Therefore, it is prudent to suggest that diet


and lifestyle choices throughout the life course are ultimately responsible for how we age.3


Nutritional requirements and


issues for older people It is usual for energy requirements to fall with advancing age as people become less active,13 which is often described as the ‘anorexia of ageing’.14


consumption can lead to inadequate energy and micronutrient intake.15


However, decreased food and beverage A recent study has


identified that encouraging the elderly to consume regular healthy snacks in between small nutritionally dense meals can improve vitamin, carotenoid and mineral intakes in the elderly population.16 Unfortunately, recent evidence also proposes that older adults are failing to achieve their optimal nutritional status.3 The latest data highlights that the prevalence


of obesity among elderly people in the United Kingdom is higher than among young people, with almost three quarters of those aged between 65 and 74 years classed as obese or overweight.17


The British Medical Association18 also


suggests that the prevalence of malnutrition increases with age.


The British Association for


Parenteral and Enteral Nutrition (BAPEN)19 highlight that, at any point in time, three million people in the UK are at risk of malnutrition, with the majority aged 65 years old and over. It is also concerning that there are an unacceptable high number of elderly individuals who are developing malnutrition whilst in hospital.20


The


incidence of malnutrition is also said to be greater in nursing homes than in individuals living in residential care.18


The prevalence of


frailty in the UK is currently unknown.21 The Scientific Advisory Committee on Nutrition (SACN)22 have proposed that, despite


a significant improvement in adult dietary habits over the past 15 years, older adults aged 65 years and over have lower than recommended nutritional intakes in some of the key vitamins and minerals on a daily basis. Recently there has been a call for urgent action to improve the vitamin D status amongst older people in the UK, given that many older men and woman have very low plasma vitamin D status.23 Ageing is also associated with the increased incidence and prevalence of anaemia.24


Data from SACN22 has established that 46 per cent of adults


aged 65 years and over living in institutions and 11 per cent of ‘free living’ older adults were classified as anaemic. Furthermore, 11 per cent of free living older adults compared with 28 per cent living in institutions also showed evidence of low plasma iron status. Table One shows the daily nutritional


requirements of British adults aged 65 years and over.


Figure 2: Bio-psychosocial Barriers to Healthy Eating in the Elderly •


Chronic illness and disability impacting ability to buy, prepare and eat food27


• Dental caries secondary to medication high in sugar28 • Lack of saliva -> dry mouth and reduced mucosal immunity and protection29 • Ill fitting dentures30 • Food Poverty31 •


Cognitive decline7


• Sarcopenia of ageing32 •


Dysphagia33


What is going wrong? A recent study26


Nutrition and Healthy Ageing | Big Story However, Shepherd7


has suggested that a high


proportion of older adults in the UK had little basic nutrition knowledge, which is a barrier to healthier eating. However, there is a growing body of evidence


which has identified that there are many other bio- psychosocial issues that may prevent healthy eating advice from being put into practice within the elderly population.3 highlighted in Figure 2.


These issues are The importance of nutritional


screening Nutritional screening, in its various forms, looks for characteristics associated with nutritional problems so that the individuals identified can undergo full nutrition assessment and possible intervention.34 There are a plethora of assessment tools available, However, the Malnutrition Universal Screening Tool (‘MUST’), developed by the Malnutrition Advisory Group,35


in the UK. The mini nutritional assessment tool can also be used.36


is the most commonly used screening tool If a client is in hospital or nursing


home based care, then food and fluid charts should be used as these have been shown to support effective care planning and nutritional monitoring.37


attributed to lack of staff training38 and the lack


of provision of calibrated weighing scales with an additional reluctance to carry out nutritional screening per se.35


How to optimise nutritional


status If an elderly client is identified either at risk of or is diagnosed with a nutritional problem then a decision can be made as to how best to maximise their nutritional potential.7 Nutritional care planning is paramount and, therefore, it is suggested that the care plan should be tailored to suit individual needs taking into account personal likes, dislikes, food allergies and intolerances, in addition to ethnic and cultural beliefs.37 A balanced diet should contain a variety of


foods from the five major food groups which are shown in the ‘Eatwell plate’.39


Shepherd3 This is a cause for concern as lack of argues


that although this plate gives a visual guide to eating a balanced die, it does not consider portion sizes.


guidance may indicate that individuals may over


Table One: Daily Nutritional Requirements of British Adults Aged 65 years and over


(Adapted from Shepherd 2009,3 Nutrient


Total energy intake


carbohydrate (%) Food energy from non milk


extrinsic sugars (%) Food energy from


dietary fat (%) Protein


Fibre Iron


Vitamin D Calcium Sodium


Vitamin A Folate


SACN 200822 and Thomas & Bishop 200725


Males aged 65 years and over 2330 Kcal per day


Food energy intake from 50% per day 11% per day 35% per day


0.75g per kg of ideal body weight per day


18g per day 8.7mg per day


10 micrograms per day 700mg per day 6g per day


700 micrograms per day 200 micrograms per day


)


Females aged 65 years and over 1900 Kcal per day


50% per day 11% per day 35% per day


0.75g per kg of ideal body weight per day


18g per day 8.7mg per day


10 micrograms per day 700mg per day 6g per day


600 micrograms per day 200 micrograms per day


process of nutritional assessment may be subject to inaccuracy.


proposes that the This is thought to be


Complete Nutrition Vol.10 No.6 December/January 2010/11


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