1. Nutrition and Older Adults: Issues among Community and Long-Term Care Residents Jean Helps, RD 1 and Christina Lengyel PhD, RD 2 1 Clinical Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food Services 2 Assistant Professor, Human Nutritional Sciences, Faculty of Human Ecology, University of Manitoba University of Manitoba

3. Outline Canadian Demographics Canadian Demographics Factors affecting Nutritional Intake Factors affecting Nutritional Intake Long–Term Care Setting Long–Term Care Setting Rural and Urban Communities Rural and Urban Communities Nutritional Guidelines and Recommendations Nutritional Guidelines and Recommendations Take Home Messages Take Home Messages

4. Demographics……..Now

6. Demographics……..Future

7. Diabetes ALS COPD Dysphagia Cancer Palliative CareCeliac Disease Constipation Superbugs Congestive Heart Failure Pressure Ulcers Multiple Sclerosis Parkinson’s Disease Malabsorption Syndromes Osteoporsis GERD Pneumonia Falls Alcohol Abuse Stroke Osteoarthritis Anemia Family Related Issues Renal Disease Nutrition Issues For Older Adults System Issues Dementia Mental Illness Obesity Malnutrition

8. Nutrition and Quality of Life Healthy food choices positively influence the quality of life of older adults. Healthy food choices positively influence the quality of life of older adults. Older adults are at risk for inadequate dietary intakes which may lead to: Older adults are at risk for inadequate dietary intakes which may lead to: –Poor nutritional status –Decreased quality of life –Functional disability –Increased health care costs –Greater risk for morbidity and mortality

9. Factors Affecting Nutrition Status Physiological Physiological –Declining digestion and absorption –Reduced sensory perception visual, olfactory, taste acuity, thirst visual, olfactory, taste acuity, thirst –Anorexia of Aging Physical Physical –Chewing and swallowing difficulty –Affects on body systems Integumentary (skin), renal, musculoskeletal, cardiovascular Integumentary (skin), renal, musculoskeletal, cardiovascular

10. Factors Affecting Nutrition Status (cont’d) Psychological Psychological –Depression –Loneliness –Dementia –Food likes/dislikes Social and Economical Social and Economical –Poverty –Transportation availability –Lack of knowledge of nutrition –Inadequate cooking knowledge (men) – ↓ Social support

11. Factors Affecting Nutrition Status (cont’d) Cultural beliefs Cultural beliefs –Provision of culturally appropriate food and setting are both important (Wu and Barker, 2008) (Wu and Barker, 2008) Others Others –Medical conditions –Prescribed diets –Medication side effects

12. The Continuum of Care

13. Long-Term Care Setting

15. Malnutrition Inappropriate amount of, or quality of nutrients comprising a healthy diet are not consumed for an extended period of time Inappropriate amount of, or quality of nutrients comprising a healthy diet are not consumed for an extended period of timeUndernutrition: Often thought to be a problem of third world countries Often thought to be a problem of third world countries Inadequate consumption, poor absorption, or excessive loss of nutrients Inadequate consumption, poor absorption, or excessive loss of nutrientsOvernutrition: Excessive intake of specific nutrients Excessive intake of specific nutrients

17. Prevalence of Malnutrition in the Elderly Hospitalized Patients: 32% to 50% 32% to 50% Long Term Care: 5% to 85% (Average= 30%) 5% to 85% (Average= 30%)

19. Causes of Malnutrition- Organizational Failure to help residents eat or recognize malnutrition Failure to help residents eat or recognize malnutrition Importance of nutrition not realized Importance of nutrition not realized Absence of Dietitian Absence of Dietitian Lack of staff, lack of communication, inadequate training and education Lack of staff, lack of communication, inadequate training and education Monotonous diet, inappropriate diet or mealtime environment Monotonous diet, inappropriate diet or mealtime environment Inappropriate medication prescribing Inappropriate medication prescribing (Cowan et al., 2004) (Cowan et al., 2004)

20. Liberalization of the Diet Prescription Therapeutic diets may contribute to malnutrition through restriction of: preferred food & beverages preferred food & beverages components in food which promote intake (e.g., salt) components in food which promote intake (e.g., salt) Culturally significant foods Culturally significant foods * A balanced approach is needed in assessment

21. Combating Malnutrition – Dining Room Set-up for Residents with Dementia Simplify the environment Simplify the environment Simplify the food – Provision of too many foods at one time leads to over- stimulation, agitation and reduced intake Simplify the food – Provision of too many foods at one time leads to over- stimulation, agitation and reduced intake Communicate Communicate Provide flexible care Provide flexible care –Self-feeding if possible (i.e., finger foods)

22. Nutrition Based Interventions Oral Nutritional Supplements Oral Nutritional Supplements Changes to the meal pattern: Changes to the meal pattern: –Protein, energy enriched foods –Small, frequent meals (i.e., between meal snacks) –Individualizing the meal pattern to accommodate social and cultural preferences

23. Nutritional Issues in Rural and Urban Communities

24. Prevalence of Malnutrition Undernutrition: 5% to 20% prevalence of malnutrition 5% to 20% prevalence of malnutrition ~40% are at risk of malnutrition ~40% are at risk of malnutritionOvernutrition: Increasing in all age groups Increasing in all age groups 25% obesity among adults 65+ and older 25% obesity among adults 65+ and older

26. Baby Boomer and Nutrition Study 10 focus groups conducted in rural and urban Manitoba communities 10 focus groups conducted in rural and urban Manitoba communities 8-12 participants/group recruited by MAFRI GO Team Representatives in specified areas 8-12 participants/group recruited by MAFRI GO Team Representatives in specified areas All participants completed a focus group questionnaire All participants completed a focus group questionnaire Moderator facilitated the sessions for a 2 hour period Moderator facilitated the sessions for a 2 hour period

27. Preliminary Key Findings Distrust in nutrition labeling Distrust in nutrition labeling Misleading advertising on packaging Misleading advertising on packaging Importance of locally grown foods, their availability in local markets and supporting the local economy Importance of locally grown foods, their availability in local markets and supporting the local economy Portion control on packages Portion control on packages Costs associated with healthier products Costs associated with healthier products Environmental concerns Environmental concerns More nutrition education needed More nutrition education needed Importance of flavor, texture, taste and variety in food products Importance of flavor, texture, taste and variety in food products

28. Nutritional Guidelines and Recommendations

29. (www.healthcanada.gc.ca/foodguide)

30. Reading Food Labels Compare the Nutrition Facts Table on food labels to choose products that contain less fat, saturated fat, trans fat, sugar and sodium. Compare the Nutrition Facts Table on food labels to choose products that contain less fat, saturated fat, trans fat, sugar and sodium. The calories and nutrients listed are for the specific amount of food found at the top of the Nutrition Facts Table. The calories and nutrients listed are for the specific amount of food found at the top of the Nutrition Facts Table. (http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/educat/info-nutri-label-etiquet-eng.php)

31. (Canadian Diabetes Association and Dietitians of Canada, 2007)

32. Dietary Fibre Increase dietary fibre intake to 21 g/day for women and 30 g/day for men (51+ years) Increase dietary fibre intake to 21 g/day for women and 30 g/day for men (51+ years) Replace refined cereals and flour products with whole grain foods Replace refined cereals and flour products with whole grain foods Increase fibre slowly to prevent excessive bloating, cramping, flatulence and diarrhea Increase fibre slowly to prevent excessive bloating, cramping, flatulence and diarrhea Drink adequate amount of fluids Drink adequate amount of fluids Examples: oat bran, psyllium, legumes, fruits, vegetables, wheat bran, flax seeds Examples: oat bran, psyllium, legumes, fruits, vegetables, wheat bran, flax seeds

33. Fluid Intake Dietary Reference Intake (DRIs) (51+ years) Females: 2.7 L/day total water (2.2 L = 9 cups total beverages) Females: 2.7 L/day total water (2.2 L = 9 cups total beverages) Males: 3.7 L/day total water (3.0 L = 13 cups total beverages) Males: 3.7 L/day total water (3.0 L = 13 cups total beverages) NOTE: these values may be difficult to achieve for older adults due to reduced food intake. Aim for 6-8 cups per day. NOTE: these values may be difficult to achieve for older adults due to reduced food intake. Aim for 6-8 cups per day.

34. Vitamins and Minerals Vitamin D Vitamin D –Current DRI’s are: Males and Females 51-70 years: 10 ug (400 IU) Males and Females 51-70 years: 10 ug (400 IU) Males and Females 70 +years: 15 ug (600 IU) Males and Females 70 +years: 15 ug (600 IU) –Canada’s Food Guide recommends an additional daily vitamin D supplement of 10 ug (400 IU) for everyone over the age of 50 –New research is demonstrating a need for increasing vitamin D requirements for older adults

35. Canada’s Physical Activity Guide to Healthy Active Living for Older Adults (www.phac-aspc.gc.ca/pau-uap/paguide/older/index.html)

36. Take Home Messages Nutrition is one of the major determinants of healthy aging Nutrition is one of the major determinants of healthy aging Individualized care Individualized care –Ensuring effects of aging are considered High quality diet is important across the lifespan High quality diet is important across the lifespan Consume a variety of nutrient dense foods from the four food groups Consume a variety of nutrient dense foods from the four food groups Nutrient supplementation with low-dose multivitamin and mineral supplements can be useful in achieving recommended intake levels Nutrient supplementation with low-dose multivitamin and mineral supplements can be useful in achieving recommended intake levels Enjoy your meals! Enjoy your meals!

37. Resources Dietitians of Canada Dietitians of Canada –www.dietitians.ca Eating Well with Canada’s Food Guide Eating Well with Canada’s Food Guide –www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php Canada’s Physical Activity Guide for Older Adults Canada’s Physical Activity Guide for Older Adults –www.phac-aspc.gc.ca/pau-uap/fitness/pdf/guide_older_e.pdf Nutrition Labelling Nutrition Labelling –www.healthcanada.gc.ca/nutritionlabelling Alzheimer Society of Canada Alzheimer Society of Canada –www.alzheimer.ca/english/care/dailyliving-mealtime.htm

38. “If we knew what it was we were doing, it would not be called research, would it?” Albert Einstein

39. Any Questions?