Nutrition and Older Adults: Nutrition and Older Adults: Issues among Community Issues among Community

and and Long-Term Care ResidentsLong-Term Care Residents

Jean Helps, RDJean Helps, RD11 and Christina Lengyel PhD, and Christina Lengyel PhD, RDRD22

11Clinical Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food Clinical Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food ServicesServices22Assistant Professor, Human Nutritional Sciences, Faculty of Human Ecology, Assistant Professor, Human Nutritional Sciences, Faculty of Human Ecology, University of ManitobaUniversity of Manitoba

OutlineOutline

Canadian DemographicsCanadian Demographics Factors affecting Nutritional IntakeFactors affecting Nutritional Intake Long–Term Care SettingLong–Term Care Setting Rural and Urban CommunitiesRural and Urban Communities Nutritional Guidelines and Nutritional Guidelines and

RecommendationsRecommendations Take Home MessagesTake Home Messages

Demographics……..NoDemographics……..Noww

Demographics……..FutuDemographics……..Futurere

Diabetes

ALS

COPDDysphagia

Cancer

Palliative CareCeliac Disease

Constipation

SuperbugsCongestive

HeartFailure

PressureUlcers

MultipleSclerosis

Parkinson’sDisease

MalabsorptionSyndromes

Osteoporsis

GERD

Pneumonia

Falls

AlcoholAbuseStroke

Osteoarthritis

Anemia

Family RelatedIssues

Renal Disease Nutrition Nutrition IssuesIssues

For Older For Older AdultsAdults

System Issues

Dementia

Mental Illness

Obesity

Malnutrition

Nutrition and Quality of Nutrition and Quality of LifeLife

Healthy food choices positively influence Healthy food choices positively influence the quality of life of older adults.the quality of life of older adults.

Older adults are at risk for inadequate Older adults are at risk for inadequate dietary intakes which may lead to:dietary intakes which may lead to:– Poor nutritional statusPoor nutritional status– Decreased quality of lifeDecreased quality of life– Functional disabilityFunctional disability– Increased health care costsIncreased health care costs– Greater risk for morbidity and mortalityGreater risk for morbidity and mortality

Factors Affecting Factors Affecting Nutrition Status Nutrition Status

PhysiologicalPhysiological– Declining digestion and absorptionDeclining digestion and absorption– Reduced sensory perceptionReduced sensory perception

visual, olfactory, taste acuity, thirstvisual, olfactory, taste acuity, thirst– Anorexia of AgingAnorexia of Aging

PhysicalPhysical– Chewing and swallowing difficultyChewing and swallowing difficulty– Affects on body systemsAffects on body systems

Integumentary (skin), renal, Integumentary (skin), renal, musculoskeletal, cardiovascularmusculoskeletal, cardiovascular

Factors Affecting Factors Affecting Nutrition Status Nutrition Status

(cont’d)(cont’d) PsychologicalPsychological

– DepressionDepression– LonelinessLoneliness– DementiaDementia– Food likes/dislikesFood likes/dislikes

Social and EconomicalSocial and Economical– PovertyPoverty– Transportation availabilityTransportation availability– Lack of knowledge of nutritionLack of knowledge of nutrition– Inadequate cooking knowledge (men)Inadequate cooking knowledge (men)– ↓ ↓ Social supportSocial support

Factors Affecting Factors Affecting Nutrition Status Nutrition Status

(cont’d)(cont’d) Cultural beliefsCultural beliefs

– Provision of culturally appropriate Provision of culturally appropriate food and setting are both importantfood and setting are both important

(Wu and Barker, 2008)(Wu and Barker, 2008)

OthersOthers– Medical conditionsMedical conditions– Prescribed dietsPrescribed diets– Medication side effectsMedication side effects

The Continuum of CareThe Continuum of Care

Long-Term Care Long-Term Care SettingSetting

MalnutritionMalnutrition

Inappropriate amount of, or quality of Inappropriate amount of, or quality of nutrients comprising a healthy diet are nutrients comprising a healthy diet are not consumed for an extended period of not consumed for an extended period of timetime

Undernutrition: Undernutrition: Often thought to be a problem of third Often thought to be a problem of third

world countriesworld countries Inadequate consumption, poor Inadequate consumption, poor

absorption, or excessive loss of nutrientsabsorption, or excessive loss of nutrients

Overnutrition:Overnutrition: Excessive intake of specific nutrientsExcessive intake of specific nutrients

Prevalence of Prevalence of Malnutrition in the Malnutrition in the

ElderlyElderly

Hospitalized Patients:Hospitalized Patients: 32% to 50%32% to 50%

Long Term Care:Long Term Care: 5% to 85% (Average= 30%)5% to 85% (Average= 30%)

Causes of Causes of Malnutrition- Malnutrition-

OrganizationalOrganizational Failure to help residents eat or recognize Failure to help residents eat or recognize

malnutritionmalnutrition Importance of nutrition not realizedImportance of nutrition not realized Absence of DietitianAbsence of Dietitian Lack of staff, lack of communication, Lack of staff, lack of communication,

inadequate training and educationinadequate training and education Monotonous diet, inappropriate diet or Monotonous diet, inappropriate diet or

mealtime environmentmealtime environment Inappropriate medication prescribingInappropriate medication prescribing

(Cowan et al., 2004)(Cowan et al., 2004)

Liberalization of the Liberalization of the Diet PrescriptionDiet Prescription

Therapeutic diets may contribute to Therapeutic diets may contribute to malnutrition through restriction of:malnutrition through restriction of:

preferred food & beveragespreferred food & beverages components in food which promote intake components in food which promote intake

(e.g., salt)(e.g., salt) Culturally significant foodsCulturally significant foods

* A balanced approach is needed in * A balanced approach is needed in assessmentassessment

Combating Malnutrition – Combating Malnutrition – Dining Room Set-up for Dining Room Set-up for

Residents with DementiaResidents with Dementia Simplify the environmentSimplify the environment Simplify the food – Provision of too Simplify the food – Provision of too

many foods at one time leads to many foods at one time leads to over-stimulation, agitation and over-stimulation, agitation and reduced intakereduced intake

CommunicateCommunicate Provide flexible careProvide flexible care

– Self-feeding if possible (i.e., finger Self-feeding if possible (i.e., finger foods)foods)

Nutrition Based Nutrition Based Interventions Interventions

Oral Nutritional SupplementsOral Nutritional Supplements Changes to the meal pattern:Changes to the meal pattern:

– Protein, energy enriched foodsProtein, energy enriched foods– Small, frequent meals (i.e., between Small, frequent meals (i.e., between

meal snacks)meal snacks)– Individualizing the meal pattern to Individualizing the meal pattern to

accommodate social and cultural accommodate social and cultural preferencespreferences

Nutritional Issues in Nutritional Issues in Rural and Urban Rural and Urban

CommunitiesCommunities

Prevalence of Prevalence of MalnutritionMalnutrition

Undernutrition:Undernutrition: 5% to 20% prevalence of malnutrition5% to 20% prevalence of malnutrition ~40% are at risk of malnutrition~40% are at risk of malnutrition

Overnutrition:Overnutrition: Increasing in all age groupsIncreasing in all age groups 25% obesity among adults 65+ and 25% obesity among adults 65+ and

olderolder

Baby Boomer and Baby Boomer and Nutrition StudyNutrition Study

10 focus groups conducted in rural 10 focus groups conducted in rural and urban Manitoba communitiesand urban Manitoba communities

8-12 participants/group recruited by 8-12 participants/group recruited by MAFRI GO Team Representatives in MAFRI GO Team Representatives in specified areasspecified areas

All participants completed a focus All participants completed a focus group questionnairegroup questionnaire

Moderator facilitated the sessions Moderator facilitated the sessions for a 2 hour periodfor a 2 hour period

Preliminary Key Preliminary Key FindingsFindings

Distrust in nutrition labelingDistrust in nutrition labeling Misleading advertising on packagingMisleading advertising on packaging Importance of locally grown foods, their Importance of locally grown foods, their

availability in local markets and availability in local markets and supporting the local economysupporting the local economy

Portion control on packagesPortion control on packages Costs associated with healthier products Costs associated with healthier products Environmental concernsEnvironmental concerns More nutrition education neededMore nutrition education needed Importance of flavor, texture, taste and Importance of flavor, texture, taste and

variety in food productsvariety in food products

Nutritional Guidelines Nutritional Guidelines and Recommendationsand Recommendations

(www.healthcanada.gc.ca/foodguide)

Reading Food LabelsReading Food Labels

Compare the Nutrition Compare the Nutrition Facts Table on food labels Facts Table on food labels to choose products that to choose products that contain less fat, saturated contain less fat, saturated fat, trans fat, sugar and fat, trans fat, sugar and sodium.sodium.

The calories and nutrients The calories and nutrients listed are for the specific listed are for the specific amount of food found at amount of food found at the top of the Nutrition the top of the Nutrition Facts Table.Facts Table.

(http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/educat/info-nutri-label-etiquet-eng.php)

(Canadian Diabetes Association and Dietitians of Canada, 2007)

Dietary FibreDietary Fibre

Increase dietary fibre intake to 21 g/day for Increase dietary fibre intake to 21 g/day for women and 30 g/day for men (51+ years)women and 30 g/day for men (51+ years)

Replace refined cereals and flour products Replace refined cereals and flour products with whole grain foodswith whole grain foods

Increase fibre slowly to prevent excessive Increase fibre slowly to prevent excessive bloating, cramping, flatulence and diarrheabloating, cramping, flatulence and diarrhea

Drink adequate amount of fluidsDrink adequate amount of fluids Examples: oat bran, psyllium, legumes, Examples: oat bran, psyllium, legumes,

fruits, vegetables, wheat bran, flax seedsfruits, vegetables, wheat bran, flax seeds

Fluid IntakeFluid Intake

Dietary Reference Intake (DRIs) (51+ Dietary Reference Intake (DRIs) (51+ years)years)

Females: 2.7 L/day total water Females: 2.7 L/day total water (2.2 L = 9 cups total beverages)(2.2 L = 9 cups total beverages)

Males: 3.7 L/day total water Males: 3.7 L/day total water (3.0 L = 13 cups total beverages)(3.0 L = 13 cups total beverages)

NOTE: these values may be difficult to NOTE: these values may be difficult to achieve for older adults due to reduced achieve for older adults due to reduced food intake. Aim for 6-8 cups per day.food intake. Aim for 6-8 cups per day.

Vitamins and MineralsVitamins and Minerals

Vitamin DVitamin D– Current DRI’s are:Current DRI’s are:

Males and Females 51-70 years: 10 ug (400 IU) Males and Females 51-70 years: 10 ug (400 IU) Males and Females 70 +years: 15 ug (600 IU)Males and Females 70 +years: 15 ug (600 IU)

– Canada’s Food Guide recommends an Canada’s Food Guide recommends an additional daily vitamin D supplement of additional daily vitamin D supplement of 10 ug (400 IU) for everyone over the age of 10 ug (400 IU) for everyone over the age of 5050

– New research is demonstrating a need for New research is demonstrating a need for increasing vitamin D requirements for increasing vitamin D requirements for older adults older adults

Canada’s Physical Activity Guide to Canada’s Physical Activity Guide to Healthy Active Living for Older AdultsHealthy Active Living for Older Adults

(www.phac-aspc.gc.ca/pau-uap/paguide/older/index.html)

Take Home MessagesTake Home Messages

Nutrition is one of the major determinants of Nutrition is one of the major determinants of healthy aginghealthy aging

Individualized care Individualized care – Ensuring effects of aging are consideredEnsuring effects of aging are considered

High quality diet is important across the High quality diet is important across the lifespanlifespan

Consume a variety of nutrient dense foods from Consume a variety of nutrient dense foods from the four food groupsthe four food groups

Nutrient supplementation with low-dose Nutrient supplementation with low-dose multivitamin and mineral supplements can be multivitamin and mineral supplements can be useful in achieving recommended intake levelsuseful in achieving recommended intake levels

Enjoy your meals!Enjoy your meals!

ResourcesResources

Dietitians of CanadaDietitians of Canada– www.dietitians.cawww.dietitians.ca

Eating Well with Canada’s Food GuideEating Well with Canada’s Food Guide– www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.phpwww.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

Canada’s Physical Activity Guide for Older AdultsCanada’s Physical Activity Guide for Older Adults– www.phac-aspc.gc.ca/pau-uap/fitness/pdf/www.phac-aspc.gc.ca/pau-uap/fitness/pdf/

guide_older_e.pdfguide_older_e.pdf Nutrition LabellingNutrition Labelling

– www.healthcanada.gc.ca/nutritionlabellingwww.healthcanada.gc.ca/nutritionlabelling Alzheimer Society of CanadaAlzheimer Society of Canada

– www.alzheimer.ca/english/care/dailyliving-mealtime.htmwww.alzheimer.ca/english/care/dailyliving-mealtime.htm

“If we knew what it was we were doing, it would not be called research, would it?”

Albert Einstein

Any Questions?Any Questions?