Make a sustainable success of a well-balanced nutrition and sensorially adapted for Seniors – RENESSENS

The RENESSENS project has developed a methodology to provide a personalized food offer, i.e. adapted to the needs, capacities and preferences of each dependent elderly person for his or her food. This methodology includes: a diagnostic tool to determine the «eating profile« of a senior, and an intervention plan adapted to each profile. This plan includes recommendations (food plan, monitoring plan) and solutions (cooking techniques, food), and a training plan for health and catering professionals to adapt the food supply to the nutritional needs of the senior. The RENESSENS project then set up several clinical studies at home and in nursing homes (EHPAD – Etablissement d'Hébergement pour Personnes Âgée Dépendantes) in order to test the methodology previously developed in the field. The objective of these studies was to evaluate the benefits of a personalized diet for the senior (health and well-being benefits), for the facilities (cost/benefit of implementing a personalized diet) and for society (sustainability of the proposed solutions).

Among seniors with culinary dependence, 7 out of 10 do not eat enough to cover their nutritional needs mainly because they are not able to eat enough (loss of appetite). It is essential to enrich the diet of seniors with loss of appetite in order to prevent the risk of malnutrition. Enriching means increasing the nutritional density of dishes without increasing (or potentially reducing) portion sizes.

The objectives and continuity of the RENESSENS project will continue through new projects and collaborations.

The results of RENESSENS have been the subject of numerous publications and communications, particularly among the socio-professional community and senior citizens themselves. A conference was organized on 20 November 2018 in Paris, and a guide on the care of the elderly with small appetites should be published by the end of 2019. The RENESSENS project has also led to the development of ingredients - now available on the market - to enrich and enhance the texture of food (patent registration).

In the context of an ageing French population, the major societal concern today is to allow everyone to age successfully. Among others, successful ageing means allowing the elderly person to benefit from relevant support when difficulties arise with accomplishing certain activities. Relevant support implies on the one hand that it corresponds to the person’s needs and expectations, and on the other hand that costs engendered by this support are incorporated within a sustainable strategy to guarantee maintenance of the support over time. The term culinary dependence describes situations in which elderly people have to delegate all or part of their meal shopping and/or preparation to others (home help, meals-on-wheels, nursing homes’ catering service) because of the onset of disabilities (lack of skills, physical disability, cognitive impairment). Without presuming any cause and effect relationship between dependence and malnutrition, several studies have shown that despite the resources deployed for the support of dependent elderly persons, the risk of malnutrition is high in this population. Malnutrition corresponds to a deficiency in nutritional intake. Without prevention and without care, malnutrition leads to decreased mobility, an increased risk of falls or fractures, increased vulnerability to infectious diseases and exacerbation of chronic diseases. With regard to this situation there are:
- Environmental cost. Food wastage in nursing homes ranges from 15 to 40%. Regarding meal-on-wheels service, 20 to 30% of the meal supplied for lunch is not consumed: one third of the leftover food was consumed for the dinner, one third was given to the pet and one third was thrown out.
- Economic cost. The cost of providing support to an elderly person with regard to meals is far from negligible, for both elderly persons themselves and for society at large. This cost is even higher in cases of malnutrition (oral nutritional supplements, increased cost due to the management of malnutrition impact on health).
- Societal cost. A survey conducted in 559 French people of 65 years and older showed that “pleasure to eat” remained the same whatever the level of dependence, whereas satisfaction with the meals consumed decreased with dependence. Support that does not take the person’s expectations and preferences into account is detrimental to the person’s quality of life.
Though public health policy propose and try to enforce nutritional recommendations for elderly persons, there are few recommendations for dependent elderly persons who present specific eater profiles such as small eaters, persons presenting functional or cognitive impairment, persons who are fussy about their food. Consequently, the aim of RENESSENS is to improve food efficiency for dependent elderly persons, by developing tools and solutions to “personalize” the support given to them. RENESSENS will consist in developing: 1. a diagnostic tool to determine the “eater profile” of the elderly person; 2. an intervention strategy for each profile, which includes recommendations (nutritional advice, diet plans…) and solutions (suggestions for foods, food preparation techniques, services…); 3. a training program to implement this approach. This will take the form of a guide “Screen to nourish better”, so that the food and meal provided to the elderly people correspond as much as possible to their needs, abilities and preferences. This approach will then be implemented through a pilot study in voluntary structures, so as to evaluate the cost/benefit ratio of personalized meals for the elderly (health benefit, well-being), for the establishments (cost/benefit ratio of implementing personalized meals) and for society (sustainability of the solutions). This guide will then be diffused to professionals in charge of dependent elderly people and to authorities, so as to complement the strategies already in place to prevent and fight against malnutrition in this population.