Big Story | Nutrition and Healthy Ageing or under eat.40
References: 1. Stanner S (2009). Healthy ageing: The role of Nutrition. Nursing and Residential Care; 11(5): 239-42. 2. National Office of Statistics (2010). Ageing: Accessed online:
www.statistics.gov.uk . 3. Shepherd A (2009). the role of nutrition in maintaining good health in later life: Nursing & Residential Care; 11(7): 337 – 345. 4. Denny A (2008). An overview of the role of diet in the ageing process. Br J Community Nurs.; 13(2): 58-67. 5. Kaiser M, Bandinelli S, Lunenfeld B (2010). Frailty and the role of nutrition in older people. A review of the current literature. Acta Biomed.; 81; Suppl 1: 37-45. 6. Brundtland GH (1988). Director General of the World Health Organisation Speech to the 51st World Health Assembly Geneva. WHO Geneva. 7. Shepherd A (2010). The hand in hand nature of nutrition and cognitive decline. Nursing & Residential Care; 12(8): 370-376. 8. Rajah MN, et al (2009). Biological changes associated with healthy versus pathological aging: A symposium review. Ageing Res Rev.; 8(2): 140–146. 9. Pandey KB, Rizvi SI (2010) Markers of oxidative stress in erythrocytes and plasma during ageing in humans. Oxid Med Cell Longev Jan-Feb; 3(1): 2-12. 10. Gille D (2010). Overview of the physiological changes and optimal diet in the golden age generation over 50. Eur Rev Aging Phys Act.; 7: 27-36.
11.Morley JE, Chahla E, AlKaade S (2010) Antiaging, longevity and calorie restriction. Current Opinion in Clinical Nutrition and Metabolic care 13: 40-45. 12. Smith DA, et al (2010). Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. Accessed online:
http://www.plosone.org/article/info% 3Adoi%2F10.1371%2Fjournal.pone.0012244. 13. Risonar MGD, et al (2009). Physical activity, energy requirements and adequacy of dietary intakes of older persons in a rural Filipino. Community Nutrition Journal; 8:19 doi: 10.1186/1475-2891-8-19. 14. Donini LM, Savina C, Cannella C (2010). Nutritional Interventions in the anorexia of aging. J Nutr Health and Aging.; 14(6): 494-6. 15. Zizza CA, Arsiwalla DD, Ellison KJ (2010). Contribution of snacking to older adults vitamin, carotenoid and mineral intakes. J Am Diet assoc.; 110(5): 768-72. 16. Zizza CA, Tayie FA, Lino M (2007). Benefits of snacking in older Americans. J Am Diet Assoc.; 107(5): 800-6. 17. Gulland A (2010). Obesity among the over 65’s in UK reflects “Lifetime of gaining weight”. BMJ; 341: c3585. 18. British Medical Association (2009). Nutrition of Older People Malnutrition in care Homes. Accessed online:
http://tinyurl.comy3rz6ny. 19. British Association of Enteral and Parenteral Nutrition (2009). Combating Malnutrition Recommendations for action. BAPEN Accessed online:
www.bapen.org.uk/pdfs/reports/ advisory_group _report.pdf 20. Age UK (2010). Still Hungry to be heard the scandal of people in later life becoming malnourished in hospital. Accessed online:
http://www.ageuk.org.uk/get-involved/campaign/malnutrition-in-hospital- hungry-to-be-heard/?ito=1944&itc=0&gclid=CMfClcj30aQCFaP92AoddgquKQ 21. Sydall H, et al (2010). Prevalence and correlates of frailty among community dwelling older men and women: findings from the Hertfordshire Cohort study. Age Ageing; 39(2): 197-203. 22. Scientific Advisory Committee on Nutrition (2008). The Nutritional Wellbeing of the British Population. SACN London. 23. Hirani V, Tull K, Ali A, Mindell J (2010) Urgent action needed to improve vitamin D status among older people in England! Age and Ageing 39: 62-68. 24. Ferrucci L, Balducci L (2008). Anaemia of ageing: The role of chronic Inflammation and cancer. Semin Hematol.; 45(4): 242-9. 25. Thomas B, Bishop J (2007). Manual of Dietetic Practice 4th Ed. Blackwell Publishing Oxford. 26. Al Riyami A, Al Habadabi MA, Abd El Aty et al (2010) Nutrition knowledge, beliefs and dietary habits amongst elderly people in Nizwa Oman: Implications for policy. EMHJ 16 (8): August 2010. 27. Jones J, et al (2009). Older people living in the community nutritional needs barriers and interventions a literature review. The Scottish Government. Edinburgh. Accessed online:
http://eresearch.qmu.ac.uk/1259/1/ eResearch_1259.pdf. 28. British Nutrition Foundation (2009). Healthy Ageing: the role of nutrition and lifestyle. The report of a British Nutrition Foundation Task Force. Edited by Stanner S, Thompson R Buttriss JL. Wiley-Blackwell Oxford. 29. Sakamoto Y, et al (2009). Effects of exercise, ageing and functional capacity on acute secretory immunoglobulin A response in elderly people over 75 years of age. Geriatr Gerontol Int.; 9(1): 81-8. 30. Shepherd A (2003). Nutrition for Optimum Wound Healing. Nursing Standard.; 18(6): 56-58. 31. Age Concern (2008). Heat or Eat? Pensioner poverty debated at conferences. Age Concern England’s political bulletin November 2008 ACE London. Accessed online;
http://tinyurl.comr9pqn6. 32. Marzetti E, et al (2009). Sarcopaenia of ageing Underlying cellular mechanisms and protection by calorie restriction. Biofactors.; 35 (91): 28-35. 33. Nazarko L (2010). Recognizing and Managing Dysphagia Nursing & Residential Care.; 12(3): 133 – 137. 34. Berner YN (2003). Assessment tools for nutritional status in the elderly. IMAJ.; 5: 365-367. 35. British Association of Enteral and Parenteral Nutrition (2007). ‘MUST’ - Malnutrition Universal Screening Tool. Accessed online:
http://www.bapen.org.uk/pdfs/must/ must_full.pdf 36. Salva A, et al (2009). Nutritional Assessment of residents in long term care facilities recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA . J Nutr Health and Ageing.; 13(6): 475-83. 37. Dunne A (2009). Malnutrition in care homes. Improving nutritional status Nursing and Residential Care; 11(9): 437-52. 38. Healthcare Commission (2007). Caring for Dignity. A national report caring for older people in hospital. Accessed online:
http://www.cqc.org.uk/_db/_documents/ Caring_for_dignity.pdf. 39. Food Standards Agency (2007). The Eatwell Plate. Accessed online:
http://www.eatwell.gov.uk/healthydiet/eatwellplate/ 40. British Dietetic Association (2007) Dieticians Hail return of balanced diet plates. Media Release 12th September BDA UK accessed online at
www.bda.uk.com/ news/070917eatwell_plate.pdf 41. Age UK (2010). Healthy Eating. Accessed online:
http://www.ageuk.org.uk/health- wellbeing/healthy-eating-landing/ 42. Forrest C (2008) Oral Nutritional Supplements a review of patient prescribing practices. J of human Nutr and Dietetics 21(4): 388 43. Milne AC et al (2009) Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews. Issue 2, art no:
CD003288.DOI:10.1002/
14651858.CD003288.pub3 44. Kirshbaum M (2010) Does protein and energy supplementation benefit older people at risk of malnutrition? Nursing Times 106 39 p 22. 45. Burnham A (2010) Oral feeding difficulties and dilemmas. Royal College of Physicians London Co-Published with the British Society of Gastroenterology Available for order online at http://bookshop
.rcplondon.ac.uk/details.aspx?e=295 46. National Association of care Catering (2010). Oral Feeding difficulties and dilemmas. Report: Accessed online at
www.thenacc.co.uk/index
Table Two provides a practical
indication as to how elderly individuals may achieve a balanced diet. If required, a useful and effective way of
weight reduction is to use a combination of foods with a high nutrient density (high fibre) and low energy values incorporated with increased physical activity, aimed at accruing lean muscle mass.10
For those individuals who are either
malnourished, or have the potential to become so, it is important to utilise fortified foods in order to promote the consumption of extra calories to promote weight gain.25, 7
Nutrition support If sufficient energy intake cannot be achieved with either normal foods or the use of fortified foods then it may be necessary to consider the use of oral nutritional supplements.3
regarding the use of oral nutritional supplements in the elderly. It is of concern to note that, according to the some elderly
Royal College of Physicians,45
residents in nursing homes are being tube fed in order to save time and money.
However, the
inferences that artificial feeding is an easy option and preferable to providing appropriate meals is not acceptable practice.46, 7
Conclusion The UK population is ageing but healthy life expectancy has not increased at the same rate. In order to optimise the nutritional status
However, these supplements are often costly and Forrest42 argues
that it is important that they are used appropriately within the community and acute care settings. Data from a Cochrane Systematic Review43 suggests that there is a small consistent benefit from protein and energy oral supplementation for older people in institutional settings and at home. Despite the weak quality of the majority of the studies included in the review, Kirshbaum44 recommends that this is the best available evidence
of the elderly, research has shown that by adopting a healthy diet, engaging in regular physical activity and smoking cessation can help reduce the individual’s chances of suffering from chronic disease and ill health, particularly if these habits are adopted through the lifespan.3 In instances where elderly individuals are
found to be at a risk of nutritional problems, and in order to achieve excellence of care, it is important that the nutritional intervention chosen is tailored to suit the individual’s needs. The options include assisted eating, and the use of oral sip feeds where appropriate. The use of artificial enteral feeding should only be considered as a last resort.
Table Two: Practical Ways to Achieve a Healthy Diet (Adapted from Age UK 201041
and Shepherd 20093
Food Groups Starchy foods
) Achieving a ‘Healthy Balance’
4-6 servings a day: • 3 tablespoons of a breakfast cereal • 1 slice of bread from a medium sized loaf • 2 tablespoons of cooked pasta, rice or noodles • An egg-sized potato
Fruit and vegetables
Aim for 5 portions per day including fresh, frozen or canned fruit and vegetables where 1 portion is: • 1 Medium sized apple or banana (fist size handful, of grapes) • 1 150ml glass of fruit juice • 1 Medium cereal bowl of side salad • 1 tomato and lettuce in a sandwich • 3 tablespoons of peas or sweetcorn
Milk and dairy foods
2-3 servings per day: • 1 125g pot of fruit yoghurt • 1 40g piece (matchbox size) of hard cheese • 1 small pot (100g) of cottage cheese
Meat, fish and alternatives
2 serving per day to include meat, fish, poultry, offal, eggs, beans and lentils. • Fish: 1 small salmon steak 100-150g in weight or 1 small can of tin tuna • Meat: 80g (about the size of a pack of cards) or 2 low fat sausages, or 1 chicken breast
Foods containing fat and sugar
• Beans/pulses: 2-3 heaped tablespoons • Choose low fat crisps
• Grill bake or steam foods as opposed to frying them • Try to limit cakes biscuits and sweets to once or twice a week • Choose leaner cuts of meat and take excess fat off meat products • Choose semi skimmed and skimmed milk products
Salt
• Limit snacking on salty food (for example, salted crisps or peanuts) • Read and compare food labels at the supermarket • Don’t add salt while cooking or to food • Look out for low salt options
10 | Complete Nutrition Vol.10 No.6 December/January 2010/11
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