According to the briefing paper ‘Nutrition in Older People’ (1996), Ageing is defined as a “regression of physiological function accompanied by advancement of age (qtd. by Imahori ,1992)” Besides these certain other factors such as genetics, life style and diet also play an important role in ageing process.
Mc Bean et al (2001) stated that successful ageing is avoidance of “disease and disability, maintenance of high cognitive and physical functioning and being engaged with life (qtd. in ‘Successful Aging’ by Dr. Rowe and Dr. Kahn)” The needs of the present age demand the health educators, nutritionists and dietitians to provide and advise the dietary needs suitable to the lifestyle requirements of a person (customized) to aid them age successfully and lead a quality life.
Statistics and Projections
McBean et al (2001) stated that about 13% of the population in US is above 65 years of age and is projected to rise to 20% in 2030. Population aged 85 years and more is rapidly growing and is expected to double by 2025 and increase five fold by 2050.
This group called older adults comprises only of 13% of US population but account for 30% of all healthcare expenditure. Older adults suffer from chronic ailments such as hypertension, heart disease and arthritis. About 38% have limited activity, 4% live in nursing homes and 12% experience some kind of mobility problems.
According to the briefing paper ‘Nutrition in Older People’ (1996), 11% of the population of England and Wales in early 1950s were aged above 65 years, which rose to 16% in 1991 and is expected to reach 25% by the year 2030 of which more than 50% are expected to be aged above 75 years.
Consequences of Aging
Nicholas et al (2001) stated that about 10% to 25% aged above 65 years are frail and subjects 85 years and older appear frail due to some deficit and/or stress. Pathologies such as Heart disease, cancer and cerebrovascular disease account for about 75% of deaths in men and women aged 65 years and above. It is suspected that cases of neurodegenerative diseases such as Alzheimer’s disease would be on rise and become a significant factor of mortality.
As stated in the briefing paper ‘Nutrition in Older People’ (1996), reduction in bone density is due to aging and is more visible in women then in men consequently leading to fractures due to weakening of bones (Osteoporosis). The loss of bone density in women is more after menopause.
Taste sensitivity declines with age; this may also be due to excess usage of drugs and certain other medical conditions. The Gastric acid secretion declines with age due to more prevalent atrophic gastritis thus reducing the bioavailability of calcium, iron, vitamin B12 and folate. The loss of gastric ‘intrinsic-factor’ due to aging leads to decrease in absorption of vitamin B12. Secretion of pancreatic juice may also fall significantly thus leading to impairment in digestion of fat and protein when consumed in higher amounts.
The bile secretion may also be effected due to loss in sensitivity of gall bladder to cholecystokinin leading into an adverse effect on fat digestion. The elasticity of wall of colon and rectum may reduce due to aging contributing to constipation.
Status of Nutrition
According to the briefing paper ‘Nutrition in Older People’ (1996), illness effects nutrient absorption by way of poor intake of requisite foods and nutrients. Infections and other illness may lead to higher BMR causing fever, synthesis of acute phase proteins and/or breathlessness.
Reduced appetite may be due to sensory changes in aged people and as a result the variety of food intake chosen may differ and decline leading to inadequate intake of nutrients, but this change is undesirable. The changes in hormonal responses may also cause a decline in food intake.
Decreased intestinal wall strength may affect gastrointestinal motility affecting the feeling of satiety. Psychological factors such as bereavement, confusion, physical and social factors like mobility and social isolation may also affect appetite.
Poor dentition may affect the type of foods consumed since chewing would be difficult if the dentures do not fit well, thus consequently soft foods may be chosen with scant regard to its nutritional values. Raw fresh fruits and lightly cooked vegetables should not be taken to avoid chewing thus reducing the vitamin intake.
Sometimes the intake of drugs may be for long periods causing some physiological and pathological changes reducing the effectiveness of drugs.
The food intake also affects the absorption metabolism of some drugs not being efficiently absorbed by the intestines. While some drugs induce the requirement of certain nutrients, some others may cause reduction in appetite. “Some nutritional problems associated with drug treatment may be reduced by ensuring a nutrient-rich diet.” (Nutrition in Older People, 1996)
As stated in the briefing paper ‘Nutrition in Older People’ (1996), maintenance of physical activity helps reduce the normal decrease in energy requirements and maintain intake of micronutrients. Older people who are institutionalized such as the ones staying for prolonged periods in hospitals and residential or nursing homes may have lower energy and nutrient intakes then their counterparts living a free life.
This could be due to lower intake of vitamin rich nutrient food in hospital, a study conducted by Morgan et al (1986) stated a reduction in body weight, blood albumin, triceps skinfold, arm circumference and plasma vitamin C among the patients staying in institutions.
The study also stated that patients staying for long due to acute or chronic illness and with higher degree of immobility exhibited reduced nutritional intake. Subsequently these lower intakes result in poor anthropometric and biochemical measures.
Malnutrition or under-nutrition in older people admitted to hospital is a matter of concern and the hospital staffs including the doctors need to be trained in this context. However the Royal College of Nursing has adopted the following strategies to ensure