in SPIRE HUIPUT The Characteristics Of Food Products For Elderly Population In Finland Writers Helena Kautola, Tuija Pirttijärvi, Tiina Mäenpää, Raija Tahvonen and Eila Järvenpää TIIVISTELMÄ Suomalaisille vanhuksille suunnattujen elintarviketuotteiden ominaisuudet Elintarviketeollisuuden ja sen tuotekehityksen tulee ottaa huomioon vanhukset suurenevana kuluttajaryhmänä. Vanhusten elämänlaadulle on tärkeää hyvä ravitsemus. Suomessa kotonaan itsenäisesti asuvat yli 65 vuotiaat vanhukset kärsivät vähemmän aliravitsemuksesta kuin laitoshoidossa olevat. EU-hankkeen OPTIFEL pyrkimyksenä on selvittää edellytyksiä ravinnon saannin parantamiseksi lisäämällä tietoisuutta ravinnon tarpeista, ruokasuosituksista ja vanhusten fyysisistä kyvyistä. Projekti keskittyy lähinnä vihannes- ja hedelmätuotteisiin. Suomalaisten vanhusten dieetissä marjat ovat merkittävä vitamiinien ja hivenaineiden tulolähde. Tutkimuksessa tarkasteltiin haluttujen ja toivottujen elintarvikkeita ja pakkausten soveltuvuutta vanhusten käyttöön. Pohjatiedot suomalaisten vanhusten ravitsemuksesta kerättiin tutkimuksista ja julkaisuista. Elintarvikkeiden koostumustietopankkia Fineliä käytettiin ravitsevien ruoka-aineiden löytämiseksi tuotekehitystä varten. 89 yli 65 vuotiasta vanhusta, jotka asuivat joko kotona itsenäisesti, kotona, jonne tuotiin ruoka, tai palvelutalossa/hoitokodissa, haastateltiin ruokailutottumuksistaan sekä asenteistaan eri ruokia, etenkin vihanneksia ja hedelmiä, kohtaan. Suppea markkinatutkimus tehtiin Etelä-Suomessa smoothie- ja mehutyyppisistä prosessoiduista hedelmistä ja vihanneksista. Vanhukset eivät tunteneet teollisia smoothie-tyyppisiä tuotteita. Suomessa vanhukset saavat usein ravinnosta liian vähän D- ja E-vitamiinia, foolihappoa ja kuituja. Arvokkaita tuotekehityksessä käytettäviä raakaaineita ovat pähkinät, kuivatut hedelmät, kuivatut pavut ja munankeltuaiset. Tärkeinä pidettäviä kriteerejä olivat valmis-syötäväksi, helppo-niellä, perinteinen ja helppo-avata-pakkaukset. Avainsanat: Vanhukset, ravitsemus, ruokasuositukset INTRODUCTION Good nutrition and overall welfare are important factors in quality of life for elderly people. In Finland the nutritional status of hospitalized elderly population has not been much studied, but at home independently living >65 years old people suffer less from malnutrition than those hospitalized(1). The improvement of the nutrition for the elderly by increasing knowledge of nutritional needs, food preferences, physical capacities and willingness are the aims of the EU-project OPTIFEL(2), in concerning vegetable, fruit and berry products. A study on the preferable and enjoyable characteristics of food and the suitability in capability of the elderly using the packages were investigated (4). 89 elderly >65 years old living either in home independently, home with food service or service houses/ nursing homes were interviewed on their eating preferences, capabilities and attitudes towards different food, especially vegetables, fruits and berries. in SPIRE HUIPUT 1
Good nutrition is an important factor in quality of life for elderly people. In Finland, at home independently living >65 years old people suffer less from malnutrition than those who are hospitalized(1). The improvement of the nutrition for the elderly by increasing knowledge of nutritional needs, food preferences and physical capacities is the aim of the EU-project OPTI- FEL(2). This project focuses mostly on vegetable and fruit products. In the diet of Finnish elderly, berries constitute a considerable part of natural sources for vitamins and minerals. A study on the preferable characteristics of food and the suitability of the packages for elderly people were investigated. METHODS In a survey study, 89 elderly (65 to 98 years) living in different accommodations were interviewed on their eating preferences, sensory capabilities and attitudes towards different food, especially vegetables and fruits. Caretakers and caterers (N=12) from nursing homes were interviewed in focus groups. The themes of interviews were for example food preparation and delivery as well as foods preferred by elderly. Information on nutritional status of elderly people in Finland was collected from Finnish studies and publications. Nutritious food materials were found in food composition databases. In a survey study, 89 elderly (65 to 98 years) living either at home independently, at home with food service or in service houses/nursing homes were interviewed on their eating preferences and attitudes towards different food, especially vegetables and fruits. A market study on smoothie and juice-type of processed product from fruits and vegetables was carried out in Finland. RESULTS The time between food preparation and serving to the elderly varied only from 10 to 30 minutes. The serving time was flexible and the delivery took place 4 times a day. The portion size was mainly estimated according to the appetite of the elderly. In FIG.1 it is shown that vegetables are eaten mainly at lunch and dinner times and at afternoon and evening snack nonprocessed fruits. Elderly in Finland were not familiar with industrial smoothie-type of products. 69% of the asked elderly did not know what is a smoothie. From 20 smoothie and 51 juice-type products of fruits and vegetables marketed in south Finland, 6 were tested with a very limited group of ten elderly. From banana, pineapple, cocos, mango, strawberry, carrot, blueberry and cranberry, the preferred combinations were apple-carrotstrawberry and pineapple-carrot-mango. For more reliable results, a larger test should have been done. The elderly liked (1 least, 5 most) mostly vegetables in soups or plain boiled (4,6 4,8). For oven or steam cooked or braised vegetables the score was 4,2 4,4 and for gratinated, raw or fried vegetables 3,8 4,0. FIGURE 1 Percentages of subjects (n=89) who consumed fruits and/or vegetables in different forms at different meals (6). 2
FIGURE 2 Percentage of person disliked certain fruits and vegetables. Fruits and vegetables only 50 % or less of person knew are not shown. Fruits and vegetables that most liked are shown at the bottom of this graph (5). 3
Elderly in Finland often lack of vitamin D and E, folic acid and fibre (6). According to the Finnish food composition database (3) valuable foods considered as ingredients for product development were nuts, dried fruits, dried beans, egg yolk. The most important criteria for suitable products and packages are ready-to-eat, easiness of swallowing, tradition and easy-to-open packages. The elderly had difficulties to open caps (58%) and cans (40%). TABLE 1 The unknown foods by the Finnish elderly (n=89) are listed below. % Quince jelly 90 Pomelo 87 Endive 83 Chickpea 58 Chicory 51 Chestnut 48 Fennel 46 Broad bean 45 Artichoke 39 Avocado 33 Eggplant 33 Lentils 31 Blackberry 27 Sweet potato 27 Exotic fruit juice 25 Sorrel 24 Dried beans 18 Mango 17 Nectarine 17 Spinach in salad 15 Asparagus 10 The elderly people gave improvement ideas which were also very practical and useful. They preferred more taste and more variability in their food. Both more traditional foods and more new foods were suggested. Specially, smaller packages which were easyto-open and smaller portion sizes at meals-on-wheels were recommended. Beautiful servings and appearances of the food would give them more appetite. Vegetables were preferred to serve separately. Foods to have more in the servings were berries, fruits, meat, butter and cream. Those giving the opposite opinion (more/less) were on spices, salts, butter and fat. There was also a wish that there should be an opportunity to choose foods from the meals-on-wheels food provider more often and not at a time for several months, like in some cases. The elderly like the food texture to be planned for their needs. Food should be well-cooked, tender, soft, and easy to eat. Tough meat and hard and large pieces cause problems with bad teeth or difficulties in swallowing. Runny and broth food easily induce coughing. Dry foods or foods with seeds are difficult to eat as they are easily inhaled. The Finnish interviewees emphasize that the food for elderly should be distinguishable, and not a uniform mush. The elderly prefer simple dishes. Soups are well appreciated. Especially nursing home residents get protein supplement like cream and butter and full milk. Energy drinks can be served, but they are not popular because of being too sweet. Starchy food is used on every meal. Potatoes with sauce is preferred to rice and pasta. Finnish elderly liked porridge, but not chicken dishes. Very spicy foods and food with a lot of little bones or fish bones, fat food, some sausages and tough steak are not considered suitable for the elderly. Ice cream is a special and popular treat for the elderly. The elderly population has mainly different kind of sensory problems. Among the interviewed elderly were found the following difficulties. Elderly had visual problems 48% (a lot), of which only 19% caused problems when eating, From the interviewed 19% were wearing a denture. 87% of the elderly did not feel pain during eating. During eating from the elderly 72% did not have mouth pain and 65% no teeth or gum pain, 75% no throat pain, and 76% no dry mouth. 71% considered their health better that other people at their age. The elderly felt some pleasure when eating. From the interviewed 99% felt a reduced strength, 28% had difficulties in carrying hot dishes, and 77% in carrying own plates. It was found that 27% had difficulties in cutting and peeling hard food. From the interviewed elderly 10% had difficulties in swallowing food. CONCLUSIONS The study gave us good advice on what kind of things we have to focus on when developing different kind of foods for the elderly. It is especially important to know the preferences also for the food industry, product development and marketing sector as well as the meals-on-wheels providers and catering sector. The challenging demand was on more variability and individualisation in food. There is a higher need of considering the texture of the food and especially also its safety. There is a need to pay attension to the visuality of the food, to choose right type of raw materials for better taste and to improve packaging of food. It was found that in general elderly like vegetables and fruits and there is a need to develop fruit and vegetable snack products. In the afternoon >55% and evening >72% of elderly would eat such snacks. 4
REFERENCES 1) The National Nutrition Council 2010. Ravitsemussuositukset ikääntyneille (Nutrition recommendations for elderly people.) Helsinki: Edita Prima Oy. (in Finnish) 2) Optimised food products for elderly populations. KBBE-2012-6-ss: FP7-311754-OPTIFEL www.optifel.eu 3) National Institute for Health and Welfare. Fineli Finnish food composition database. Accessed: 27.11.2013 http://www.fineli. fi/index.php?lang=en 4) Järvenpää, E., Tahvonen, R., Tupasela, T., Pirttijärvi, T., Mäenpää, T. & Kautola, H. 2014. Ikääntyneet pitää huomioida pakkausten käyttäjinä (The elderly must be considered as users of the packages) 2014. Kehittyvä Elintarvike 4/2014, 38. (in Finnish) 5) Mäenpää, T., Pirttijärvi, T., Kautola, H., Tahvonen, R. & Järvenpää, E. 2014. Sensory Aspects in the Survey Study during the Project Optimised Food Products for Elderly Populations in Finland. International Snoezelen Association Multisensory Environment XII World Conference. ISNA-MSE s XII World Conference 30. 31.10.2014, HAMK University of Applied Sciences, Hämeenlinna, Finland. 6) Kautola, H., Pirttijärvi, T., Mäenpää, T., Vekka, A., Myyrä, M., Tahvonen, R., Järvenpää, E. 2014. The Characteristics of Food Used by Elderly Consumers Living in Different Accommodations in Southern Finland. Abstracts and Poster 17th IUFoST World Congress on Food Science and Technology, Montreal, Canada 17. 21.8.2014, UP471. PHOTO 1 by Auli Lehtonen, Luke. Writers Helena Kautola Principal Lecturer, Häme University of Applied Sciences (HAMK), Finland Tuija Pirttijärvi Principal Lecturer, Häme University of Applied Sciences (HAMK), Finland Tiina Mäenpää Principal Lecturer, Häme University of Applied Sciences (HAMK), Finland Raija Tahvonen Professor, Research Centre for Natural Resources (Luke) Jokioinen, Finland Eila Järvenpää Special Researcher, Research Centre for Natural Resources (Luke) Jokioinen, Finland Reference of the article Kautola, H., Pirttijärvi, T., Mäenpää, T., Tahvonen, R. & Järvenpää, E. 2015. The Characteristics of Food Products for Elderly Population in Finland. HAMKinSpire -publication 1/2015. Häme University of Applied Sciences. Publisher HAMKin huiput / HAMKinSpire 22th edition www.hamk.fi/huiput Editorial staff Editor-in-chief Janne Salminen, Vice President Layout HAMK Publications Feedback julkaisut@hamk.fi Häme University of Applied Sciences PO BOX 230 (Visamäentie 35 A) FI-13101 Hämeenlinna, FINLAND tel. (03) 6461 firstname.lastname@hamk.fi www.hamk.fi/julkaisut ISSN 1459-7888 (web) 5