1. #EldersForum2018 #AgeingInCommon #NCF2018

2. #EldersForum2018 #AgeingInCommon #NCF2018
SKY 3 – Ageing in Healthy Communities
Chair: Margie van Zyl Chapman, Chairperson, South African Care Forum
Jo Boylan, Director Operations, Southern Cross Care (SA & NT) Inc, Australia
Making Healthy Normal’ in aged care
Ngaire Hobbins, Dietitian Specialising in Ageing, Brain Health and Dementia
The Unique Nutrition Needs of Our Elders
#EldersForum #AgeingInCommon #NCF2018

3. The Unique Nutrition Needs of Our Elders
Presentation to:
The Inaugural Commonwealth Elders Forum
Reading, UK, April 16-18, 2018
Ngaire Hobbins APD

4. What is different about the nutrition needs of young adults and older?
Younger adults: Easily get adequate protein More likely to overeat Weight loss often essential Excess sugars etc problematic Gut health impacted by low fibre, probably by arrays of food additives, excess of highly processed foods
Older Adults:
Higher protein needs
Often reduced appetite
Weight loss more harm than good
Early life benefits – little need for sugar restriction
Gut health impacted by age, reduced food variety, excessive sanitisation, institutionalisation, inadequate fibre intake

5. Most current health advice is not aimed at elders, but do they know that?
Unhelpful, potentially damaging: Lose weight, stay lean, reduce abdominal girth Cut out sugar Reduce fat Minimise treats Cut out salt

6. Why does eating advice need to be different for older adults?
Muscle: protein reserve for: immune system
organ repair and maintenance
repair after injury/surgery etc
brain glucose supply
also assists insulin action – helps avoid IR, T2D
more likely to be lost: weight loss = muscle loss
immobilisation
chronic inflammation
less likely to be rebuilt: age related
inactivity (& immobilisation)

7. Why does eating advice need to be different for older adults?
Low appetite is very common:
Age related decline
Medication influences
Emotional/psychological influences
Food Security is a significant factor
Societal attitudes can exacerbate – weight loss is ‘normal’

8. The burden of malnutrition
Even if adequate food available, challenge is getting enough nutrition in smaller meals:
Many have nutrient intakes below requirements
It may not be obvious – can occur in absence of extreme weight loss
Malnutrition 1 up to 38% of community dwelling malnourished or at risk
up to 67% in care homes
up to 86% in hospitals
1. Kaiser MJ et al. (2009) World-Wide Data on Malnutrition in the Elderly According to the Mini Nutritional Assessment® (MNA) – Insights from an International Pooled Database. Clinical Nutrition;4 (S2): 113.

9. The burden of malnutrition
Malnourished older people have:
Double the risk of long-term mortality 2
3 times longer length of hospitalisation 3,4
3 times higher risk of infection 5
Increased hospital care costs 6
Greater likelihood of hospital readmission after discharge 7
Higher chance of losing independence and ability to carry out activities of daily living (ADLs)
And low levels of vitamin E, B12 and D associated with a decline in functional mobility
(References at end of presentation)

10. Can occur in the absence of a medical event as a result of:
Dieting to lose weight (without GOOD exercise)
Unintentional weight loss
Following age-inappropriate eating advice
Reproduced from: ‘Malnutrition in the Older Adult’. a Nestle Nutrition brochure

11. The impact of accumulated damage over the years
Chronic inflammation
both a cause and a result of muscle loss
contributes to accumulation of damage thought to lead to cognitive decline and dementia
Oxidative Damage
free radical damage to cells accumulates over years
associated with chronic inflammation
contributes to both muscle loss and cell damage
Both exacerbated by reduced intake of antioxidants/anti-inflammatory foods

12. The immense benefit of being an elder now:
These wonderful, wise people: Grew up on the food we would like youngsters to eat now Led active lives in younger years So: Sugar not an issue! Most ‘evils’ in modern food are really not an issue

13. The advice we need to offer:
Exercise to strengthen and maintain muscle
Maintains physical function
Reduces inflammation
Maintains body organs
Reduces Insulin Resistance and progression to type 2 diabetes and worsening of diabetes control
Improves cognition, reduces incidence of dementia

14. The advice we need to offer:
PROTEIN & COLORS

15. The advice we need to offer:
Weight loss beyond 65+ without very good exercise causes muscle loss
“Whatever you weigh now, don’t go losing any”

16. References:
2. Sullivan DH et al. (2002) The GAIN (Geriatric Anorexia Nutrition) registry: the impact of appetite and weight on mortality in a long-term care population. Jour of Nutr, Health and Aging; 6; Pichard C et al. (2004) Nutritional Assessment : Lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr; 79: Smith PE, Smith AE. (1997) High-quality nutritional interventions reduce costs. Healthcare Finance Management; 51: Pirlich, M et al. (2006) The German hospital malnutrition study. Clinical Nutrition; 25: Chima CS et al. (1997) Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. J Amer Diet Assoc; 97: Thomas DL et al. (2002) Malnutrition in subacute care. Am J Clin Nutr; 75;

17. Ngaire Hobbins APD
Instagram: Ngaire Hobbins Dietitian
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18. #EldersForum2018 #AgeingInCommon #NCF2018