Vonetta Nurse | Nutrition care for the elderly
Healthy eating is just as important during older years as it is during childhood. As we age, it is important to eat healthy as good nutrition helps to improve how we feel, helps to ward off sickness, and prevents or reduces the onset of chronic diseases. It is important to note that as a person grows older, the definition of healthy eating does change. Ageing is associated with a decline in many body functions, change in structure, loss of lean body mass, loss of bone mass, and a relative increase in fat mass over time. The nutritional needs change as they age for a number of reasons, including the ageing process, reduced physical ability, emotional state, and also cognitive impairment.
There are numerous studies that evaluate the role of nutrition in the ageing immune response and show that nutrition can improve this response and the ability to fight disease. It is, however, a common misfortune for people aged over 70 to not eat enough to meet their nutritional needs. Indeed, our metabolism slows down as we age, which means that the body spends less energy doing various activities. It is, therefore, normal for the appetite of an elder person to diminish as well. Older adults tend also to have difficulties absorbing certain vitamins and minerals such as calcium.
Sadly, this all comes at a time of life when getting adequate nutrition – including protein, fibre, hydration, vitamins, and minerals – may be more difficult, and adds to the myriad chronic medical conditions that most elderly deal with. This lack of adequate nutrition – malnutrition – is induced in the elderly by several factors. These include:
• Dysphagia (difficulty swallowing) – Ageing, wear and tear on the oesophagus, and a risk of conditions such as a stroke increase the risk of swallowing and even chewing difficulties, which makes it harder for the elderly to take in adequate nourishment and fluids.
• Decreased sense of taste/and/or smell/vision loss – With age, many people’s taste buds become less able to detect flavours. Normal food might be bland and unappetising to them. Vision changes may lead to less activity and inability to see well enough to cook or grocery shop.
• Appetite loss – During the ageing process, changes to the physiology of the body, changes in psychological functioning and social circumstances, acute illness, chronic diseases, and use of medication may cause a decrease in appetite.
• Loss of physical strength or mobility – Impaired functional mobility, or weakness, or loss of bone mass can hinder access to proper nutrition and hydration. For instance, the decreased ability to stand for long periods may render the elderly unable to cook at home. The decreased ability to walk and drive may also prevent them from being able to go to the grocery store. Impaired motor skills such as holding utensils to eat are also factors to consider.
• Financial insecurity – Limited finance and resources make it difficult to maintain good health and consume a nutritious diet. For instance, many will shift the composition of their food expenditures towards staple foods and away from more nutritious foods.
• Emotional and mental factors – Mental health problems such as depression and anxiety or a change in mental state due to bereavement, loneliness, or lack of social/family support can affect an elder’s appetite and interest in eating.
• Certain treatment or medications – Some medicines or medical treatment have unpleasant side effects, which include appetite loss, reduced absorption of nutrients, or diarrhoea, which could result in eating less or malabsorption of nutrients from food
If left unaddressed, malnutrition in the elderly can lead to serious consequences for their health and well-being such as the loss of muscle mass, exhaustion, increased risk of falling, susceptibility to infections, and aggravation of chronic illnesses. This will also contribute to the reduction in quality of life, and, even worse, life expectancy. Therefore, it is imperative to understand its causes and find ways to remedy the situation.
THE COVID SPOTLIGHT
Encouraging and promoting proper nutrition for the elderly, especially throughout the current COVID-9 pandemic, is critical. This is especially crucial for elderly folks living with chronic conditions such as diabetes, hypertension, or heart disease. Recent studies and information from global health experts have highlighted COVID-19’s heightened effects on the elderly, classing them as persons of high risk. The ongoing pandemic has also put a spotlight on chronic non-communicable diseases, including heart disease, diabetes, and hypertension, as underlying conditions that predispose the elderly to the risks of the COVID-19 virus.
As such, efforts to address the nutritional needs of the elderly and those living with chronic conditions must be emphasised by our local health experts, policymakers, food and beverage manufacturers, caregivers, and the wider public. Good nutrition and maintaining a healthy weight can help our elderly population stay active and independent even throughout the current global crises.
As the elderly population is among the most affected by COVID-19, the adoption of policies by our national health and industrial systems, such as front-of-package (FOP) warning labels which make food choices easier for caregivers and the elderly, will help in reflecting the importance of nutrition for healthy ageing, including disease recovery. These care pathways are necessary not only in the context of COVID-19, but also on a broader basis in our ageing societies where the maintenance of functional ability will enable our elderly to live longer, healthier, more active lives.
At all ages, it is important that we consume a variety of foods, in sufficient quantities, to meet our nutritional needs. Vitamins, minerals, proteins, and carbohydrates all have their own role to play as they are all essential to the proper functioning of the human body.
Nonetheless, there are some nutrients that need to be especially monitored since elderly people often don’t get enough of them or may be unable to absorb them in their bodies. They are indispensable to maintaining their health. Here is some information about some of the most important nutrients and practical tips for our elderly population or caregivers of our loved ones.
• Make small adjustments to help you enjoy the foods and beverages you eat and drink.
• Add flavour to foods with spices and herbs instead of salt, and look for low-sodium packaged foods.
• Add sliced fruits and vegetables to meals and snacks. Look for pre-sliced fruits and vegetables on sale if slicing and chopping are a challenge.
• Ask your doctor to suggest other options if the medications you take affect your appetite or change your desire to eat. Ensure that meals are not skipped.
• Drink water, fat-free or low-fat milk, or unsweetened blended fruit juices instead of sugary drinks.
• Consume foods fortified with vitamin B12, such as fortified cereals, and foods with omega-3 fatty acids such as salmon, mackerel, sardines, tuna, flaxseed, soybeans, walnut, and cod liver oil.
• Being physically active can help you stay strong and independent as you age. If you are overweight or obese, weight loss can improve your quality of life and reduce the risk of disease and disability. For adults 65 years old and over, the WHO recommends at least 150 minutes of moderate-intensity aerobic physical activity weekly, for example, 30 minutes of aerobic activity a day (such as brisk walking, light jogging, swimming).
• Limit alcohol intake, if any at all. Drinking too much alcohol can raise the blood pressure, further increasing risk of stroke and other NCDs.
• Make meals and snacks nutrient-dense by using foods that provide a lot of nutritional value without consuming too many calories. For example, snack on crunchy vegetables or nuts instead of chips, or satisfy a sweet tooth with naturally sweet fruit instead of candy and cookies.
• If you have a small appetite, boost nutrition without adding lots of extra food. For example, add extra sauces, gravies, and grated cheese to entrées and side dishes or stir powdered low-fat milk into cold and hot cereals.
• Make meals colourful and appealing.
• Protein - It plays several essential roles in our health, notably by contributing to preserving muscle mass. Include protein-rich food sources in the diet such as poultry, legumes, nuts, seeds and dairy.
• Calcium and Vitamin D – Essential for bone health and can be found in foods such as dairy; spinach; fish such as mackerel, salmon, sardines; and fortified cereals.
• Iron – Iron is needed to make haemoglobin, a protein that carries oxygen to tissues in the body. Iron also plays a role as part of other proteins within the body. Iron-rich foods include callaloo, spinach, pak-choi, and other dark-green leafy vegetables, dried fruit such as raisins, beans such as red peas and chickpeas, liver, and red meat.
• Potassium – Potassium is critical in normal nerve function, heart rhythm, energy levels, and brain function, just to name a few. Bananas, oranges, tomatoes, cooked spinach, broccoli, potatoes, cucumbers, pumpkin, cod fish, and red peas are just a few of the many foods that contain potassium.
• Fibre – It prevents constipation, maintains bowel health, and reduces cholesterol levels. Several foods such as whole-grain bread and cereal, vegetables, fruits, and legumes contain fibre.
• Dietary Supplements – Although a diet consisting of a variety of healthy foods is the best for the elderly, some don’t get enough vitamins and minerals from their daily diet either due to appetite loss or difficulty chewing. Their doctors or dieticians may recommend a dietary supplement to provide nutrients that might be missing from their daily diet, which may come in powder form such as whey protein, pills/capsules such as Omega fatty acids, gels, or most popularly, nutritional liquids and shakes. Choose brands that your doctor, dietitian, or pharmacist recommend. Be sure to also check that the claims about a dietary supplement are based on scientific proof.
Every person – including our elderly– should have the opportunity to live a long and healthy life.
Vonetta Nurse is the advocacy officer for the Global Health Advocacy Project at the Heart Foundation of Jamaica. You can send your feedback on this article to firstname.lastname@example.org