Healthy Eating and Active Living Guidelines in Retirement Homes Toolkit

The intent of these guidelines is to enable retirement homes to promote and implement healthy eating and active living practices to residents so that they may live healthy, enjoyable and productive lives.

Rationale for the Guidelines 

Ottawa has 12,750 retirement home suites and thirteen percent of Ottawa’s population is made up of older adults, 65 years and older, according to the 2011 census. Ottawa’s population is growing and ageing, and the number of older adults is expected to more than double over the next 20 years, reaching one fifth of the population by 2031. 

The later years of life can be healthful, enjoyable and productive if chronic diseases and/or decreased functioning and independence can be prevented or managed. 

These Healthy Eating and Active Living (HEAL) guidelines for residents in retirement homes were developed using current evidence and best practices in the field of health for older adults in Ontario. They provide an opportunity for retirement homes to address some of the nutritional and physical activity challenges older adults face. The guidelines bear in mind the importance of keeping older adults healthy and active longer to prevent the onset of chronic disease and/or decreased functioning and independence. Addressing nutrition risk is challenging given that this age group experiences increased nutritional needs while at the same time experiencing decreased appetite and/or interest in eating. Locally, falls are the leading cause of injury related ER visits, hospitalizations and deaths in adults 65 years and older. Research has shown that being physically active and less sedentary is effective in preventing falls and injuries.

Retirement homes are well positioned to implement change. They can:

• Provide healthy and safe food, in a positive eating environment
• Encourage residents to spend less time sitting and more time enjoying basic movement throughout the day
• Provide residents with a wide range of opportunities to be active, including staff-led activities and time for activity indoors and out
• Act as role models for healthy eating and physical activity

Through the successful implementation of healthy eating and active living guidelines in retirement homes, seniors can live healthy and enjoyable lives. 

Healthy Eating Guidelines 

Overall Goal

Retirement homes promote healthy eating by providing a wide range of nutritious and safe foods in a positive and supportive environment in accordance with the Retirement Homes Act, Canada's food guide (CFG), and A Guide to Eating Well for Older Adults.

Healthy Menus

Healthy eating principles are followed when planning, preparing and offering healthy menus in retirement homes:

Planning

1. Three meals are offered a day at reasonable and regular meal hours
2. Menus are based on CFG.
3. Residents’ food preferences and special needs are taken into consideration when a menu is planned such as intolerances, allergies, cultural practices, and chewing issues.
4. Daily and weekly menus are available for resident to view.
5. Modified menus are provided when needed, and when possible, reviewed by a registered dietitian.
6. Snacks and fluids are available between meals and in the evening and provided for those residents who are unable to access them independently.

Preparing

1. Only healthy food preparation techniques are used, such as baking, broiling, and steaming. Limit deep-frying.
2. Little or no salt is used in cooking and less sugar in baking.
3. Small amounts of unsaturated fat such as canola, olive or soybean oil, non-hydrogenated margarine and mayonnaise are used.

Offering

Offer a variety of healthy foods every day.

Vegetables and Fruit

1. Offering a variety of vegetables and fruit every day.
2. Offering whole fruits and vegetables, instead of juices and drinks.
3. Offering seasonal vegetables and fruit when possible.

Whole Grains

1. Offering whole grains such as brown rice, quinoa and whole grain pasta.

Protein Foods

1. Offering a variety of lower fat, fortified milk choices/beverages daily, for example cow's milk, soy beverages, yogurt, cheese and lactose free milk. 
2. Offering plant-based protein foods more often, including legumes such as dried beans, chickpeas and lentils, and tofu. 
3. Offering low mercury fish such as light tuna, salmon, cod, haddock, halibut, pollock and tilapia.
4. Selecting lean meats, such as chicken and extra lean ground beef, prepared with little or no added fat /salt.

Healthy Eating Environment

Create an eating environment that promotes health and well-being by:

1. Providing adequate and attractive space for residents to eat together.
2. Presenting food on plates in such a way to boost interest in eating.
3. Serving food with a positive attitude and welcoming residents to mealtime.
4. Providing residents ample time to enjoy and finish their meal.
5. Tray service is available to residents who may require additional support.

Healthy Hydration

Improve fluid intake of residents by:

1. Placing pitchers of fresh water on each table during meals. Tap water is the beverage of choice. 
2. Pre-pour water when possible.
3. Offering fluids at snacks, lunch, dinner, and socials.
4. Encourage fluids at physical activity classes, and in games rooms or programs.
5. Ensuring staff are adequately trained in the importance of hydration for older adults.

Food Safety

Create a safe food environment by:

1. Establishing and promoting proper hand washing routine for staff who handle, prepare and serve food.
2. Expect one staff in the kitchen to have Retirement Homes Act compliant Food Handler Certification at all times.
3. Encouraging residents to follow proper hand washing routines.
4. Ensuring dining and snack areas are clean of debris.
5. Foods are stored, prepared and served so as to retain maximum nutritive value and prevent contamination.

Active Living Guidelines 

Overall Goal

Retirement homes promote active living by providing a wide range of activities and programs in a positive, safe and supportive environment in accordance with the Retirement Home Act and the Canadian Physical Activity Guidelines for Older Adults.

Active Living Environment

Promote and adopt a culture of active living where movement and being active is part of daily life.

1. Promote engaging and positive active living messages.
2. Staff engage older adults and offer opportunities for daily exercise, as well as regular activity and movement throughout the day.
3. Adapt indoor and outdoor spaces to create a safe environment that supports activity, movement and exercise.
4. Provide adequate and adaptable space and equipment to promote independence with activities and and exercise.
5. Offer a variety of daily activities and exercise programs with consideration for a range of exercise capacity and interests. Consider scheduling physical activities at different times than sedentary activities.
6. Consider safety and accessibility needs of older adults who have physical, sensory, cognitive and mobility challenges.
7. Ensure staff are adequately trained if delivering physical activity programs for older adults, and that they stay current with the latest research and best practices.

Sedentary Behavior

Promote and provide opportunities to move more throughout the day.

1. Provide reminders and opportunities to move throughout the day in addition to participation in structured programs.
2. Promote the need to break up sitting time with movement every 30 to 60 minutes.

Canadian Physical Activity Guidelines

These guidelines provide opportunities for all residents to be active and do exercise in a safe, supportive fun environment. Older adults who participant in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Encourage movement every day and strive to meet the Canadian Physical Activity Guidelines for adults 65 years and older. Although these guidelines are applicable to all relatively healthy older adults, all residents should be encouraged to do as much as their abilities allow. Any movement is better than none. Keep in mind those who are most limited may benefit the most from physical activity opportunities.

The Canadian Physical Activity Guidelines for adults 65 years and older suggest:

• Accumulate at least 150 minutes of moderate-to-vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more. Moderate-intensity aerobic activity makes one breathe a little harder and the heart pumps a little more vigorous than normal.
• Muscle and bone-strengthening activities using major muscle groups, at least 2 days per week.
• All should be encouraged to participate in physical activities daily to enhance balance and prevent falls.
• More daily physical activity provides greater benefits.
• Inactive older adults should start with small amounts of physical activity and gradually increase duration, frequency and intensity over time.
• When older adults cannot do the recommended amounts of physical activities, they should be as physically active as their abilities and conditions allow.
• Avoid brisk walking for older adults who have strength and balance deficits as it can increase their risk of falls.

Application of Healthy Eating and Active Living Guidelines 

These guidelines are voluntary and are available for use in all retirement homes. By helping residents manage or prevent chronic diseases through healthy food choices and being active daily, even at a later stage in life, life can be healthful, enjoyable and productive.

For more information, or to access additional resources, please visit Ottawa.ca/health, contact the Ottawa Public Health Information Line at 613-580-6744 or send your request by email to healthsante@ottawa.ca. 

References 

Healthy Eating

1. Benschop, N., Castro, J, Depo, J. Environmental Strategies to Promote Food Intake in Older Adults: A Narrative Review. Journal of Nutrition in Gerontology and Geriatrics: 2016:35:95-112.
2. City of Ottawa (2012-2014). Older Adult Action Plan.
3. Curle, L., Keller, H. Resident interactions at mealtime: an exploratory study. European Journal of Ageing. 2010:7:3:189-200.
4. Dorner, B. Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities. 2010:110:10:1549-1553.
5. Government of Alberta. (2014) Alberta Health Services: Design Guidelines for Continuing Care Facilities in Alberta.
6. Government of Canada. (2015) Safe food handling for adults age 60 and over.
7. Jean-Levesque, M. (2017) Creating Healthy Eating and Active Living in Retirement Homes in Ottawa. Nursing Student, Ottawa Public Health.
8. Kichler, E. (2016) Creating Healthy Food Environments in Seniors Residences in Ottawa. Dietetic Intern Project, Ottawa Public Health.
9. McMaster Health Form. (2015) Addressing Nutritional Risk Among Older Adults in Ontario.
10. Ottawa Public Health. (2017) Healthy Eating Active Living Project Charter. Ottawa Public Health.
11. Stroebele-Benschop, N., Depa, J., de Castro, J.M. Environment Strategies to Promote Food Intake in Older Adults: A Narrative Review. Journal of Nutrition in Gerontology and Geriatrics. 2016:35:2:95-112.
12. Tyler, S., Corvin, J., McNab, P., Fishleder, S., Blunt, H. You Can’t Get a Side of Willpower, Nutritional Supports and Barriers in the Villages, Florida. Journal of Nutrition in Gerentology and Geriatrics 2014:33:108-125.
13. UnlockFood. (2019) A Guide to Healthy Eating in Older Adults.

Active Living

1. British Heart Foundation National Centre for Physical Activity and Health. (2012) Interpreting the UK physical activity guidelines for older adults (65+).  
2. Canadian Society of Exercise Physiology (2011). Canadian Physical Activity Guidelines – For older adults 65 years and older.
3. Dogra, S., Clarke, J. M., & Copeland, J. L. (2017). Prolonged sedentary time and physical fitness among Canadian men and women aged 60 to 69. Health Reports, 28 (2): 3-9.
4. Ottawa Public Health (2016). The leading cause of injury in Ottawa, ON (Unpublished data): Ottawa Public Health.
5. Public Health Agency of Canada. (2014). Seniors’ falls in Canada: Second report.
6. Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Lord, S. R. (2016). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine. https://www.ncbi.nlm.nih.gov/pubmed/27707740
7. Skelton, D. (2016). Improving activity levels in older adults improves clinical outcomes.
8. World Health Organization. (2011) Global Recommendations on Physical Activity for Health

Start your day with breakfast. 

Skipping a meal, especially breakfast, will make it hard to get all the nutrients you need each day. Having breakfast provides energy, can help you stay at a healthy weight, and helps maintain blood sugar levels. Some breakfast ideas include: oatmeal with berries and milk; hard-boiled egg with whole grain toast and fresh fruit; yogurt with fruit, nuts and/or granola.    

Good nutrition is important at any age.

Nutrient needs change as you age; older adults need smaller portions but still the same or more vitamins and minerals. Eating nutrient-rich foods will help you get the vitamins, minerals, protein, carbohydrates, and fats you need. Healthy eating will also help to prevent or manage heart disease, diabetes, osteoporosis and some cancers. Get the most of your calories from nutrient-dense foods, such as: vegetables and fruits, beans and lentils, nuts and seeds, whole grains, dairy products such as milk, yogurt, cheese and lean protein. 

Drink plenty of fluids.

Many older people do not drink enough fluids. As we age, our sense of thirst declines. Also, some medications you can take cause your body to lose fluids. You need to drink whether or not you feel thirsty. Dehydration can lead to constipation, dizziness, headache, or low blood pressure which may lead to a fall. Enjoy plenty of water, milk, juice, soup, and even coffee and tea can contribute to daily fluid intake. Learn about how much fluid you need each day.

Eat your veggies…and fruit!

Vegetables and fruit taste great and contain lots of vitamins, minerals and fibre. They also contain antioxidants which may lower your risk of heart disease and cancer. An easy way to get enough vegetables and fruit is to eat them at each meal and snack. At lunch and dinner fill half your plate with vegetables. Choose a variety of vegetables and fruit every day. Add berries or sliced bananas on top of cereal, have a green salad for lunch, cut-up peppers with hummus or grab an apple for your morning or afternoon snack. 

Build up your bones with calcium and vitamin D.

Older adults are at a higher risk for developing osteoporosis; this is when bones get weak and thin. Calcium and vitamin D are good for your bones, and calcium helps your heart, muscles and nerves work properly. It is best to get your calcium from food: milk, fortified soy beverage, yogurt, cheese and canned salmon with bones. If you do not eat a variety of foods high in calcium every day, speak to your health care provider as you may need a calcium supplement. Mission Healthy Bones lists food sources of both calcium and vitamin D.

Over 50: Take a vitamin D supplement every day.

Vitamin D helps your body use and absorb calcium. It is not naturally found in many foods but it is in fatty fish, egg yolk and liver. That is why vitamin D is added to some foods like cow's milk, some orange juice, soy, almond or rice beverages, and margarine. Health Canada recommends that everyone over the age of 50 should take a daily vitamin D supplement of 400 IU. Talk to your health care provider about taking a vitamin D supplement.

Eat enough fibre.

Fibre is essential for a healthy digestive system. To avoid constipation and other problems, include fibre-rich foods at every meal. Soluble fibre is especially important for maintaining healthy cholesterol levels. Good sources of fibre include: vegetables and fruits, beans and lentils, whole grains, and nuts, seeds and dried fruit.

Stay social – Eating together is better.

When you can, enjoy meals with your friends and family. Eating with someone promotes healthy eating and mental health.  Social interaction can turn mealtimes into an enjoyable affair, rather than a chore you would rather skip. Make your mealtime special; you will be more likely to eat better and enjoy your meals more.  

Speak to a Registered Dietitian.

If you have any questions or concerns about nutrition and your health, ask a registered dietitian. Telehealth Ontario is a call centre that provides confidential medical advice at no cost. Services are offered in both English and French, with translation support for other languages if needed. Call Telehealth Ontario and ask to speak with a registered dietitian. Available Monday to Friday 9 am-5 pm at 1-866-797-0000 (TTY: 1-866-797-0007). You can also find a registered dietitian in Ottawa by going to Ottawa Public Health Find a Registered Dietitian webpage.

How are your eating habits? 

Find out with Nutri-eSCREEN^®! This short questionnaire that will help you find out how you are doing with choosing foods that help you stay healthy and active. You will get a report that tells you what you’re doing well and how you can improve. The report includes healthy eating tips, links to credible nutrition articles, community resources and tools, and delicious healthy recipes.

Handwashing for your health.

As you age, your immune system weakens, even if you are otherwise healthy and live a healthy lifestyle. Handwashing is a simple way to prevent illness and infections from spreading. Wash your hands: every time you use the washroom, before and after meals, after you cough, blow your nose or sneeze, after handling a pet, and after doing any type of cleaning around the apartment/room. Wash your hands with soap and warm water and air or towel dry. Have hand sanitizer near you in case you do not have access to a sink.

Keep fit and improve your balance by joining a fitness class at your residence.

Engage in 150 minutes physical activity every week. It is your best defense against falls. Add strength and balance activities such as the OPH Strength and Balance Exercises, at least two days per week. Ask your physiotherapist, doctor, or recreation staff for advice on exercises that are right for you. Consult your doctor before you start an exercise program.

There are great health benefits for older adults who are physically active. 

These include:

• Lower rates of heart disease, high blood pressure, stroke and type 2 diabetes.
• Lower rates of colon and breast cancers.
• Improved self-esteem, mood and the ability to handle stress.
• Lower risk of falling and better cognitive function.
• Improved strength, balance, flexibility and mobility.
• Improved quality of life.

Getting started is easier than you think.

For cardiovascular fitness, start with a walking program of 5 minutes of slow walking several times each day, 5 to 6 days a week. Gradually increase to 10 minutes per session, 3 times a day. Before you know, you will have reached the 150 minutes per week guideline for healthy living!

Participating in weight-bearing exercises and resistance training at least 2 times a week is a great way to build strong bones and muscles.

Include Strength and Balance Exercises at least 2 days a week to prevent falls.

To improve your strength and balance, consider joining a group exercise class offered at your retirement home. 

On days you cannot attend, follow the Ottawa Public Health Strength and Balance Exercises sheets in the exercise area or the comfort of your room.

Physical activity is safe for most people.

If you have any health concerns, consult with your health care provider before starting a program and find out which exercises are beneficial and safe for you. Join a supervised exercise program before exercising on your own.

Prolonged sitting may increase our risk for poor health or falls.

Reduce the amount of time spent being sedentary (sitting or lying down). Start by standing more and sitting less. Begin with 5 minutes or whatever you can manage then gradually work up to 30 minutes a day of cardiovascular exercise most days of the week. Move more often every day!

Older adults who participate in any amount of physical activity gain some health benefits.

More activity provides great health benefits. Aim to be active daily. Over the period of a week, aerobic activity should add up to at least 150 minutes. Include activities to improve muscle strength at least 2 days a week. Incorporate activities to improve balance and co-ordination on at least 2 days a week. Try to minimize the amount of time spent sitting.

Frailer, older people should take part in some physical activity daily.

Programs, which emphasize balance training, limb co-ordination and muscle strengthening and are tailored to the individual, are safe and effective in reducing the risk of falls among frailer older people. Breaking up long periods of sedentary behaviours, even in those who are chair bound, is highly recommended. Both standing and assisted walking around for a few minutes, slow sit to stand or seated physical activity are recommended.

General advice for older adults.

• Move more often every day!
• Something is better that nothing
• Build up your physical activity gradually
• Be sure to add activities that will help you be strong and steady
• Limit and break up the amount of time you spend sitting still
• The health benefits of physical activity outweigh the risk.

Fall prevention messages 

Be ready for your medical appointments.

It is important to have a regular check-up with your doctor or nurse practitioner. Before you meet, make a list of the questions you want to ask. Bring your medications and any tests or procedures from specialists you have seen. Before you leave, review what you have discussed. Take notes if needed.

Have your eyes checked every year for changes in their health and vision.

Keep your room well lit. Use nightlights in hallways, bedroom and bathrooms to maintain even lighting at night. Give your eyes time to adjust when you move from dark to much brighter areas. Be careful on the stairs and curbs if you wear multifocal lenses.

Make sure your room is safe.

Reduce clutter! Keep your room well lit and free of trip hazards. Remove scatter rugs and loose carpets. Make sure the path is clear between the bedroom and bathroom.

Be Medication Wise.

Review your medications with your doctor or pharmacist every year. Take your medications as prescribed. Keep a list of all medications you take including vitamins, over-the-counter drugs, and herbal products. Use the same pharmacy for all your prescriptions.

Recommendations for establishing good sleep habits.

1. Have a regular and relaxing bedtime routine: Make your bedroom a sleep-inducing space that is dark, quiet, comfortable and cool. Use your bedroom ONLY for sleep. Avoid doing other activities like eating, watching TV or using the internet at bedtime
2. Exercising regularly will help you sleep better. Unless you have been taking a ‘siesta’ for years, naps can affect your normal sleep pattern. Stay busy with different activities during the day. If you must nap, limit it to 30-40 minutes in the afternoon and have your nap in your bed. Set an alarm even if you think you are just resting.
3. Get plenty of sunlight during the day. If you are outside between 11am and 4pm, remember to take UV/sun safety precautions when the sun’s rays are strongest. To increase your indoor exposure to sunlight, do activities near a window. Be facing or sideways to the window.
4. Avoid caffeine, nicotine and alcohol before bedtime
5. Avoid eating and drinking 2-3 hours before bedtime.

Healthy Eating Resources

Healthy Menus

Health Canada: Information about the new Canada’s food guide. (Online only)

Dietitians of Canada:

• Planning Meals using Eating Well with Canada’s Food Guide. Get the food and nutrients you need when planning meals.
• Nutri-eSCREEN. On-line Eating Habits Quiz for Older Adults. Find our what you are doing well when it comes to healthy eating. Get tips on nutrients, shopping, recipes etc. and web links to trusted nutrition resources, tools and recipes.

Unlock Food: A Guide to Healthy Eating for Older Adults. Includes information on weight gain or loss, breakfast, veggies and fruit, calcium and vitamin D, protein, eating alone, grocery shopping and recipes.

Healthy Eating Environment

Dietitians of Canada: Best Practices for Nutrition, Food Service and Dining in Long Term Care Homes. A working paper that includes a section on Meal Service/Pleasurable Dining that can be applied to a retirement home setting (pages 17-22).

Healthy Hydration

Hamilton Health Sciences: Preventing dehydration in older adults. Tips to increase fluid intake.

Finding Balance and Injury Prevention Centre: Hydration Tips for Seniors. Take action to prevent dehydration. (Available in English only)

Food Safety

Government of Canada: Safe Food Handling for Adults 60+. Tips on reducing the risk of foodborne illness by following safe food-handling and cooking practices.

York Region: Food Safety for Older Adults. Tips on the four critical steps in food safety: clean, separate, cook and chill.

Active Living Resources

Strength and Balance Exercise Posters: Strength and balance exercises should be incorporated into ones’ daily routine. Strong muscles and improved balance make it easier to do daily activities and help to prevent falls.

Winnipeg In-Motion: Older Adult Exercise video that provides a complete exercise class, including warm-up, cardio, strength, balance and stretching exercises. All exercises are led in both standing and sitting positions. *In-motion Older Adult Exercise DVD’s are available for free. Please call Ottawa Public Health for more information. 

"You CAN prevent Falls" factsheet [PDF] is available, to assist older adult in making the needed adjustments to their home and lifestyle to help stay independent and safe. It includes a tool to assist in identifying hazards around the home, information about protective health behaviors to reduce personal risk, and an action plan to make changes.

The Staying Independent Checklist is a self-screening tool for older adults to find out if they are at risk for falling. Older adults are encouraged to complete the Checklist and to follow-up with their healthcare provider as needed. 

Active Aging Canada: Active living tip sheets (multi-lingual) and exercise posters for successful aging. Residents and staff can also subscribe to Your Active Aging Minute series that provides a new healthy living tip weekly. 

The Canadian Centre for Activity and Aging is Canada’s leader in current research and program development for improved physical ability and healthy aging for older adults.  Staff may be interested in attending courses or workshops which provide physical activity instruction across the mobility spectrum. Training is periodically offered in the Ottawa area. (Available in English only)

Heart Wise Exercise partners with community organizations to develop programming and designate facilities, programs and classes where individuals can exercise regularly to prevent or limit the effects of living with a chronic health condition.