Coeliac disease is an autoimmune condition that causes a person’s immune system to abnormally react to gluten ingestion. Gluten is a protein found in many products containing wheat, rye, barley and oats.

For someone without coeliac disease, gluten does not cause any negative effects. However, for those with the disease, even a very small amount of gluten can cause damage to the lining of the intestine and cause villous atrophy, which reduces the surface area of the small intestine’s absorption layer. This process can cause a range of other health issues from debilitating gut symptoms to reduced bone density (source: https://www.coeliac.org.au/s/coeliac-disease).

Coeliac disease is most often diagnosed by a genetic marker serology test followed by an endoscopy to confirm. If confirmed, clients can feel lost and restricted when it comes to following a gluten free diet; this is where a Plena Dietitian can help.

Dietitians can often educate on ways to improve the variety of foods that someone with coeliac disease can have, make recommendations about meal ideas that are achievable and bust myths that make a gluten-free diet unnecessarily overwhelming! Dietitians can even support a client seek a diagnosis of coeliac disease as we are often asking clients questions about gut symptoms, known deficiencies and energy levels [2], which are some of the key markers of Coeliac disease.

At Plena, our Dietitians support our aged care homes to provide meals to residents with coeliac disease that are nutritionally balanced, promote dietary variety and support the kitchen to correctly prepare meals to avoid gluten contamination. We also support the client, their families and their GPs with education about gluten-free diets.

Nutrition Education within residential aged care homes is beneficial for several reasons:
  1. A home could serve the most nutritious meal available, but it all goes to waste if the resident does not actually eat it. Educating staff on topics such as appetite, meal preferences, assistance and pre-meal care improve the likelihood of meals being eaten.
  2. The noticeable effects of poor nutrition in an aged care resident are often gradual, therefore it is important that staff can recognise warning signs of malnourishment before it becomes a risk to quality of life and hastened mortality.
  3. Nutritional care needs to be front of mind at every mealtime and the dietitian cannot always be there to support this. This means that the more awareness staff have about nutrition issues, the more likely dietetic interventions will be effective.
  4. When aged care staff are empowered and confident in their ability to improve nutrition outcomes for a client, they begin to advocate and share their knowledge with team members, which improves nutrition across a whole home.

Plena Dietitians are also able to provide a range of education sessions for clinical staff, food service staff and aged care management teams. This may include anything from supporting wound healing to educating kitchen staff about gluten-free diet preparation. Nutrition education also provides staff with an opportunity to ask questions about nutrition processes in the home and discuss specific client cases.

Here are some signs that a RACF may benefit from nutrition education:
  • There are large amounts of wastage of food or nutrition supplements.
  • The dining room is noisy, poorly lit or distracting for many residents.
  • Staff are struggling to find time to provide meal assistance to all residents who need it.
  • There are a high number of residents having gluten-free or dairy-free meals.
  • There are a high number of residents with pressure wounds.

Case study: Toaster contamination

Mary, an 80-year-old client with coeliac disease, diagnosed in her 30’s, had been living at a residential aged care home for over a year. She was concerned that the meals being served to her, were causing uncomfortable bloating and constipation. Mary had also recently returned a blood test result that showed her iron levels were low.

When our Dietitian spoke to staff at Mary’s home, they reported that they struggled to know what to offer her at mealtimes; Mary and her family were also frustrated by the lack of coordination within the kitchen. Some weeks, Mary was served chicken, rice and vegetables at every meal for days.

Our Dietitian spoke to the kitchen staff and management who agreed to some training with the food service team about the importance of a gluten-free diet and how to reduce risk of contamination in the kitchen. During the training and with guidance from our Plena Dietitian, staff discovered that they had been preparing Mary’s gluten free bread for breakfast in the same toaster as regular bread. This caused tiny amounts of gluten to be consumed by Mary every morning through contaminated toast crumbs. This was simply fixed by having a toaster and knife dedicated to preparing Mary’s breakfast. By the next review in a month’s time, Mary reported that her symptoms had reduced significantly.

Would you like to find out more about how we can make your life easier and take care of your residents allied healthcare needs or provide expert training to your staff click here.

References

  1. Coeliac Australia. (2023). What is Coeliac Disease?. Webpage. https://www.coeliac.org.au/s/coeliac-disease
  2. Shepherd, Sue & Gibson, Peter. (2006). Understanding the gluten‐free diet for teaching in Australia. Nutrition & Dietetics. 63. 155 – 165. 10.1111/j.1747-0080.2006.00090.x.