CHA Bulletin #2

 

Committee for Healthy Ageing
Bulletin No 2, June 2010
 
 
Welcome to the second issue of our Bulletin, updating you on issues of importance or topical interest relating to nutrition and physical activity of older people.
 
SPECIAL FEATURE:
Nutrition risk status of community-living older people: Findings from the LILACS NZ feasibility study
In each issue of the bulletin, we include a special feature highlighting a particular topic of interest or new piece of research. This time Carol Wham describes recent research conducted by the University of Auckland’s Life and Living in Advanced Age, a Cohort Study in New Zealand (LILACS NZ) study, Te Puāwaitanga O Nga Tapuwae Kia Ora Tonu (the blossoming of the path to maintain good health).
 
What is LILACS NZ?
 
There is a need to know more about advanced age as the oldest age group is the fastest growing and disability and dependence restricts quality of life and results in excess health and welfare spending. What factors predict successful advanced ageing, especially older Maori, and what pathways do those in advanced age take? What is the relative importance of health and nutrition, frailty, social and economic factors? The HRC grant, LILACS NZ, initiates a prospective cohort study of the oldest old, non-Mâori turning 85 years and Mâori 80-90 years in the Bay of Plenty and Rotorua regions to answer these questions. The principle investigator Professor Ngaire Kerse has engaged a broad research team including those with special interests in cardiovascular health, nutrition, respiratory health, bone health, physical function/frailty, health services, cultural identity, social networks and support and psychological health.

The Feasibility Study
           
Research to establish the feasibility for the longitudinal cohort study began in January 2008 and was completed in August the same year. The research examined the feasibility of identification of older people, recruitment, evaluation methods for health, social, environmental, physiological and biomedical factors and ascertainment of the relevant outcomes. The feasibility study for LILACS NZ was conducted among 112 participants (57% women and 43% men) aged 85 years (75- 79 for Maori) living in three North Island locations (urban and rural).
 
How did we assess Nutrition Risk?

The pathways to nutritional health in advanced age are complex and multi-factorial. The oldest old often have multiple health problems, different functional status and social and economic issues. Nutritional assessment is therefore a challenge and may be limited by extensive time, expense and respondent burden. Nutrition screening tools provide an effective and rapid method to identify individuals with compromised nutritional status. They help to identify factors or characteristics related to nutritional status that could lead to malnutrition and related health issues. No one screening tool is a gold standard for identifying malnutrition. In the current study ‘Seniors in the Community Risk Evaluation for Eating and Nutrition’ (SCREEN-II) was selected as an effective tool to identify risk for impaired nutrition. It determines nutrition risk using four key factors: food intake, physiological, adaptive and functional parameters. SCREEN-II has been validated and has good inter-rater and test-retest reliability as well as excellent sensitivity and specificity. It is widely used in the community in Canada and has been used to identify factors affecting nutrition risk among community-living older people in Christchurch and North Shore City in Auckland.
 
Measures
 
Nutrition risk (SCREEN II) and physical activity (PASE) was assessed by questionnaire. Fasting blood samples were collected. Comprehensive health and physical assessments included height, weight and body composition.
 
What did we find?
 
·        Half (52%) of the participants in this study were found to be at nutrition risk (SCREEN II score <50; range 29-58; out of maximum score 64).
·        The mean score for SCREEN II was higher for older people who lived with others (50.3 ±5.1) compared to those who lived alone (46.4 ±5.8) p=0.001.
·        Those in a shared living situation tended to eat foods from the meat group more often (70%) (i.e. at least two or more times a day) versus those living alone (30%) p=0.006.
·        Lower levels of physical activity (p=0.027), haemoglobin (p=0.007) and serum zinc (p=0.029) were associated with high nutrition risk.
·        Those with CVD had no greater nutrition risk versus those with no CVD as evidenced by SCREEN II score (47.9±6.1 vs 49.2±5.9; p>0.05). 
·        Anthropometry measures were higher in those with CVD compared to those with no CVD: BMI (28.8±7.8 vs. 25.4±3.9; p=0.018), waist circumference (98.9±16.1cm vs. 88.8±11.6cm; p=0.001) and waist-hip ratio (0.91±0.08 vs. 0.87±0.08; p=0.031).  Using a regression model controlling for gender, lipids and blood pressure only WC remain significantly associated with CVD. 
What can we conclude?
 
In this sample those who live alone and do not have the opportunity to share meals with others appear to be at higher nutrition risk. This helps to validate the 2009 draft Food and Nutrition Guideline Statement for Healthy Older people: “take opportunities to eat meals with other people.” High nutrition risk was associated with less physical activity and lower levels of haemoglobin and serum zinc. Further investigations related to nutrition will be investigated in the longitudinal study.
 
References
Wham C, Teh R, Kerse N (2009). Nutrition Risk and Living to Advanced Age. World Congress of Gerontology, Paris. Abstract: The Journal of Nutrition, Health and Aging, Volume 13, Supplement 1, S462
Teh R, Wham C, Kerse N, Doughty R (2009). Cardiovascular Disease and Nutrition Risk among Those Living to advanced Age.World Congress of Gerontology, Paris. Abstract: The Journal of Nutrition, Health and Aging, Volume 13, Supplement 1, S581
 
Wham C, Teh R, Hayman K , Kerse N, Robinson E (2009). Factors Affecting Nutrition Risk and Living to Advanced Age. World Congress of Gerontology, Paris. Abstract: The Journal of Nutrition, Health and Aging, Volume 13, Supplement 2, S22
 
 
Perspectives on ageing and long term conditions
 
Perspectives on ageing and long term conditions: a one day conference to discuss local and international research on ageing, was held in Auckland on March 2, 2010. The future for New Zealand research in ageing is exciting, with the NZ Longitudinal Study of Ageing: a population based prospective exploration of health and well-being, CHALICE – the Canterbury Health Ageing and life course study – a cohort of 50 year-olds to be followed for 50 years, and the LILAC study – Life and Living in Advanced Ageing: another cohort study of Maori (aged 80-90) and non-Maori (aged 85) New Zealanders. See Dr Carol Wham’s feature in this Bulletin.
 
To see the powerpoint presentations from this conference visit http://webdropoff.auckland.ac.nz/cgi-bin/pickup/a321fd929eb7677b4644a7b0f79b48/375428
 
 
Nutrition risk in older people: making meals matter
 
The NZNF Committee for Healthy Ageing presented two seminars in Nelson early in May. A first for us was a seminar designed especially for the older community, and with an attendance of 64 (a full house – standing room only), this was a great success. Our speakers were the founding Chair of the Committee for Healthy Ageing, Kaye Dennison, who asked “When is it time to review our diet?” – we are all excellent at reviewing other parts of our lives as we age, but diet can be neglected. She reminded us that as we age, our needs and priorities change, and we need to adapt to ensure the best quality of life. Annette Nistor, President of Dietitians NZ, then discussed what older people should be eating in terms of their changing needs, and finally Sally Watson discussed issues about shopping – the tricks of the supermarket trade, and quoted some interesting facts about supermarket pricing.
 
Powerpoint presentations of this session, and the seminar for health professionals on “Nutrition risk in older people: making meals matter” are on the NZNF website. www.nutritionfoundation.org.nz
 
 
Healthy Ageing Initiative
 
The International Food Information Council (IFIC) Foundation has launched a “Healthy Ageing Initiative”. The Foundation has developed resources on topics ranging from diabetes to heart health to food safety, and offers a wealth of information to help adults live well and live longer. Check the website www.foodinsight.org/For-Consumers/Healthy-Aging.aspx
 
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: September 2010. 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.