Nutrition Insight
Article

Challenges to Nutrition

Friday, August 26, 2016

Related to Ill Health and Frailty

Ageing and its effect on nutrition can be considered a continuum, that if addressed early enough, can support healthy ageing and the maintenance of life quality.

Here are some of the main challenges:

Increased requirements for nutrients

Despite declining activity levels and a lower need for kilojoules, age related metabolic changes in the elderly increase the need for many other nutrients, not simply protein.

 

Age related loss of taste and smell

The decline in sense of smell with age compounds the changes that also take place to taste. Research shows salt added to a soup needed to be two to three times greater to be detected in older age groups compared to younger.

 

Poor appetite (anorexia of aging) 

Challenges to Nutrition

A lack of appetite and subsequent poor food intake is largely due to changes that impair the body’s response to hunger. This may then be compounded by other impacts on food intake outlined here such as; reduced taste perception, swallowing and chewing issues and the side effects of medication.

 

Side effects of medications

It’s not uncommon for the elderly to suffer from multiple chronic illnesses. The number of medications necessary to treat these can produce side effects such as nausea, sedation (sleepiness), early satiety (fullness), swallowing issues or constipation which will all impact on appetite and food intake.

 

Poor dentition (problems with teeth or dentures)

Poor oral care or ill-fitting dentures can result in difficulty with chewing. The forced choice of softer foods and potentially painful eating can impact on enjoyment and appetite at meals.

 

Difficulty swallowing (dysphagia)

Dysphagia [dis fa jah] is the medical term for difficulty swallowing and has been found in as many as 68% of residents in aged care facilities. It may occur simply as a result of changes due to age or to many of the diseases that are common among the elderly such as stroke, Parkinson’s disease, multiple sclerosis, cancer of the mouth, throat or oesophagus (food pipe).

 

Chronic disease

Illness and disease have effects on appetite and metabolic processes that are independent of age. Because the elderly are very likely to have multiple medical issues the effects on nutritional state are often compounded.

 

Dementia

Nutrition is impacted in many ways by the onset and progression of dementia, and this chronic degenerative disease presents many challenges for carers attempting to support nutrition and adequate food intake.

 

Depression

Older people are at greater risk of mental health issues due to the additive effects of chronic disease and social isolation. It’s estimated that 10- 15% of Australia’s elderly are affected by depression with rates in residential aged care as high as 35%.

 

 

REFERENCES

  1. Volkert D et al. ESPEN Guidelines on Nutrition in Dementia. Clin Nutr. 2015 Dec;34(6):1052-73
  2. Visvanathan R. Under-Nutrition in Older People: A Serious and Growing Global Problem. J Postgrad Med. 2003;49(4):352-360
  3. Boyce MR, Shone GR. Effects of aging on smell and taste. Postgrad Med J 2006;82:239–241
  4. Nutrient Reference Values (NRVs) for Australia and New Zealand (Including Recommended Dietary Intakes) 2006. Australian National Health and Medical Research Council.
  5. Martone MA, et al. Anorexia of Aging: A Modifiable Risk Factor for Frailty. Nutrients 2013;5:4126-4133
  6. The Speech Pathology Association of Australia. Dysphagia Clinical Guidance. 2012
  7. Better Health Channel. Depression and Aging. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/depression-and-ageing (accessed April 2016)