Fueling Independence: How Nutrition Shapes Healthy Ageing
The aged care journey, especially for family carers , can feel overwhelming and emotionally draining. We often focus on big life changes, but one of the most powerful and often overlooked areas for support is nutrition. In this vital conversation, we sit down with Dietitian Pip Spence to understand how the right approach to food can be the key to maintaining strength, independence, and overall well-being for older Australians.
The Hidden Challenge: Not Eating Enough
One of the biggest nutritional challenges Pip sees isn't about what older people are eating, but not eating enough. Appetite often decreases with age, and many older Australians feel they're "not doing anything" to work up a hunger.
However, the latest research shows that older people actually need higher amounts of certain nutrients, particularly protein and calcium, than younger adults.
“I think one of the issues that we come across in our older clients is they've often followed diets when they're younger... and now that they, you know, maybe into their 80s or even 90s, some of those diets don't need to be so restrictive.” — Pip Spence
The food rules from earlier in life—like restrictive diets for weight or cholesterol—often don't apply, or should be relaxed, to help maintain crucial bone and muscle strength. For family carers, it's a great opportunity to encourage enjoyment, maybe even with a little more dessert or nutritionally dense snacks between meals.
Key Takeaways for Carers and Care Managers
Focus on Protein and Calcium: These are the super-nutrients for older Australians. Protein is essential for muscle mass, strength, and wound healing, while calcium supports bone health. Dairy products (yogurt, custard, milkshakes) are often the easiest and most effective way to pack a punch of both.
The Power of the APD (Accredited Practising Dietitian): A dietitian is university-qualified and regulated, meaning they are better equipped to address clinical and complex medical conditions like diabetes, dementia, and swallowing difficulties. Don't confuse them with an unregulated 'nutritionist'.
A Holistic Assessment: An APD visit is much more than just a diet plan. It’s a full, holistic assessment that looks at medical history, medications, chewing/swallowing ability, and even the contents of the fridge and cupboards to spot issues like food waste or poor shopping habits.
Multidisciplinary Teamwork: A dietitian often flags the need for other supports. Loss of strength or poor balance might mean a referral to a physiotherapist for fall prevention, while difficulty with cutlery could prompt a visit from an Occupational Therapist (OT).
It's Covered by Support at Home: For those covered by a Home Care Support Plan, dietetic services fall under clinical services, and there is typically no core contribution required from the participant. Case managers should absolutely be encouraged to explore this essential support.
Pip reminds us that food is for enjoyment as well as fuel. Making small, individualised changes can make a massive difference to an older person's safety, health, and ability to stay happily in their own home for longer.
Learn more about the program or access resources to support your caregiving journey through the following links:
Department of Health and Aged Care - www.health.gov.au/our-work/support-at-home/about
My Aged Care - www.myagedcare.gov.au/support-home-program Carer Gateway - www.carergateway.gov.au/help-and-support/getting-support-carergatewy
Full Episode Transcription - 13 How Nutrition Shapes Healthy Ageing Feat Phillipa Spence
Giselle
Hello and welcome back to another episode of conversations with G and G. Today we have a special episode lined up. We'll be exploring a topic that affects so many families. Supporting healthy aging through nutrition. Joining us is the amazing dietitian Pip, who will be sharing her insights on how the right diet can help older adults maintain independence, strength and well-being. Welcome, Pip.
Pip
Thank you for having me.
Giovanni
Welcome Pip. Nutrition is such an underrated topic. I think we feel we see in our home care, space. And we love to hear more about, your perspective in this, very, important, topic. And if you can tell us a little bit about your background as well, that would be great.
Pip
Yeah. Well, thank you for having me. Yeah, I've worked in the nutrition, space, particularly in aged care for probably 17, 18 years now.
Both in residential aged care facilities, but also, for clients in, in home care. So, I guess I've probably got a pretty good understanding now with, some of the challenges and, I guess nutritional issues facing older people. And it is an area that I'm really passionate about because I think it's an area we can make a lot of difference and probably hasn't had the attention in the past that it's needed.
Giovanni
Interesting about that. Can you tell us why do you feel like it got a little bit under the radar?
Pip
Yeah, I think, I mean, obviously we've got a really ageing population, so we're seeing so many more older people now. And I think aged care, as we know in the media at the moment, we've discovered has not had the attention, funding, that it needs and nutrition has been a huge area of that.
So with the new aged care standards that have come into place recently, there's now a whole standard on food and nutrition. So, I think there's definitely now the attention, on that, I just don't think it was seen as an area of focus. And a lot of the clients that I see in residential facilities can come in quite malnourished if they've been living at home, without the support they need for nutrition.
So homecare nutrition is also really important, to support people living in their homes as long as they can and as well as they can.
Giselle
It can have a huge effect on people's, medical conditions and wellbeing. Right? Like osteoporosis or wound if they've got a wound like nutrition is so important in making sure that it heals. And also lot’s of things, diabetes. So it's really an important thing to look at in older people. Forget about it.
Pip
Yeah. Absolutely. And I really think that, small changes can make a really big difference with someone's nutrition and. Yeah, how they living their life. So yeah, absolutely.
Giovanni
When we talk about challenges, can you tell us the top three challenges you experienced, you know, in aged care, yourself?
Pip
Yeah, I think probably one of the main issues I see in older people is actually not eating enough. So, we often find as people get older, their appetites become a lot less, they might, you know, I guess the comment that I hear a lot is I'm not doing anything, so I'm not working up an appetite, not feeling as hungry.
Or, you know, they just they might have medical conditions that mean they're not feeling hungry, they feel nauseous. They might have chewing and swallowing difficulties. That affects how they eat and enjoy their meals. But what we actually have found, particularly in recent years, there's been a lot of, research into, the nutrient requirements of older people and things like protein and calcium are actually needed in higher amounts in older people, yet they're often not eating as much.
So I think that's probably one of the challenges, is supporting people to get their nutrition in, in smaller quantities. Yeah. And I think, there's a bit of a buzzword at the moment with protein, and that's probably one of the key, the key areas that we see is people not getting enough protein, to maintain their muscle mass, help with wound healing, and maintain their strength.
Giovanni
Interesting. So not eating, not eat, not eating enough. So would that be applicable to me as well? I should eat a little bit more.
Giselle
You wish.
Pip
I think one of the misconceptions or one of the issues that we come across in our older clients is they've often followed diets when they're younger. They might have been put on a diet for cholesterol lowering or managing their weight or their diabetes.
And now that they, you know, maybe into their 80s or even 90s, some of those diets don't need to be so restrictive and they actually need to eat more to, to maintain their bone and muscle strength and maintain their weight. So it's a really individual thing. But yeah, I think we have to think of this population is a little bit differently to what, we would normally prescribe for healthy younger Australians.
Giovanni
Of course.
Giselle
Yeah.
Pip
The, the kind of dietary guidelines don't necessarily apply so much to older people. There's a specific set of guidelines for. Yeah.
Giovanni
And it's also an opportunity to enjoy life, you know, a bit more. Right. Having that a little bit more of a dessert.
Pip
Yes.
Giovanni
A little bit more of these and more like food that you wouldn't normally recommend.
Pip
Yeah. And that's where I think sometimes we have to look at how people are eating and kind of focus on foods that are a lot more nutritionally dense. And like you said, introducing maybe having a dessert with lunch and dinner might be some yogurt or some custard, but if you're not eating as much at your mealtimes and your needing more nutrients, then you often do need to actually eat, a little bit differently. Or having, you know, more substantial snacks between your meals.
Giselle
Yeah.
Giovanni
Interesting. Yeah.
Giselle
How and when does a nutritionist get involved? Like either in residential care. In home care? Like how would it work?
Pip
Yeah. So in the residential, setting, there would be a series of malnutrition screening that might take place by, the nurses in charge that might flag someone as being malnourished or at risk. But obviously for any other reasons. Wound healing, diabetes management. We see a lot of clients with dementia, sorry, a lot of behaviors around food. And it would be the same in the home care setting as well. So flagging those people that might be at risk, of having a poor appetite or having swallowing difficulties is another really big area.
Giselle
Yeah.
Pip
But yeah, dementia is probably the area that, we're seeing a lot of support needed, particularly for people that might not be eating as much because of their dementia. They might not be recognising food, they might have trouble, sort of feeding themselves or shopping, preparing their food.
Giselle
Remembering to eat. Yeah.
Pip
Yeah. So yeah.
Giovanni
That's interesting. So what are, people, in your opinion, the top three, tips you would give to care partners or care managers, for referring a nutritionist?
Pip
Yeah. So I think if you are a carer, supporting someone, perhaps in the home, one of the key sort of flags for someone becoming malnourished or maybe not eating as well is if they're losing weight. And that might not be on a scale that you've noticed, but you might be noticing their clothes are becoming quite loose, jewelry is loose, dentures aren't feeding very well. Some of those kind of signs that someone is losing weight often suggest they're not eating enough. So if you are looking after someone and you feel like they're not eating enough, that would be a reason to refer.
But any other concerns as well, that you notice someone's not eating well, that they're not chewing or swallowing properly, that they're reporting that they're feeling unwell. Feeling nauseous, or having bowel issues is often a really important one to have a look at. So, I guess if the person is covered by a home care support plan, you can actually ask your case manager to refer you on to a dietitian and that is covered with that funding. So yeah, sometimes it might just be a once off visit that you need to put a plan in place. It may be that the person needs ongoing care, but sometimes it is just. Yeah, doing a really thorough assessment and finding out where we can help.
Giovanni
Exactly. Right.
Giselle
Can you explain the difference between a nutritionist and a dietitian? Because I think I feel like people use it interchangeably, but it's true for me. There's a lot of nutritionists on Instagram.
Giovanni
Okay.
Pip
So dietitians are university qualified. So we complete either an undergraduate degree or you can do a master's in nutrition and dietetics. We, accredited and maintain our professional development. So, I guess a dietitian is probably, in most cases, more qualified at addressing kind of medical conditions. Really anyone can call themself a nutritionist. There's no, sort of qualification needed to do so.
Giovanni
It's not a regulated.
Pip
Yeah it’s not regulated.
Giovanni
I see. Are you are a dietitian?
Pip
So I'm a dietitian. Yeah. So we we have to maintain our skills constantly. And it's really on the dietitians that are, covered by Medicare and. Yeah, things like that.
Giselle
Yeah. I think that's important because I think it always gets used interchangeably. Doesn't it.
Pip
It does. Some dietitians to make it more confusing will call themselves a nutritionist as well. But yeah, I think if you're looking for someone who has experience in geriatric nutrition, clinical care. Then you want to look for an accredited practicing dietitian.
Giselle
Amazing.
Giovanni
Your perfect example here. Someone with great experience in the sector that can really make a difference in the care plans of participants.
Pip
Yeah, I like to think that .
Giovanni
Yeah, no doubt. And interesting you say that because, dietetic services. That's how you call it, right? Correct me if I am wrong.
Pip
Dietetic services, yes.
Giovanni
Yeah. Actually, fall into the category of clinical services and there is no core contributions, required by participants under the, the new support at home, program. So, yeah, by all means, I think it's, it's an area that I would encourage all the care managers out there to explore and, and, and be more aware that, having a good, you know, assessment done by a qualified dietitian can really make a huge difference to the quality of life of our participants.
Pip
Yeah, absolutely. And I think too, sometimes with that assessment, we can link you in with other services, whether it's meal, meals support, helping with cooking, shopping, preparation of meals. There's a whole lot of, I guess, areas that we can help you with support for.
Giselle
Yeah.
Giovanni
Yeah, that's interesting. And also what other, I guess, areas you can identify after a good thorough assessment. For example, you might be able to identify that he might need a physiotherapist to come in and do a fall prevention program, for example.
Pip
Yeah. Yeah. I actually saw a client the other day that I was saying for sort of general nutrition and this was someone who was working on maintaining weight, but also we identified that she really needed to build some strength as well. So that's where I suggested, you know, perhaps linking in with a physiotherapist, because often that diet and exercise go hand in hand.
So we don't just work as a siloed area. We actually we do link in. It might be dental services that, you know, you need looked at or a speech pathologist if there's swallowing difficulties. So OT are also really important.
Giselle
So good.
Pip
If there's issues with maybe using utensils and cutlery. They're really, really useful, in that sort of space.
Giselle
Yeah. So the dietitian is really important in the multidisciplinary team right. Like interacting with all of the other health professionals.
Pip
I think so.
Giselle
That's a key component of that. It’s so good to see.
Giovanni
So Pip, what should we expect from your assessment? Can you walk us through a little bit about what happens during the assessment and the report that comes out of it?
Pip
Yeah, sure. So if you are, a client in your home and we're going, to visit you in your home, we usually take about an hour, on site visiting you, and we'll actually work through, a full sort of assessment of your medical history, what medications you're taking, any sort of clinical issues that might be affecting your nutrition. So we'll talk about your teeth, how well you're chewing and swallowing. Whether there's any gut issues, bowel issues, skin issues and wounds.
We'll obviously, even if it's not so much a weight focused consultation, we'll have a look at what your weight is, whether you've got a scale at home or I will bring one with me, and take any sort of measurements that are relevant. So that might be, weighing, checking height, maybe taking a calf circumference sometimes will do, which is a measure of muscle.
We'll then have a look at what you're actually eating. So we talk about maybe what a typical day is for you. When I am visiting people at home, the beauty is that we can go and have a look in your fridge and look in your cupboard and see sort of, what brands and tighten the foods that you're eating. And that might be where we can offer suggestions about, about how we can improve.
Giselle
Do you look at things like if they’re managing their food, like if you open the fridge and there's moldy bread, everything's out of date. So it's something that you can..
Pip
Yeah, absolutely. If we open up a fridge and there's not much in there, that might be a flag that this person's not managing, shopping and preparing food. Other times we might have a look and say, you know, if we're seeing someone, perhaps, for diabetes management and, you know, there's, there's big jars of lollies and things like that, you know, that might be a bit of a flag.
Giovanni
A bit too many bottles of wine.
Pip
What's going on? Yeah, there's a few wine bottles in the corner. It's not so much we're snooping, but it really, it really, I guess informs our assessment. So, and it's very much about consulting with the person. So as much as we talk about, diet, we tend to look at the person as a whole as well. So we will talk about how much exercise they're doing, how they're sleeping, what their moods like. Because all those things impacts.
Giselle
Yeah, and their goals, I guess. Like what they want to achieve.
Pip
What they want to achieve. Not me coming in saying this is what this is how we do. Yeah, it's really working with the person to “what do you want to get out of this? And how can we help you?”
Giselle
Yes.
Giovanni
Sounds like it's a really holistic assessment.
Pip
Very holistic.
Giovanni
It's not just, you know, you just write up a diet, and here you go.
Pip
No. Yeah. And I think it's really important to remember that we have to make the person where they are. So, you know, some things might not be important to one person, but they are important to another. So it's a very individual assessment. And it's about, working on the things that they want to work on.
Giselle
Yep. Do they need to bring along with them like any blood test results to look at vitamin D levels, iron, all those types of things, if they’ve got them? Is that helpful?
Pip
Yeah usually before I go and visit someone, I check if they’ve got a scale. Have they got any recent pathology? Have they, you know, if they can have a list of their medications that they're taking. Because medications can impact on how they’re eating or how their body's absorbing. Yeah. So, we look at all those sorts of things.
So the more information they can have. Yeah. Sometimes I've got people writing down when they're going to the toilet and, you know, when they're using their bowels and things. But all that sort of information just helps us to kind of have a more thorough assessment.
Giselle
Yeah. That's great. Sounds good.
Giovanni
And is there a, like, a universal piece of advice that you give in terms of what healthy foods looks like for all the people?
Pip
Yeah, look I think it's really important to remember that everyone is individual. So as much as we can offer some general advice, everyone's situation and medical conditions, medical background is really individual. So we've got to be really careful about taking advice that's too general or reading, you know, an article in a magazine or listening to what your neighbor's sister said that they're doing. But I think for most older people, like I said, there's a few key nutrients that are really important to focus on.
One of those being protein. So making sure that we're getting enough protein. It's been shown that about 25 to 30g in a meal is the ideal amount for older people. To assist with muscle repair and maintaining muscle mass. And that can be really hard for some older people.
Giselle
What is that equivalent to? Like 30g is that a steak?
Pip
Yeah, it might be a chicken breast.
Giselle
Yeah. It could be a lot.
Pip
Yeah. When you think an eggs, only got about 6 or 7g per egg. That can be quite a lot. And a lot of our high protein foods, like meat, can sometimes be difficult for older people to eat, particularly if there's dental issues. Chewing and swallowing issues often meats the first thing to go. And you find they just are eating vegetables because they're easy to eat or, you know, pasta style soups and things. So, getting enough protein is really important.
Giselle
How about legumes?
Pip
Legumes, they're really good. They're not as high in protein as your animal products. So if someone is relying on those they need a lot more of them. The probably the food that I think is the superfood for protein and calcium is dairy. And that's where a lot of our strategies, if someone can eat dairy, it's a really easy way. So it might be having a smoothie or two or a milkshake a day, having snacks that, you know, cheese and biscuits. So yogurt or high protein yogurt.
Giovanni
Lots of gelato.
Pip
Lots of gelato. So yes.
Giovanni
Yeah, I love that.
Pip
It's really easy strategies like we talked about, you know, the dessert with a meal, it might be having some custard or yogurt with the meal to kind of get that extra. Some of the yogurts available now we've got 15, 20g. Right. So yeah. There you go. You're almost there.
So protein is a really big one and calcium for bone health is also a really important nutrient and one that, the requirements increased for older people.
Giselle
Yeah right.
Pip
Again if you're having that dairy, you're getting good bang for your buck with the calcium.
Giselle
Yeah so good.
Giovanni
Then what else. Is there anything like greens and broccoli or.
Pip
Yeah I mean obviously following a varied diet, eating lots of different foods, likely would advise for the normal population.But I think sometimes we have to focus on those areas that really need attention, like the protein and calcium. So as much as our veggies and fruits are really important, if that individual's really needing to maintain weight and, and bone health, our attention goes to those more. High protein foods.
Giselle
Yeah, right. And what are your thoughts about like the I don't want to call it like a meal I don't know in the dietitian world what they’re called but the replacement drinks and the powders.
Pip
So for weight loss? Or for, like a Sustagen.
Giselle
Yeah.
Pip
So obviously our philosophy as dietitians is always food first. Yeah, we want to we want people eating whole food. It's usually better absorbed. It's more palatable. It tastes nice. But there is a place, I think, for some of those meal supplements.
Giselle
And those supplements would be prescribed by a dietitian so it's not something that you would encourage people just to grab them and start using them on their own accord, or?
Pip
So yeah, I mean, look, they're readily available at supermarkets and things. And like I said, there's so many protein fortified foods now that everything's got added protein.
Giselle
Yeah.
Pip
You can often get away with having just regular foods and not needing those. I think if it was a case of someone requiring those, it's probably based done under the guidance of a dietitian. So that you’re using them correctly, so that you're not filling up on those things and then not having space for other foods.
Giselle
Yes. Yeah.
Pip
And there there are things that too, if you are seeing a dietitian under your home care package that, some of those products can be, subsidised with that package, too, if they're required.
Giselle
Yeah.
Pip
But yeah, there is a place for them, but I think we usually would try and focus on food first.
Giselle
Yeah, makes sense.
Giovanni
And Pip, what are your thoughts about those, ready to eat meals, like, Lite n Easy and that category.
Pip
Yeah, I think there is gone are the days when we had sort of a local Meals on Wheels service, and that was all that was available for home care, or people living in their homes requiring food delivery. There's such a wider range now, of meal services. Your Lite n Easy or some of those other companies now make specific meals designed for older people. So, even though they're from perhaps traditionally a weight loss company, they are suitable for people in their home. There are some great local companies. So I think that if someone needs meals available, it's better to have that meal service if you're struggling to prepare meals.
And again, a dietitian can link you in with an appropriate company or your case manager if you've got one, can direct you as to what the best thing would be.
Giovanni
Yeah, it's definitely becoming very, very popular amongst our participants.
Pip
Yes.
Giovanni
They're convenient.
Pip
Yeah, yeah. And I think when we're wanting to promote people staying in their homes longer, we need to kind of welcome those services. Because sometimes shopping and preparing meals can be really tedious.
Giselle
Yeah. Especially if you're just one alone or there's two of you in the home. And sometimes preparing
Pip
Yeah and we say so often, you know, people living alone that they're having what I call the ‘tea and toast’ style diet where they just can't be bothered, so they'll have a piece of toast for dinner.
Giselle
Yeah.
Pip
Which is really they're not meeting their requirements. And that's when we start to see malnutrition and weight loss. They're having falls and things like that. Whereas if they can have these ready meals available. Which the feedback I get is pretty that they're fairly good most of them.
Giselle
I think I've tried one.
Pip
Yeah. Sometimes some are probably better than others and everyone needs to find what works. But I think there's definitely a place for diets.
Giovanni
But I do feel that having your own caregivers maybe helping you out, go out and do the shopping with you, and then there'll be the meal prep together. You get the social aspect as well as the fresh nutrition.
Pip
Yes.
Giselle
Yeah an activity to do with the caregiver.
Giovanni
That's got to be considered I think more as well.
Pip
People want to eat what they like to eat.
Giselle
Yeah. True.
Pip
So, if the meal delivery services are not suitable for someone, carers can always go shopping and prepare food for clients in their home as well.
Giselle
Especially cultural meals. You know when. People yeah like to eat what they've grown up with and what they've had their whole life.
Pip
Yeah definitely.
Giselle
Oh, that's so nice. Yeah.
Giovanni
Oh, that's been great. Is there any other topic or piece of advice you like to share with us?
Pip
Yeah, I think, like I said, I think we have to remember that food is for enjoyment as well. So I think probably one of my best pieces of advice would pay to, if you are concerned about your nutrition, is to engage a dietitian or speak with your case manager about maybe getting some nutrition support, because I think if you're enjoying your meals and you're eating the best you can, you're actually going to feel better, and be more safe and healthy in your home and be able to stay in your home for longer.
So I think, yeah, eating for what suits you, I guess is really important.
Giselle
Yeah, yeah.
Giovanni
And also, before closing this, brain health is also very, very important. And I know, you know, eating healthy helps.
Pip
Yeah.
Giovanni
Get your brain healthy as well. Yeah. I think there's a connection there.
Pip
There's a lot of mixed evidence on, you know, whether there's food and nutrients that can slow cognitive decline and dementia. But there are certainly eating patterns as younger people that put us at lower risk, things like the Mediterranean sort of style diet, lots of fish and omega three’s have been shown to improve cognitive health. But I think for older people that are already in that sort of space where cognitive decline might be happening, I think again, the most important thing is that they're eating enough and are well-nourished. Because if you're feeling well and you're healthy, you're going to be going out more and socialising and doing those things that have been shown to slow and steep decline as well.
Giselle
Yeah. And there's also a link between gut and mental health, isn't there? Diet and yeah like all the serotonin and chemicals.
Pip
Yeah. I think if you're eating and meeting your requirements and maintaining your bone and muscle health, you're going to be able to be more active and engaged.
Giselle
Yeah. That helps too.
Pip
You're going to sleep better. You're going to have better gut health. So I think if you are concerned about any of those things, it really is worth reaching out and seeing what we can do to support you in that area.
Giselle
Sounds amazing. Well, thank you so much for coming along.
Pip
Thank you for having me.
Giselle
It’s been very informative. I've learned a lot and I think, that clients and their families are going to love hearing about this, and it's definitely very important for them to reach out to their local dietitian and seek some advice and see how food can help them stay home for longer. Stay happy and healthy.
Pip
Thank you.
Giselle
Thank you.
Giovanni
Thank you very much.