#4 - December 2010
Committee for Healthy Ageing
Bulletin No 4, December 2010
Welcome to the fourth issue of our Bulletin, updating you on issues of importance or topical interest relating to nutrition and physical activity of older people.
SPECIAL FEATURE:
The Healthy Eating message – modifications for older people
I recently acquired the age when people of European descent are classed as ‘older’ in New Zealand – 65 years. However, and possibly not surprisingly, I like to stretch that descriptor out to 70 years! This is the cut-off for the nutrient reference values for older people, as established by the Australian National Health and Medical Research Council (NHMRC) and the New Zealand Ministry of Health. Here, nutritional requirements have been established for four groups of adults (excluding pregnancy and lactation) – 19-30 years; 31-50 years; 51-70 years, and >70 years.
Of particular interest in the older age group are the higher levels of three important nutrients – protein, calcium and vitamin D. The requirements for these are higher in the >70 years group than at any other time in adult life (except during pregnancy and lactation). Yet this is often the time when people believe their needs are lower than when they were younger. We are also now seeing people entering the older age group well and truly indoctrinated with the ‘healthy eating’ low fat, low sugar, high fibre message. This is, of course, still extremely relevant as people go through young adulthood to middle age, where overweight and obesity is rife, and put the population at increased risk of the lifestyle diseases of type 2 diabetes, cardiovascular disease and some cancers.
A recent paper from the Journal of the American Geriatric Society reported on a couple of studies in Australia – The Health in Men Study, and the Australian Longitudinal Study of Women’s Health. 1. The study examined all-cause and cause-specific mortality in an older population, associated with being underweight, normal weight, overweight or obese. Study participants were 9973 adults (49.4% men and 50.6% women) aged 70-75 when recruited, and were followed up for 10 years or until they died, whichever came first. The researchers found mortality risk was lowest for both men and women in those classified ‘overweight’, according to BMI. Those at the lower end of the ‘normal’ BMI range had almost double the risk of mortality than those who were overweight. Non-sedentary subjects were at lower risk than sedentary men and women in all BMI categories. The risk of dying from cause-specific conditions (namely cardiovascular disease, cancer or chronic respiratory disease) was also lower for men and women whose BMI fell into the ‘overweight’ range. It is important to note a greater risk of mortality was found in extreme obesity. The study concludes its findings are consistent with the hypothesis that weight loss in older people is harmful, that overweight older people are not at greater mortality risk, and that there is little evidence dieting in this age group confers any benefit.
This may mean older people need to re-evaluate their eating patterns as they age, and ensure they eat regularly, including between-meal snacks, especially if they only eat small amounts. It is important to include good sources of protein, probably in at least two meals if portion sizes tend to be small, and as noted in Bulletin 3, to include three servings of foods high in calcium. Balance this with plenty of vegetables and fruits, including lots of different colours, and breads and cereals, including whole grain or wholemeal varieties. Finish off with plenty of fluids – about 2 litres or 8 large glasses.
Finally, older people need to keep as active as possible. Be aware of their weight and check this regularly. They should not be aiming to lose weight unless very obese.
1. Flicker L. McCaul KA, Hankey GJ, Jamrozik K, Brown WJ, Byles JE, Almeida OP. Body mass index and survival in men and women aged 70-75. J Am Geriatr Soc 2010; 58: 234-41.
Eat well, move well to age well – a seminar for health professionals and caregivers working with older people in Maori and Pacific communities
The Foundation sees it has an important role in providing training and education to enhance the nutrition knowledge and awareness of people working with older New Zealanders. To this end, the Committee for Healthy Ageing hosted a very successful seminar in Christchurch in November, where delegates were exposed to some meaningful insights into the way Maori and Pacific older people in our community view nutrition messages. Understanding these should help us deliver much more relevant and culturally appropriate services. Speakers were highly respected health professionals from Maori, Samoan and Tongan backgrounds. Several key messages became common themes throughout the seminar:
- Food should be enjoyed. It is used to show respect and hospitality, and is a very important part of traditional gatherings.
- Being big is healthy; thin people are thought to be unwell
- Nutrition is not the most important role of food in the Pacific diet
- Messages for dietary change cannot be interpreted as being for only one person. Changes must involve the whole family. If someone is identified as ‘different’ it won’t work.
- The children are the most important – older family members will go without to ensure youngsters have enough to eat.
- Older people in Maori and Pacific communities live amongst the wider family group and play an important role in raising the children. This will always take priority over attending appointments or exercise classes, for example, as will attending weddings, funerals and similar ceremonies.
- There are often difficulties for this population in terms of transport to or from appointments and activities.
- Nutrition messages around food and healthy eating are more likely to be taken on board when they are incorporated with other social activities – music, dancing, church.
- The concept of healthy food is ‘rabbit food’ and ‘cheese and crackers’. We, as health professionals, need to show Maori and Pacific families how to make the diet they enjoy healthier – e.g. boil-ups.
- Total change will not work; our messages have to be culturally appropriate. Using Maori and Pacific health workers as the messengers has immense value.
What’s happening out there?
§ In September, the Hawke’s Bay District Health Board reported a study showing 57% of those over 65 years of age in the region were not eating properly. About one-third were estimated to be at high risk for malnutrition. Those at highest risk were older Maori or living alone.
§ In November, a Whanganui District Health Board report estimated nearly a quarter of residents in rest homes in the region was malnourished. Reported as ‘startling’, it is pertinent to note this level is within the range found internationally and, as the article pointed out, it’s not what you find out in these surveys, but what you are going to do about it.
§ A survey conducted in Nelson, Tasman and Marlborough showed 1% of the study population reported themselves underweight where, in reality, 12.9% were below the normal weight range, based on BMI data.
Please let us know if you are aware of any studies or interesting data from your region. We know the Minister of Health is interested in older people’s nutrition. The more information he can acquire, the more likelihood there is of some useful action!
Have you heard about….?
§ NZ Unit Standard 13343: Demonstrate knowledge of basic nutrition in commercial catering. This level 3 unit standard offers 4 credits, and has been developed conjointly by the Hospitality Standards Institute and the Heart Foundation. For more information, contact Pip Duncan: Pipd@heartfoundation.org.nz
§ Professional Foodservice 2nd edition. This new edition, by Pip Duncan and Julian Jensen, is a comprehensive, well-researched and practical resource for caterers, chefs, supervisors and dietitians in residential establishments. Not only will the book enable foodservice professionals to fulfil their responsibility of providing a cost-effective, quality and enjoyable meal service, it will also help them be proud of their place in New Zealand catering. Professional Foodservice is published by Pearson Education and available late December 2010. Visit www.pearson.co.nz
For more information visit the Foundation’s website, www.nutritionfoundation.org.nz, or to send us a question or comment for our attention via the ‘contact us’ link.
Next Bulletin: March 2011. Please email us if you have any topics you would like discussed, or included in the Bulletin. The NZNF reserves the right to determine the final content.