Introduction

This report focuses on the increasing prevalence of elderly malnutrition in Singapore (Lim, 2018). Malnutrition among elderly in Singapore is caused by isolation, inadequate knowledge on putting together healthy dishes and inadequate knowledge on nutritional value of food. We decided to target elderly aged 62 to 80 as the retirement age is 62 and the life expectancy in Singapore is 82 (Ministry of Manpower, 2018) (Singapore Third in the World for life Expectancy, 2017). We referred to New South Wales (NSW) government to study their successes in advertising and promoting healthy eating among children aging 0-5 in New South Wales, Australia. We then applied lessons learnt from the case study to Singapore to encourage healthier eating habits among the elderly.

Munch & Move Campaign

Firstly, we analysed the promotional techniques used in “Munch & Move” to promote healthy eating (Figure 1). “Munch & Move” is a campaign that has been ongoing since 2008. It aims to promote healthy eating habits in children, aged 0-5 (NSW Department of Education, Office of Sport and the Heart Foundation, 2018). Figure 1Munch and move campaignMunch & Move promotes healthy eating in children by targeting preschool teachers and childcare centre operators. They offer teachers and operators courses which are conducted by Early Childhood Training and Resource Centre (ECTARC). It consists of 4 modules, each lasting 2 hours long (NSW Department of Education, Office of Sport and the Heart Foundation, 2018). Since the launch of the campaign, improvements in healthy eating have been recorded (Figure 2) (NSW Ministry of Health, 2015). Water or age-appropriate drinks given to the children daily increased from 50. 5% in 2012 to 76. 0% in 2015. Daily monitoring of nutritional value of food in the lunch boxes of these children grew from 88. 9% in 2012 to 93. 3% in 2015. Figure 2Statistics showing that the campaign was successful(New South Wales Ministry of Health, 2015)

“Munch and Move: Songs to sing and groove to” music CD

One of the techniques used are songs which convey messages of healthy eating, with a songbook for reference. The songs were compiled into “Munch and Move: Songs to sing and groove to” music compact disk (CD) which were provided by the Munch & Move campaign organisers to childcare facilities operators (Figure 3. 1 & 3. 2). Figure 3. 1Munch and move songbook Figure 3. 2 One of the pages of the songbook These songs were used to encourage learning of healthy eating by facilitating activities such as group sing-alongs during the children’s lunch time. Songs are more effective in relaying messages than words (Alexandria Miller, 2017). It stimulates memory, allowing easier retention of information (Eschrich, S. , Münte, T. F. , & Altenmüller, E. O. , 2008). Through this, we learnt that music can be utilised to help information be better retained.

Lunch Box Ideas

Another technique used by Munch & Move is to improve children’s lunch boxes and make them suitable and healthy through educating parents on ways to prepare their children’s lunch boxes. The Munch & Move campaign promotes this idea via a modular poster which provides step-by-step instructions for preparing healthy and children-friendly lunch boxes (Figure 4). Figure 4 Poster promotion by the campaignA modular poster consists of a set of standardized parts or independent units that can be used to construct a more complex structure. This can be seen from the poster promotion as foods are classified into their respective food groups forming different modules. Users preparing the meal can mix-and-match the different food options in each module to suit their preferences (University of Redlands, 2018). Due to the flexibility and simplicity of the modular and ‘mix-and-match’ concepts, cooking and preparation of food becomes less complicated, encouraging parents to prepare healthy meals for their children. This is evident as after the campaign, the number of children eating at least a serving of fruit daily increased from 92. 5% in 2012 to 93. 6% in 2015 (New South Wales Ministry of Health, 2015). Through this, we learnt that including information formatted in modular and mix-and-match concepts are effective as it is flexible and comprehensive for users to understand (University of Redlands, 2018).

Healthy Eating Learning Experiences Resource

Another technique used by Munch & Move was to provide educators with resources such as ‘Healthy Eating Learning Experiences Resource’ which includes hands-on activities like games and healthy cooking to encourage healthy eating in children (NSW Department of Education, Office of Sport and the Heart Foundation, 2018). Through these interesting activities, the children were engaged effectively, which is evident from the Keiraview Children’s Centre case study (NSW Department of Education, Office of Sport and the Heart Foundation, 2018). Being educated with these resources, the children in the centre were able to retell the story, contribute suggestions to healthy eating, as well as correctly identify pictures of fruits and vegetables (NSW Department of Education, Office of Sport and the Heart Foundation, 2018). Since children are able to learn better when doing hands-on tasks, it improves the children’s attention and enjoyment, motivating them to make healthier choices (Routen, Sherar, 2017). Through this, we learnt that we should have a wide range of hands-on activities to engage our target group, to ensure that our strategies are memorable and effective.

Managing Malnutrition in Singapore

In Singapore, research found that half the elderly aged 55 and above are frail, with the main reason being malnutrition. Malnourished elderly have higher mortality rates and prolonged hospital stays (Lim, 2018). The most common effect of malnutrition, cachexia, causes severe weight loss, muscle atrophy and loss of appetite. Motor coordination is also impaired, making patients prone to falling and frailty (RichmondVale, 2016). Frail elderly are twice as likely to pass on earlier compared to others (Tan, 2017). This leads to rising healthcare costs and hence, malnutrition in elderly needs to be addressed (Yuen, 2018). To understand the reasons for malnutrition in elderly and their preferences, we surveyed 140 elderly living in Outram Park. We conducted our survey there as it has the highest density of elderly in Singapore (Department of Statistics, Ministry of Trade and Industry, Republic of Singapore, 2017). We surveyed elderly aged 62 to 80 as they are our target group.

Isolation

The root causes are isolation, inadequate knowledge of putting together healthy dishes and inadequate knowledge of nutritional value of food. Isolation is one of the primary reasons leading to 60. 7% of the elderly having difficulties in eating (Appendix) (Figure 5). Isolation can lead to dietary issues such as loss of appetite (Lifeline, 2010).

Inadequate Knowledge of Putting Together Healthy Dishes

Inadequate knowledge of putting together healthy dishes is another primary reason. Our survey showed that 16. 2% of elderly have a perception that cooking healthy dishes means reducing intake of food with high fat content and ingredients in their cooking, while 54. 3% feel that healthy food is unappetising. 64. 5% said that the reason they do not cook healthy meals regularly is because they do not know how to prepare appetising healthy meals (Figure 5) (Appendix).

Inadequate Knowledge on Nutritional Value of Food

The last primary reason is inadequate knowledge on nutritional value of food. Many elderly are not educated on the nutritional value of food, evident in a mini quiz conducted in our survey. 4 questions regarding healthy eating were presented to them, and majority of the answers provided by the elderly were incorrect. In our survey, the question regarding sources of protein had the highest percentage of incorrect answers. Of the 140 elderly surveyed, 59% thought that protein can only be obtained from meat (Figure 5) (Appendix). Furthermore, studies have shown that when knowledge on nutritional value of food increases, eating habits improve as well (Wardle, Parmenter, Waller J, 2000). Figure 5 Survey results for reasons of why elderly are not eating well

Overview of Strategies

Through our research, we gained insights on the needs of the elderly in Singapore and would like to propose a campaign called “Nu-TRI E-lderly”. “Nu-TRI E-lderly” consists of strategies, “Educate: NutriVid”, “Engage: KuppaKopi Eatery” and “Enlighten: Wok It Out Exhibition”, which will target the root causes of malnutrition (Figure 6). Nu-TRI E-lderly was chosen as a campaign name as our strategies to work together to improve nutrition in elderly. The “TRI” in Nu-TRI E-lderly represents the three strategies and the “E” represents the outcomes we aim to achieve which is healthier, happier elders.