My bedtime reading this week has been the Ministry of Health's updated 156-page Food and Nutrition Guidelines for Healthy Older People, which is primarily aimed at health practitioners. I will give you the highlights, but for the full version visit health.govt.nz/publications, where there is also a pamphlet you can download, which contains more user-friendly information.
Good nutrition is even more important for good health as we age. It can help to:
- Prevent malnutrition.
- Support and optimise physical function and mental health.
- Reduce the risk of chronic disease.
- Prevent disability.
The nutritional status of older people is affected by many factors:
- Sarcopenia (or a reduction in total body muscle mass) - this age-related process can cause weak muscles and reduced physical activity.
- Poor oral health, such as ill-fitting dentures or widespread decay, which can result in reduced enjoyment of food and often less dietary variation.
- Sensory changes, especially of taste and smell, can also affect enjoyment of food and the ability to select and prepare it.
- Poor knowledge of foods and food preparation, or an altered ability to cook (eg: after a stroke, or the loss of a partner) - a common cause of limited, nutritionally poor diets in older people.
- Medications that may alter your metabolism and your dietary requirements.
- Social isolation - associated with poor nutrition. You are more likely to eat well, and with more food variety, if you share meals with family or friends.
- Socioeconomic status. Limited income may result in a limited diet, as well as reducing social and physical activities outside the house.
- Poor access to healthy foods (eg: if you are unable to drive to the grocery store).
Some of these factors are irreversible (such as sarcopenia), but some are modifiable. Targeting these modifiable factors (perhaps by enrolling in some basic cooking classes or getting your dentist to check the fitting of your dentures) may result in an improvement in the general state of your health, as well as your enjoyment of food and life.
The updated guidelines recommend that people over the age of 65 maintain a healthy body weight by eating well and by daily physical activity.
They should also eat well by including a variety of nutritious foods from each of the four major food groups each day:
- Eat plenty of vegetables and fruit.
- Eat plenty of breads and cereals, preferably wholegrain.
- Have milk and milk products in your diet, preferably reduced or low-fat options.
- Include lean meat, poultry, seafood, eggs, nuts, seeds or legumes.
- Drink plenty of liquids each day, especially water.
- Eat three meals every day. Nutritious snacks are recommended, especially for those who are underweight or have a small appetite.
An area deserving special mention is bone health in older people. Strong, healthy bones require adequate calcium, vitamin D and regular weight-bearing activity, such as walking. A lack of any or all of these can easily lead to osteoporosis and fractures.
Many older people do not consume enough calcium each day. The recommended daily amount is about 700mg for women over 65, and 800mg for men. Calcium is found primarily in milk and other dairy products, but there are also reasonable quantities in bread, vegetables, canned fish with bones (such as salmon or sardines), legumes, nuts, tofu and dried fruit.
Vitamin D unfortunately is not readily available in food. Small amounts can be found in oily fish, eggs and liver, but most of our vitamin D is obtained from exposure to sunlight.
As older people don't absorb vitamin D as easily as younger people do, and are often immobile or house-bound due to chronic illness, they are often at risk of vitamin D deficiency.
In summer, exposing the skin on your face and arms to sunlight for at least 30 minutes will be beneficial, but this is unlikely to be enough over the winter months.
If you are living in a residential home, or are concerned about your vitamin D or calcium intake, talk to your GP, who will be able to give you dietary advice and suggest supplements if required.
Cathy Stephenson is a GP, medical forensic examiner and mother of three. If you have a question, write c/o Features Editor, The Dominion Post, PO Box 3740, Wellington 6140, or email firstname.lastname@example.org
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