The United Nations has declared 1999 as the year of the Elderly. In this context, let's have a look at nutrition and the elderly.

Most countries are experiencing a considerable rise in the proportion of elderly people in the population and life expectancy is higher today than ever before. What is the secret of this longevity? How can we not only attain longer life but also maintain optimal health through the years and through old age? From both the individual's and the socio-economic points of view, it is important to add life to the years as well as years to life.

There are many physical, mental, social and environmental changes that take place with ageing. Physiological problems are related to low food intake, digestive problems, reduced perceptions of taste and smell and impaired mental function. Chronic diseases and impairments such as arthritis, hypertension and stroke, heart conditions, respiratory problems, diabetes, cancers and osteoporosis can all affect the quality of life in an ageing population. The evidence points increasingly to the importance of nutrition in the development, susceptibility and outcome of these diseases.

As Prof. Christine Williams, Hugh Sinclair Professor of Human Nutrition, Reading University, UK, puts it, "As we live longer, so the emphasis in nutrition will shift towards the definition of nutritional needs for prevention of chronic disease. Nutrition in the acute care of elderly sick patients has also been greatly under-emphasised and further research is needed in relation to both acute and chronic nutritional needs of the elderly person".

The role of nutrition in preserving health and well-being begins with healthy diets in youth and middle age, and good nutrition also contributes to an older person's ability to recover from illness. Whether older people are living in their own homes, in hospitals or nursing homes, malnutrition is associated with increased mortality, increased susceptibility to infection and reduced quality of life.

We all require the same nutrients regardless of our age but the physiological changes during ageing may affect the amounts of each nutrient needed. It is generally accepted that energy requirements decline with age and that appetites tend to get smaller. Improving food intake improves nutritional status, leads to better immune responses and may enhance a person's mood and feelings of wellness.

Specific nutrient deficiencies include vitamins B6, B12, folate, vitamin D and calcium. For example, ageing is associated with less efficient processing of essential nutrients such as poorer ability to synthesise vitamin D in the skin and poorer ability of the gut to absorb nutrients. Nutrient antioxidants, like vitamins C and E, and other substances in fruits and vegetables are associated with protective benefits particularly with the reduction of risk of certain cancers. Older people may well need higher intakes of particular nutrients and undoubtedly the supply of adequate and appropriate nutritional care to people suffering from acute or chronic diseases will become more important as populations age.

Problems are often associated with the poor diagnosis of under-nutrition in the elderly, the neglect of validated nutritional screening and assessment tools and the prevalence of under-nutrition in hospital patients on admission which tends to get worse during their hospital stay. Better care of the elderly and the provision of necessary nutritional measures can speed up the recovery and reduce healthcare costs.

The future aims of science and medicine are not only to lengthen life but also to reduce the amount of time that people spend diseased or disabled. Healthy ageing is always difficult for those living in poverty or poor housing, but a healthy diet, exercise and avoidance of smoking can enable people to fulfil their potential and attain optimal health.

References

• Kay-Tee Khaw. Healthy ageing. British Medical Journal 315, 1090-1095, 1997 (Special issue on Ageing).
• Gariballa, S.E. and Sinclair, A.J. Nutrition, ageing and ill health. British Journal of Nutrition 80, 7-23, 1998.
• Guigoz, Y., Vellas B. and Garry, P.J. Mini Nutritional Assessment. In Nutrition in the Elderly, Suppl. 2, pp.15-32 [BJ Vellas, Y Guigoz, PJ Garry and JL Albarede, editors]. Paris: Serdi Publishing Company.

FOOD TODAY 07/1999