It is crucial for the elderly to maintain strength and daily function, writes Meera Murugesan
IF you have an elderly person at home or are a caregiver to your ageing parents, you would have probably heard them complain about meals at some point. They may eat very little, push away certain foods or claim they have no appetite.
We often dismiss these behaviours as old people being fussy or set in their ways but nutrition (alongside physical activity) plays a crucial role in healthy ageing.
Most people are not even aware that starting in their forties, healthy adults can naturally lose up to eight per cent of muscle mass every decade and after 70, that rate almost doubles up to 15 per cent. Nutrition is important in preserving muscle strength in the elderly says Professor Dr Shahrul Bahyah Kamaruzzaman, consultant geriatrician and head of the geriatric unit at University Malaya Medical Centre.
Old age is a time of change affecting the individual’s ability to maintain balanced nutrition needed for healthy and successful ageing she explains. Without good and balanced nutrition, muscle strength is affected and this can lead to frailty in the elderly, resulting in loss of ability to perform everyday activities.
Most caregivers of the elderly don’t notice this until their parents no longer have the strength to participate in family activities such as preparing meals together during festivals, going on holidays or simply enjoying a day out at the park. Even basic functions like walking or getting up from a chair may become a challenge, leading to a poor quality of life.
Dr Shahrul says caregivers need to be aware of this and provide elderly parents with both nutritional support and increased physical activity to combat muscle deterioration. There are many reasons why poor nutrition and eating habits persist among the elderly she adds.
AGEING AND EATING
As we age, our sense of taste and smell is affected and we tend to feel full very early during meals. The process in which metabolism occurs is slowed down.
Oral health is also an issue. Gums may be swollen or not in good condition and teeth may be lacking or not strong. Chewing and swallowing can be difficult, especially with certain types of food which are dry.
“Many older people face difficulty in swallowing and they just won’t eat something if they can’t swallow properly,” says Dr Shahrul.
As you grow older, you also build up a “portfolio” of diseases, and certain conditions that require you to take medication can cause you to develop dry mouth, which affects eating patterns. Having diabetes or certain neurological problems like stroke and Parkinsons also has an impact on your ability to digest food.
Dr Shahrul says there are normal problems associated with ageing which impact the ability to eat properly, added on by problems resulting from health conditions the elderly normally acquire and subsequently, the side effects from the various medications that they take.
Medications can interfere and interact, not just with each other but also the food that they consume. Depression and dementia also affect eating patterns and for the elderly who reside alone, loneliness and social isolation can result in them eating less, not eating well or skipping meals.
In some cases, eating patterns are affected because they no longer have the ability to go out and buy food themselves or prepare meals as they used to. Financial constrains also mean elderly people have limited money to spend on food and in some cases they develop food aversions or become overly restrictive in their diets due to cultural or religious reasons.
Dr Shahrul says the elderly should eat small but frequent meals to ensure better digestion and we have to find ways to ensure they have access to good, clean food. Oral nutritional supplements may also be necessary in the treatment of acutely ill older people.
The challenge in addressing this issue is that many caregivers and the elderly themselves have inadequate knowledge about food management and the importance of maintaining a proper diet. As a caregiver, it can also be difficult to implement changes for the elderly where diet and nutrition are concerned.
“As a parent you may know what’s good for your child but when you’re dealing with an older adult, who’s your parent and used to be in charge of you, it’s often difficult to break through. But understanding where they’re coming from, their needs and preferences are key to being an effective caregiver,” says Dr Shahrul.
Caregivers need to enhance their knowledge and education about nutrition and other aspects of ensuring the elderly are as healthy and independent as possible.
Another challenge comes from the fact that the nutritional needs or problems of old people are often undetected by health professionals and malnutrition is under-diagnosed.
Malnutrition is a vicious cycle. It can lead to apathy, depression and reduced attention, which in turn leads to reduced appetite, loss of muscle mass, reduced capacity to feed oneself and reduced mobility.
“In those over 65, malnutrition is quite common and we see this in patients in nursing homes, hospital wards and in rehab communities. Even healthcare professionals don’t address this issue adequately. It’s under-diagnosed and under-treated and needs to be looked into.”
Caregivers can also play a role. Whether they’re looking after old people formally in an institutionalised setting or informally, at home, they can help healthcare professionals identify those who are vulnerable to malnutrition so intervention can be implemented in order to maintain their health.
Dr Shahrul says successful ageing means managing and minimising the risk of disease and disability, maintaining physical activity and cognitive function and continuing to engage in daily activities and have good social connections. The main aim is to prevent frailty, a weakened state that can often occur before you even get to old age and the beginning of decline starts in our forties, resulting from a sedentary lifestyle and poor nutrition.
Frailty means not just being unable to get up from a chair quickly or having a slow walking speed, but it can also lead to disability and loss of function, resulting in institutionalised care in nursing homes and becoming dependent on others.
“That contineum needs to stop and its prevention starts at the beginning of decline.”
ABBOTT has launched the Ensure Gold Caregiver Campaign: Strength For The Moments That Matter to educate caregivers on the role of nutrition in supporting their parents’ overall health and muscle strength.
It aims to encourage caregivers to be mindful of muscle loss in their parents and to prioritise proper nutrition in caregiving so parents are able to continue doing the things that they love.
“Asian society is very unique. There is a strong dedication to taking care of one’s parents. It’s a wonderful concept and because of that caregivers have a unique perspective on the health of their elderly family members. They are concerned about what they eat, their heart health and they watch over them in many ways,” says Robert Cleveland, general manager of Abbott’s nutrition division in Malaysia.
Strength and muscle health in the elderly is very important but we don’t talk enough about it, he adds.
Strength and muscle health is what enables the elderly to perform daily activities, it’s what allows them to join their family for outings or play with their grandchildren at the park.
As part of the Ensure Gold Caregiver Campaign, Abbott has introduced a new chair challenge, a simple test where participants are asked to stand from sitting on a chair using only one leg and hold it for three seconds. For those who are unable to complete the test, the “Strength Chair-lenge” provides an indication of the likelihood of experiencing difficulty in walking or carrying out daily activities as they grow older.
Additionally, it also serves as a reminder to caregivers on the possible struggles faced by their elderly parents in completing simple everyday activities.
To learn more about the Strength Chair-lenge, please visit abbottnutrition.com.my/products/ensure-gold/strengthchairlenge.
DELAYING MUSCLE LOSS
STAY strong by following the tips below:
* Eat about 25g-30g of good sources of protein such as lean meat, eggs and beans at every meal.
* Choose a balanced diet of vegetables, fruits and whole grains, protein, healthy fats and key vitamins and minerals like calcium and Vitamin D.
* Discuss with your healthcare provider if you are ill, hospitalised or recovering from surgery, to manage illness-related muscle loss.
* Engage in regular exercise that includes resistance training to maintain muscle and strength.