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Article Excerpt
KEY POINTS
* There are an increasing number of elderly people with a wide range of body weights, chronic diseases, disabilities and food preferences.
* The elderly are the largest group of nutritionally vulnerable people in Australia, with those in residential care establishments having the greatest nutritional risk.
* Unintentional weight loss is associated with increased morbidity and mortality. It is not clear whether weight reduction in older obese adults has beneficial health and quality-of-life outcomes. Weight loss achieved through adoption of a healthy diet plan combined with increased physical activity could be of benefit.
* There is a reduction in energy requirements with increasing age, whereas there are increased requirements for a number of nutrients, such as: protein, riboflavin, vitamin B6, calcium, vitamin D and, for some, vitamin B12. Therefore, it is difficult for older people on relatively low-energy diets to meet their nutrient requirements from food, and vitamin supplements and/or fortified foods may be required to meet nutrient requirements.
* To ensure optimal nutritional status, we must assess nutritional requirements on an individual level and provide practical advice regarding appropriate food choices which takes into account, physical and psychological conditions, body weight, level of physical activity, medication use, food preferences, income, ethnic group, social support, access to retail food outlets, cooking facilities and access to community support schemes.
* There is a reduction in appetite with increasing age; therefore, one of the key challenges is keeping older people interested in food through the development of meals and snacks that are both nutritious and appetising.
* Animal sources of protein are generally well accepted by older people, and if tender cuts of meat are chosen and cooked correctly, even small amounts can assist the elderly to maintain adequate intakes of protein, vitamin B12 and iron
INTRODUCTION
Australia is going grey at an amazing rate. For the first time in Australian history (by 2021), those over the age of 65 years will outnumber those under 15 years. By 2051, nearly 25% of the population will be over 65 years and 5% will be over 85 years. (1) Although preventative health strategies commencing in early life are likely to have the greatest effect on chronic disease, significant reductions in morbidity and mortality can also be achieved through the adoption of healthy dietary practices in later life (between 70 and 90 years). (2) Importantly, these lifestyle improvements are likely to allow us to maintain a good quality of life in our later years. The new Nutrient Reference Values (NRVs) for Australia and New Zealand (3) have taken this into account because, for the first time, they have incorporated recommendations to reduce chronic disease risk. The suggested dietary targets for 'optimising diets' include recommendations for: vitamins A, C and E, selenium, folate, sodium/potassium, protein, fat, carbohydrate, dietary fibre, linoleic acid, [alpha]-linolenic acid, and omega-3 long-chain fats (docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA)). These recommendations are relevant not only to younger adults, but also to the older age groups.
The body composition of older people varies widely, with an increasing number of obese persons surviving into old age, but this is also coupled with an increasing number of underweight older people in those over the age of 80 years. (4) The ageing process results in a reduction in skeletal muscle mass and body weight. (5,6) Height, body weight and body mass index (BMI) decreases after age 70 years. (5) Increasing frailty (characterised by exhaustion, low walking speed and low hand grip strength) is seen in those over 70 years of age, resulting in reduced quality of life. (7) Low body weight is associated with poor physical function, disability (8) and a decline in muscle strength, (9) and it is well established that being underweight is associated with increased mortality. (10-12) Loss of body weight is associated with increased risk of hip fracture, (13-15) reduced mobility (16,17) and increased mortality. (18,19) Underweight older people are at increased risk of consuming inadequate amounts of nutrients due to low energy intakes. The ability to meet dietary requirements for older people may be further compromised by drug-nutrient interactions or by the presence of chronic diseases, which affect absorption, transportation, metabolism and excretion of essential nutrients. The majority of elderly people suffer from a range of chronic diseases, at different levels of severity, and most take some type of medication, with many taking a large number of different drugs daily. These chronic diseases can also be combined with, and/or result in, reduced appetite, (20) difficulties in self-feeding, poor mobility, (21) dementia (22) and depression....
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