous eating habits, it is never too late to improve our health by making some changes your diet. It is also never too late to try and learn something new! By understanding what a balanced diet looks like and how to fit it into your lifestyle you can look after your own health and wellbeing, and the person you care for. This toolkit is designed to help you achieve this. If you worried about your health talk to your GP. You may find that you are concerned about your nutritional intake or that of the person you care for. Be assured that there are people who can help, so if you need support outside of this toolkit please do contact the relevant support or your GP. p.3 COOKING WITH CARE TOOLKIT The Eatwell Guide The Eatwell Guide is used to show the different types of foods commonly eaten and the proportions that are recommended to achieve a healthy, balanced diet. No single food provides all the nutrients we need, so it is important to include a wide variety of foods in the diet. The guide is based on the following principles, and we should aim to base our diet on these guidelines as much as possible. Everyone is recommended to eat at least five portions of a variety of fruit and vegetables every day. We should try to base meals on potatoes, rice, pasta or other starchy carbohydrates, choosing wholegrains where possible. Have some dairy or dairy alternatives (such as soya- based products); choosing lower fat and lower sugar options (where appropriate). Eat some beans, pulses, fish, eggs, meat and other proteins. Choose unsaturated fats and use in small amounts. Drink 6-8 cups of fluid a day (this includes water, lower fat milk, sugar free drinks). Reduce the amount of foods containing high levels of fat, salt and sugar you consume. Have these less often and in small amounts. p.4 COOKING WITH CARE TOOLKIT Fruit and vegetables Fruits and vegetables are full of vitamins, minerals and fibre, and are low in fat and the Government encourage us to eat at least five portions every day. There is evidence that for every portion of fruit or vegetables eaten there is a greater protection against heart disease and strokes (by up to 30%) and some cancers (by up to 20%). Here are some handy tips on how to incorporate more fruit and vegetables into your diet: • Serve a side salad with your dinner. • Keep sticks of celery, cucumber or FACT CHECK: Proportion carrot handy for a tasty snack. of older adults meeting • Swap creamy sauces or soups for their 5-A-DAY tomato or vegetable based. • Keep tinned fruits handy in the 31.5% 65-74 year olds cupboard for a quick and easy fruit salad for a sweet treat after your 19% 75+ year olds evening meal. Check out the handy portion size guide to the right. Whilst smoothies and juices are a popular way to eat fruit and veg – it’s actually better to eat them whole. Juices are much higher in free sugars and calories, and contain less fibre than whole fruit, so stick to 150ml per day max. TOP TIP: There are many varieties of fruit and vegetables to choose from including fresh, frozen, dried and tinned. When choosing tinned fruit, opt for fruit tinned in juice rather than syrup, as the syrup can contain lots of sugar. Try to also choose vegetables in water rather than brine, as the brine can increase the salt content. Photo Credit: British Heart Foundation (2018) Eat Better https://www.bhf.org.uk/informationsupport/publications/healthy- eating-and-drinking/eat-better . p.7 COOKING WITH CARE TOOLKIT Potatoes, rice, pasta or other starchy carbohydrates Starchy foods, such as bread, rice, potatoes, pasta, pitta breads, couscous, plain chapattis and naans are a very important part of a healthy diet and should make up just over a third of the food we eat. Eating plenty of fibre is associated with a lower risk of heart disease, stroke, type 2 diabetes and bowel cancer. It can also help to relieve constipation, promote a healthy digestion system and keeps us fuller for longer. Choose higher-fibre, whole grain varieties such as wholegrain bread, whole wheat pasta or couscous, brown rice, or simply leave the skins on potatoes. As well as being low in fat and high in fibre, they are good sources of other essential nutrients - protein, vitamins and minerals. TOP TIP: Wholegrain varieties of carbohydrates (such as bread, pasta and rice) contain up to 2.5 times more fibre than white varieties! Remember to increase fibre slowly as bowel discomfort, flatulence and distension may occur if consumed in large quantities, or if the amount of fibre eaten is increased very rapidly. BREAKFAST: Swap Cornflakes for Porridge, Weetabix or Bran Flakes for a fibre boost. A handful of fresh or tinned fruit makes for a tasty addition. LUNCH: Swap a ham sandwich for granary tuna sandwich. Add fresh salad and slices of cucumber or tomato for a tasty, filling and nutritious sandwich. DINNER: Swap carbonara pasta for whole wheat penne with tomato sauce. Throw in diced celery, carrots, courgettes and/or mushrooms into your tomato sauce for added flavour and nutrition. p.8 COOKING WITH CARE TOOLKIT Dairy, dairy alternatives and Vitamin D We lose bone mass as we age, so it is essential to include plenty of calcium in our diet on a daily basis. After the menopause, older women are particularly susceptible to osteoporosis (thinning of the bones) and reduced bone density. Milk and dairy foods such as yoghurt and cheese are important sources of calcium, vitamins A, D and B12, protein and fat. Vitamin D is needed to help absorb calcium and plays an important part in strengthening the bone. However, dairy products can largely vary in saturated fat and sugar, so it’s important to pick healthier options where you can*. DID YOU KNOW: Our ability TOP TIP: You can also boost to make Vitamin D by the skin your Vitamin D intake through decreases with age. Low foods such as fortified cereals Vitamin D status is widespread (wholegrain where possible), in older people in the UK and eggs and oily fish.