Aging Well With Nutrition: What to eat and how to eat it!

Aging Well With
Nutrition:
What to eat and how to
eat it!
Health Professionals Day
Royal Agricultural Winter Fair
Nov 11, 2009
Heather Keller RD, PhD, FDC
Some Facts …
Canada
The World (in millions)
2056, 1 in 3
2000
1800
1600
1400
1200
1000
800
600
400
200
0
2005, 1.3 in 10
Over 65 years
current
2020
2050
The Aging of Canada
Source: Statistics Canada (2006) : Portrait of the Canadian Population in 2006, by Age and Sex: Data tables, figures, maps and animations
(http://www12.statcan.ca/english/census06/analysis/agesex/tables.cfm#animations)
Quantum Health Expectancy
Theory (Barondess, 2008)
• Certain quantity of life at birth
• Environmental assaults
• Healthful behaviours
• Evidence: long-lived groups/cohorts
• Common factors: social interaction,
positive attitude, cognitive stimulation,
diet/non-obese, non-smoking, none to
limited alcohol, limit stress
WHAT TO EAT?
Dietary Reference Intakes &
Older Adults
• Very little research on requirements for older adults;
extrapolation from younger age groups
• Issue of differentiating needs due to age vs. change
in requirements due to subclinical disease
• TUL? Especially considering drug- nutrient
interactions
• Known changes with age that could influence
• Loss of lean body mass – up to 30% ? Affect needs, how nutrients
transported
• Lower body water- ? Affect distribution of nutrients
• Potential gastrointestinal changes- affect intake, atrophic gastritis?
Absorption, utilization
• Large hormonal changes- affect requirement via bioavailability,
conversion, utilization
• Increased bone resorption
Vitamins
• Increased need with age for B6 - pyridoxine
phosphorylation
• Atrophic gastritis highly associated with age; impairs
B12 absorption
• All age groups increased requirement for vitamin C
and E from prior versions
• Vitamin D increased for 51+ and 71+
Minerals/Trace metals
• Calcium has increased requirement compared to
younger ages
• Sodium, chloride, iron (women) and chromium have
lower requirements than younger ages
• Phosphorus TUL is lower than other age groups
• Trace metal needs potentially reduced to decreased
body pool size
What to eat....
• Nutrient requirements for the most part are the
same or greater for the healthy older adult group
• Older adults need high quality, nutrient dense
diets
• Caloric needs greatly reduced, primarily due to
decreased activity and loss of LBM
• CAREFUL planning!
Is there a concern?
• Poor intake of all four food groups (Quebec, British
Columbia, New Brunswick, Ontario and Canadian Community
Health Survey)
•
•
•
•
A variety of nutrients consumed at low levels
Protein and energy
Involuntary weight loss
Voluntary weight loss
EWCFG Recommendations for
Food Groups
Food Group
Vegetables
and Fruit
Grain
Products
Milk and
Alternatives
Meat and
Alternatives
Oils and Fats
EWCFG
51+ age group
Male
Female
7
7
7
6
3
3
3
2
2-3
tbsp
2-3
tbsp
Tuft’s University
Modified Pyramid
for Older Adults
Heterogenity of Older
Adults
The challenge of frailty
• What are the needs?
• Diagnosing potential deficiency…
• Planning for adequate intakes
HOW TO EAT?
NuAGE Diet Resilience Study
Shatenstein et al,
2009
Quality
of food
Getting
Food to
the
Senior
Wanting
to eat
What do Social Relationships Do?
Rook 1985 & Pierce 2000
Social
Integration
Regulation,
promote
healthy
behaviour
Social
Support
Response to a Stressor
Companionship
-Emotional/Encourage
Promotes Self
Worth
-Informational
Camaraderie
-Tangible
Emotional sharing
Intimacy &
pleasure
IMPROVED FOOD INTAKE
Life Nourishment Theory
(Keller et al., 2009)
Living Life to the Fullest
with Dementia
Being connected
Mirroring
the way
we are
Adapting
to an
Evolving life
Honouring
identity
Existing
with Dementia
Having dignity
Being accepted
Being acknowledged
Having values
Veiling reality
Honouring
family and
individual
identity
Having meaningful
roles
Enabling roles
Negotiating capacity
Reaffirming Self
in the world
Having routines & traditions
Making decisions
Reminiscing
Keeping informed
Creating new stories
Honouring identity
“As a mother that was really important to me to still have that.
Because mothers and parents tend to do that for their children
so that was another thing I didn’t want to lose.”
PWD
“…you get back into discussing the past, the history of the
family or what we did, do you remember what we did back in
1972 sort of thing…”
CG
back
Being Face to
Face
Taking time
Taking Part
Focusing attention
Being
Connected
Participating
Psychologically
Sharing activities & interests
Making plans & decisions
Learning from others
Being creative
Getting and
Giving Support
Physical
Psychological
Emotional
‘But I would say I feel that we’re the most
connected then, when we’re sitting across
from each other at a table. I think a lot of it is
we’re facing each other’ (CP24).
‘opportunity to communicate, to clarify, to
reaffirm our positions and situations, caring
for each other, and learning something, all of
those things. That is a good, the mealtime is a
great place for that’ (PWD6).
Older Adults and Eating Together
• Eating together can:
– improve nutrient intake and
reduce malnutrition
– stimulate social relationships
– facilitate social bonds
– improve QOL
– provide emotional support
Refs: Nijs et al., 2006 ; Locher et al., 2005; Hubbard et al., 2003 ; Rook, 1985 ; Amella, in press
What does this mean?
• How we eat is important…
- may lead to diet resilience, ability to adapt,
better quality diets
• Leads to feelings of well-being and quality of life
• In some cases this sense of well-being is more
important than what is consumed
• Advanced dementia
• End of life
• Need to consider ‘how we eat’ in communal eating
situations
• Are we promoting connection?
• Are we honouring identity?
• If mealtimes are ‘the way we are’ perhaps
mealtimes can change who we are
Takeaways
• What to eat, for older adults is a challenge…
– Heterogeneity
– Knowledge shadow
– Should we supplement?
• As with any age group, older adults struggle with
‘eating well’; choosing foods for health
• We have to remember that how one eats, is also
important to the health picture