Brian James | Focus on elderly nutrition

World Senior Citizen’s Day is celebrated on August 21 each year. The day is intended to recognise the achievements of the elderly and also increase awareness of the factors and issues that affect them, such as health deterioration and abuse.

Healthy eating is just as important during older (over 65) years as it is during childhood. As we age, good nutrition improves our sense of wellbeing, wards off sickness and prevents, reduces, or delays the onset of chronic diseases. The definition of healthy eating changes with age. Nutritional needs also change, due to changes in body function, reduced physical activity, emotional state, and the risk of cognitive decline.

Studies have shown that good nutrition can improve immune function and the body’s ability to fight disease. It is, however, common for people over 70 years to have nutritional intake inadequate for functional requirements. Our metabolism slows down as we age, so the body spends less energy doing various activities than at a younger age. It is therefore normal for the appetite of an elder to diminish. Older adults also tend to have difficulties absorbing certain vitamins and minerals including calcium and vitamin D.

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 risk of many chronic medical conditions that the elderly face. Inadequate nutrition, or malnutrition, is induced in the elderly by several factors which may include:

• Lack of knowledge about food, cooking and nutrition

• Dysphagia (difficulty swallowing foods or liquids)

• An impaired sense of taste/and/or loss of smell or vision

• Appetite loss and poor diet

• Impaired functional mobility or weakness or loss of bone mass

• Limited finance and resources making it difficult to maintain good health and consume a nutritious diet

• Mental health problems such as depression and anxiety or a change in mental state due to bereavement, loneliness, or lack of social/family support

• Side effects of certain treatments or medications and interactions between multiple medications

If left unaddressed, malnutrition in the elderly can result in serious health consequences such as the loss of muscle mass, exhaustion, increased risk of falling, susceptibility to infections, and aggravation of chronic illnesses. This contributes to a diminution in quality of life and, potentially, life expectancy. It is therefore critical to understand its causes and find remedies if we are to improve the qualitative life experience of the elderly.

COVID-19 SPOTLIGHT

Various epidemiological observations have classified the elderly as persons at high risk regarding COVID-19. Mortality is much higher in this age group than in younger persons. The ongoing pandemic has also put a spotlight on chronic non-communicable diseases (NCDs) including heart disease, diabetes and hypertension, as underlying conditions (comorbidities) which predispose the elderly to the risks of severe disease with the COVID-19 virus.

Our seniors are also at risk for NCDs especially during this pandemic for a variety of reasons. It is thus important to redouble efforts to address the nutritional needs of the elderly and those living with chronic conditions. Local health experts, policymakers, food and beverage manufacturers, caregivers and the wider public owe this to our elderly population. Good nutrition and weight control can help our elderly population to stay active independent and healthy, even throughout the current global crisis.

NUTRITION ESSENTIALS

At all ages, it is important that we consume a variety of foods, in sufficient quantities, to meet our nutritional needs. Special attention must be paid to some nutrients since the elderly often don’t get enough of them or may have absorption problems affecting these nutrients. They are indispensable to the maintenance of good health. It is recommended that small adjustments are made to help the elderly enjoy the foods and beverages which contain these essential nutrients.

Here are some practical tips for our elderly population and their caregivers:

• Add flavour to foods using spices and herbs instead of salt and choose low sodium packaged foods.

• Add sliced fruits and vegetables to meals and snacks.

• Ask your doctor to suggest other options if the medications prescribed affect you/your loved one’s appetite or change your desire to eat.

• 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, flaxseeds, soybeans, walnuts and cod liver oil.

• For adults 65 years and over, the WHO recommends at least 150 minutes of moderate-intensity aerobic physical activity weekly such as 30 minutes of brisk walking, light jogging, or swimming per day.

• Limit alcohol intake.

• Make meals and snacks utilizing foods that are nutrient-dense 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.

• Make meals colourful and appealing.

• Protein is essential for its role in preserving muscle mass. Include protein-rich food sources in the diet such as poultry, legumes, nuts, seeds and dairy.

• Calcium & Vitamin D are essential for bone health and can be found in foods such as dairy, spinach, fish such as mackerel, salmon, and sardines as well as fortified cereals.

• Iron is needed to make haemoglobin, within the body. Iron-rich foods include callaloo, spinach, pak choi, dried fruits such as raisins, beans such as red peas and chickpeas, liver and red meat.

• Potassium is critical in normal nerve function, heart rhythm, energy levels and brain function. Bananas, oranges, tomatoes, cooked spinach, broccoli and potatoes, cucumbers, pumpkin, cod fish and red peas are some of the many foods that contain potassium.

• Fibre prevents constipation, maintains bowel health, reduces cholesterol levels, etc. Foods that contain fibre, include whole-grain bread and cereal, vegetables, fruits and legumes.

• Dietary supplements may be recommended by a doctor to provide nutrients that might be missing from their daily diet. Be sure to also check that the claims about a dietary supplement are based on scientific proof.

It is also important to practise reading food labels to know how much fats, added sugar and sodium are contained in a product. The adoption of policies by our national health and industrial systems, such as ‘High In’ front-of-package warning labels will make food choices easier for caregivers and the elderly. It will help in this thrust towards nutrition for healthy ageing, and disease recovery. These interventions are necessary not only in the context of COVID-19, but also on a broader basis in our ageing society where the maintenance of functional ability will enable our elderly to live longer, healthier, more active lives.

Every person – including our elderly– should have the opportunity to live a long and healthy life. After all, the longer we live, the more beautiful life can become so let’s take every opportunity to make every day count by leading healthier lives.

Dr Brian James is the president of the Medical Association of Jamaica. Send feedback to ghapjm@gmail.com.