Don’t Let a Fall Get You Down

1. Don’t Let a Fall Get You Down Meal Preparation and Nutrition

2. Sharing Experiences Has anyone had any falls or injuries that occurred in the kitchen, while cooking or grocery shopping?

3. In this session we’ll… • Look at ways that you can increase your ability to safely work in the kitchen, prepare food and cook after you’ve had a fall, • Discuss the importance of nutrition, • Apply the “Person, Occupation, Environment” problem solving strategy to look at ways to be safer

4. Environment Physical Institutional Occupation Physical Self Care Leisure Person Psycho-Social Cognitive Productivity Social Cultural The Canadian Model of Occupational Performance Reference: Townsend, E (ed), Enabling Occupation: An Occupational Therapy Perspective, Canadian Association of Occupational Therapists, Ottawa, ON, 2002

5. Moving Around in the Kitchen Person • Improve strength and balance through participation in a regular exercise program. Environment • Make sure there is adequate lighting in the kitchen. • Remove scatter rugs and obstacles in the path. • Consider your counter heights. If they are too high or too low, consider whether you can set up another work surface with the addition of an island or altered counter top. • Arrange your cupboards so that the items that you use most frequently are on the lower shelves. Put your “company” dishes up higher, and ask the company to help you get them down. • Consider putting pull out shelves or drawers under your counters so that you can reach the items easily. Make sure that your knives and tools are sharp and in good repair. You are more apt to cut yourself with a dull knife that slips. • Use lightweight dishes, pots and pans. Occupation • Sit at the table to prepare food whenever possible. • Slide heavy items across the counter if possible rather than carrying them. • Use a kitchen trolley to move plates or dishes with food on them to the table rather than carrying them. • If you need to step up to reach something, have a steady step stool available (preferably with a handle to hold on to) and use it. Don’t use a chair to climb up to reach something. • If you have a hard time carrying a full kettle, consider filling the kettle at the stove using a pitcher of water.

6. Food Preparation and Cooking Person • Improve standing balance through participation in a regular exercise program. Environment • Consider your counter heights. If they are too high or too low, consider whether you can set up another work surface with the addition of an island or altered counter top. Occupation • Sit at the table to prepare food whenever possible. • Use pre-prepared foods (e.g. pre-cut bagged salads, frozen vegetables) to cut down on food preparation. • If you have trouble cooking, consider Meals on Wheels or other meal preparation and delivery services in your community. This may assist you in having one full, hot meal per day; and may help you to manage lighter servings for other daily meals.

7. Grocery Shopping Person • Improve strength, flexibility and standing balance through participation in a regular exercise program. • Wear comfortable, supportive shoes with non-skid soles. Environment • Use a store scooter if available to conserve your energy. • If standing in line is difficult, let the staff know ahead of time so that they can provide a resting area or open a new cash line for you. • Take a wheeled walker with you. You can sit on the seat when you are waiting in line, or when you need to rest. • Have a cart, trolley or wagon stored near your home or apartment parking place. Move the groceries into the cart, wagon or trolley and then pull them to the door. • Keep a wheeled suitcase in your trunk. Put the groceries into the suitcase to move them from the car to your home. Occupation • Ask a family member or friend to pick up groceries for you. • Schedule your day so that you grocery shop when you have the most energy. • Shop at times when the stores are less crowded so that you are less hurried. • Ask a family member or friend to go with you to grocery shop. You can make it a social activity and have someone to help you carry the groceries into the house. • Phone the food order to the grocery store and have groceries delivered. • Take fewer bags at a time and make more trips from the car to the kitchen.

8. The Importance of Nutrition Poor nutritional status can increase your chance of falling. Some issues to be aware of include: • Blood sugar levels: If you have diabetes, be aware of how a high or low blood sugar level can decrease your energy level, cause dizziness and confusion, and cause a drop in blood pressure that can result in a fall. • Not eating enough: Even for those without diabetes, eating poorly can cause low blood sugar levels and low energy. • Poor hydration: Not taking in enough fluids can affect your digestion, give you headaches, and cause dizziness.

9. Why is nutrition an issue for older adults? • Usual physiological changes of aging • Decrease in lean body tissue, reducing energy needs and appetite; can be avoided with appropriate daily activity • Loss of bone density, increasing risk of fractures and osteoporosis • Decline in immune function, enhancing risk of infection • Reduced taste and smell, contributing to lack of appetite • Dental problems and dry mouth compromising chewing and food and fibre intake; for some individuals swallowing difficulties also compromise food intake • A decline in kidney function and thirst, increasing risk of dehydration • Changes in digestion leading to constipation and reduced absorption of some nutrients Reference: Keller, 2003, page1

10. Why is nutrition an issue for older adults? (cont’d) • Chronic disease conditions may require a modified diet. • Many seniors take over-the -counter and/or prescription drugs that affect appetite, absorption and use of nutrients by the body. Over-medicating and alcohol abuse also pose nutritional challenges for some older adults. 4. Changes in mobility and dexterity can affect access to shopping and ability to prepare meals. Many seniors rely on relatives, taxis or assisted-shopping to purchase food. adapted from Keller, 2003

11. Why is nutrition an issue for older adults? (cont’d) 5. Seniors are more likely to live alone and may not feel motivated to cook and eat by themselves. Limited food skills and knowledge of food safety are also a concern for some 6. Chewing or swallowing difficulties greatly influence the quantity and quality of food consumed. The majority of studies in this area reported an adverse effect of poor dental status, chewing difficulties or dry mouth on appetite, weight, protein and nutrient (especially B vitamins) intakes. adapted from Keller, 2003

12. Appetite Appetite largely determines food intake. Many factors can affect appetite: • some medications will increase or decrease appetite, or change the taste of food. • Physical conditions (e.g. chronic infections), mental health issues (e.g. depression), and • sensory issues (mouth pain, decreases in taste and smell) and also have an impact on appetite. Reference: (Division of Aging and Seniors, 2002)

13. What can you do to improve nutrition? Person • Talk to your doctor or pharmacist about medications and how they affect your appetite. • If you have mouth or teeth issues, see a dentist and deal with them. • Drink plenty of fluids and reduce salt intake to maintain good hydration. • Maintain a healthy weight. • Choose foods that provide a variety of nutrients. • Emphasize whole or enriched grain products such as bran cereals, multigrain bread, whole wheat pasta, barley and brown rice. • Add colourful fruits and vegetables to stimulate appetite and provide essential vitamins and minerals. • Help strengthen bones by eating foods with lots of calcium and vitamin D, and by enjoying daily activity. Choices include milk, yogourt and cheese, fortified soy beverages, puddings and soup made with milk; • For high quality protein include foods such as meat, poultry, fish, eggs, tofu and legumes. • Choose lower fat foods more often. Add less fat in cooking and at the table.

14. What can you do to improve nutrition? Environment: • Atmosphere is important. Make meal time a pleasant time. Take your meal out on the porch or sit near a window or listen to music or watch TV or read a book or go to the park for a picnic. • Share a potluck dinner with a friend. • Enjoy a dinner out in a restaurant or at a local Seniors Community Centre. • Start cooking together with some friends. Find a place where a few of you can meet to plan, shop and prepare several meals together. These meals can be taken home and frozen to be used when you don't feel like shopping or cooking.

15. What can you do to improve nutrition? Occupation: • Buy foods sold in small, easy to open packaging assist food preparation. • Plan meals to suit your schedule. You may prefer to eat your large meal at noon or a combination of small meals and snacks throughout the day. The pattern is not important as long as you eat a variety of foods to meet your nutritional needs every day. • Shop on seniors discount days or during the week when stores are less busy. Having the time to read labels and comparison shop will help you to choose the foods you want at the best price. • Save money by buying larger quantities of some items and dividing them into smaller portions to freeze or split with a friend. • Make the best use of your time by doubling the recipe and freezing the extra in serving sizes for another day

16. References Keller, H. Bringing Nutrition Screening to Seniors in Canada: Nutrition for Seniors, Dietitians of Canada and University of Guelph, retrieved May 14, 2008 http://www.dietitians.ca/seniors/pdf/Nutrition_Seniors_Fact_Sheet_ENG.pdf Division of Aging and Seniors, Health Canada, Healthy Aging Nutrition and Healthy Aging,2002, retrieved May 14, 2008 http://www.phac-aspc.gc.ca/seniors-ines/pubs/workshop_healthyaging/pdf/nutrition_e.pdf Dieticians of Canada: Senior-Friendly Fact Sheets, including tips on cooking for one or two, meal planning on a budget, and many more, retrieved May 14, 2008: http://www.dietitians.ca/public/content/eat_well_live_well/english/faqs_tips_facts/fact_sheets/index.asp?fn=view&id=2359&idstring=7969%7C2540%7C2359%7C1267%7C1201 Ness, K., Take Charge! Good Nutrition for a Lifetime, Dieticians of Canada, June 2, 1999, retrieved May 14, 2008 http://www.dietitians.ca/public/content/eat_well_live_well/english/faqs_tips_facts/fact_sheets/index.asp?fn=view&id=1267&idstring=7969%7C2540%7C2359%7C1267%7C1201