4. Copyright British Nutrition
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• Average life expectancy has doubled over the
last 200 years and been increasing by ~2y
per decade (10 years over 50 years)
• For the first time there are more people over
the age of 60 than under 16 (2001 census)
• Around 16% of the UK population is aged
over 65 years (13% in 1971) and the
proportion is increasing rapidly
• The greatest increase is in those over the age
of 85 - this reached 1.2 million people in 2005
• These demographic changes pose many
challenges for society and our health care
systems
Ageing in the UK
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Changes with ageing - 1
• Increased risk of chronic disease, cognitive impairment and
dementia, arthritis
• Activity level usually declines
• Decline in lean body mass (muscle) and BMR
• Reduction in bone density (especially in women)
– increased risk of fractures
• Impaired dentition
• Impairments in digestive function (e.g. gastric acid and
digestive enzymes) can lead to reduced nutrient
bioavailability
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Changes with ageing - 2
• Skin changes (less vitamin D produced)
• Changes in taste perception (by age 74-85 the number
of taste buds falls by 65% and sensitivity to salty and
bitter tastes decrease)
• Changes in sense of smell can reduce pleasure of eating
• Eyesight & arthritis may make food preparation difficult
• Psychosocial factors may also exert a substantial effect
on food choice and intake, and hence nutritional status
All may influence nutritional status
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Introduction
• Diet and nutrition issues
relevant to older adults
• The basic biology of
ageing
Ageing and specific
organ systems
• Teeth and the oral cavity
• Bone health
• The joints
• Skeletal muscle
• The skin
• The brain
• The eyes
• The cardiovascular system
• The immune system
• The gastrointestinal tract
• The endocrine system
Public health issues
• Public health implications
• Recommendations
BNF Task Force Report
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Cardiovascular System
• Coronary heart disease most common cause of death
in the UK - 105,000 deaths a year
• Leading cause of death and disability in old age –
accounts for 40% of deaths over the age of 75 years
• Every 2 minutes someone has a heart attack in this
country
• In about 30% of heart attacks the patient dies before
reaching hospital
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Premature heart disease can be
prevented
Smoking Regular physical activity
Fat, particularly
saturated fats
Fruit and
vegetables
Salt Fibre - wholegrains &
pulses
Alcohol Oily fish
Maintain healthy body weight
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Diet & physical activity -
synergistic effects
• For overweight/ obese individuals a low fat diet
PLUS physical activity reduces risk of type 2
diabetes by 50%
• Benefit continues after intervention ends
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Bone
Bone health is optimised
and maintained by
exercise and a healthy
diet.
Weight bearing activity improves bone mass, as well as
coordination, flexibility, muscle strength and balance.
Calcium and vitamin D are both essential for healthy bones.
Vitamin K is also important.
Menopause
17. Copyright British Nutrition
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• Vitamin D can be produced by the skin in response
to the sun.
• Low vitamin D status is widespread in the population,
particularly among elderly people – 37% of elderly people
in ‘homes’.
• Older adults (65 years or over) should take a vitamin D
supplement (10μg/day RNI).
• Osteoporosis: 1 in 3 women and 1 in 12 men over 55
years.
• Calcium & vitamin D – reduced fractures in fragile elderly.
• High vitamin A intakes, alcohol, smoking, inactivity all
harmful.
Bone
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Eye health
• 1 in 4 over age 85 are visually impaired
• 50% of visual impairment in older people
is due to treatable conditions
– cataract, refractive error, diabetic retinopathy
• Risk factors: smoking, also high exposure to sunlight, and
obesity
• Studies suggest dietary antioxidants (vitamin C, lutein,
zeaxanthein) may help protect against cataract and AMD
• Evidence less robust, but it is likely that consuming at least
1 portion of oily fish/week will reduce risk of AMD
• No evidence from trials to support use of supplements in
prevention of eye disease
Cataract
AMD
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• Stroke, dementia, Parkinson’s disease
and depression account for most cases
of disability in older people
• Incidence increases exponentially with increasing
age
• In UK, stroke is 3rd most common cause of death
and the major cause of disability in older people
• In UK, 1 in 14 people over 65 years and 1 in 6
over 80 have a form of dementia
– Affects about 700,000 in the UK and 24 million worldwide
• Depression affects 1 in 4 people over their lifetime
The ageing brain
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• Major modifiable risk factors: smoking, high blood
pressure & high blood lipids, obesity, ‘unhealthy’ diet,
physical inactivity
• Dietary factors: reducing alcohol, reducing salt,
increasing fruit and veg intake, reducing saturated fat
and trans fat, increasing intake of unsaturated fatty
acids (oily fish, vegetable oils)
• Many of the established risk factors for stroke
are also believed to be relevant to dementia,
Parkinson’s disease and depression
Diet and stroke
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Diet and dementia
• High blood pressure & high cholesterol are key risk
factors
• Healthy diet - ? fish
• Mental stimulation
• Not smoking, keeping active and eating a healthy diet
have been associated with healthy mental ageing
• Low/moderate amounts of alcohol may be protective
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Digestive System - cancer
• Upper GI: smoking, high alcohol intake & obesity risk of
cancer. High fruit /veg (especially those rich in vitamin C or
beta-carotene and allium veg eg garlic) offer some
protection.
• Colon: obesity and high alcohol intake (convincing);
consumption of large amounts of red meat (particularly
processed meat) modestly increases risk; attenuated by
high fibre intake
• Calcium supplementation/milk consumption is moderately
important in relation to protection against colon cancer
• Strong evidence for benefits of physical activity – colon
cancer.
23. Copyright British Nutrition
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Digestive System - other conditions
• Gut flora changes with age ( bifidobacteria, increased diversity).
• Prebiotics may help reverse this but there are few studies in older
people
– calcium absorption,
– ? cancer protection
– gut barrier function against infection
• Probiotics - alone or in combination with prebiotics, show
considerable promise as therapy for antibiotic-associated diarrhoea.
May be able to counter C. difficle associated diarrhoea
• High fibre intake protects against diverticular disease
• Fibre plus adequate fluid may protect against constipation. Also a role
for probiotics and some prebiotics.
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Benefits of a
healthy diet
• Protection against chronic diseases
• Preservation of immune function, digestive health, functional
ability, bone health, oral health, vision (for example)
• Benefits for cognitive function, mental health, wellbeing
• Minimises risk of weight loss, under-nutrition, low nutrient
status, deficiency diseases (e.g. anaemia)
• Aids recovery from illness.
26. Copyright British Nutrition
Foundation
Benefits of physical activity
• Important for the maintenance of mobility and
independent living
• Improving strength, balance and co-ordination
is highly effective in reducing the risk of falls
• Helps prevent CVD, type 2 diabetes, obesity
and some types of cancer
• Benefits bone, joint and digestive health
• Improves mental wellbeing and can help
prevent depression.
• Also associated with reduced risk of cognitive
decline
27. Copyright British Nutrition
Foundation
• All adults, including older people
should aim to achieve at least 5 x 30
minutes of moderate intensity activity
each week
– include activities to improve strength
& balance e.g. dancing, yoga, taichi
• Only 18% of males and 14% of
females aged 65-74 years
achieve this (HSE 2004)
Benefits of physical activity
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• Accumulating evidence that physical activity
influences cognitive health in later life
– better cognitive function and less cognitive decline in
later life
• 38% lower risk of dementia
– 6-year follow up of 1740 people 65 y+ in those
exercising more than 3x/week versus those who
didn’t exercise regularly (Larson et al 2006)
Physical activity
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Prevalence (%) of low vitamin D status
in the UK (<25nmol/L)
Age (years) Males (%) Females (%)
4-6, 7-10 3, 4 2, 7
11-14, 15-18 11, 16 11, 10
19-24 24 28
25-49 16, 12 13, 15
50-64 9 11
65-74 (community) 5 6
75-84 (community) 5 15
85+ (community) 13 25
65-84 (institutions) 36 38
Source: NDNS series
31. Copyright British Nutrition
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Vitamin D status (25OHD)
Winter/ Spring Summer/ Autumn
<25nmol/L 15.5% 3.2%
<40nmol/L 46.6% 15.4%
<75nmol/L 87.1% 60.9%
Source: Hypponen & Power 2007
UK subjects aged 47y (n=7437) in 1958 birth cohort
32. Copyright British Nutrition
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Vitamin C status, older people
Plasma vitamin C
(mol/l)
Free living, own teeth 49.1
Free living, without teeth 39.4
Residential care, own teeth 24.6
Residential care, without 21.1
(median 11.4)
Steele et al, 1998 Below 11 mol/l - biochemical depletion
33. Copyright British Nutrition
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NDNS older people: % with a low
status of selected nutrients
0
10
20
30
40
50
60
i
r
o
n
(
H
b
)
V
i
t
c
F
o
l
a
t
e
B
1
2
B
1
B
2
V
i
t
D
free living
men
free living
women
institutions
men
institutions
women
34. Copyright British Nutrition
Foundation
Malnutrition in older adults -1
• Despite rates of obesity, malnutrition is still
surprisingly common in older adults
• Reduces immune response, impairs wound healing,
reduces muscle strength, causes fatigue and
depression
• Increased risk of hospital admission and increased
length of stay in hospital
• Estimated that 10-40% of adults in UK hospitals
and care homes are malnourished (based on BMI
< 20) (NICE 2006)
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Chronic illness
Disability
Isolation
Transport, access,
mobility and income
Institutionalisation
Depression
Dentition
Intake, absorption and
utilisation of nutrients
Reduced taste
perception
Factors that affect food choice
36. Copyright British Nutrition
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Khaw KT et al. (2008) PLoS Med 5(1): e15
Health behaviours and risk of death
More health behaviours ↑
probability of survival
(not smoking, sensible
drinking, 5 A Day,
physically active)
20,000 men &
women 45-79y
37. Copyright British Nutrition
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Need for good hydration
• Important for all – 1.5-2L fluid /day (~ third from food)
• Ensuring that older people are well hydrated is essential
• Dehydration, by as little as 2% loss of body weight, results
in impaired physiological and performance responses
• In extreme cases, mental confusion that has been
interpreted as the onset of senility, has been reversed by
adequate hydration
38. Copyright British Nutrition
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Conclusions
• Nutrition and lifestyle can have a profound
impact on healthy life expectancy: start
young!!
• A healthy diet & regular physical activity will
aid recovery from illness and help protect
against health problems
– such as anaemia, diabetes, osteoporosis, heart
disease, stroke, under- /overweight, constipation &
other digestive disorders
• With longevity increasing, health care costs
are set to escalate out of control
39. Copyright British Nutrition
Foundation
Tips on healthy ageing
• Eat an enjoyable and varied diet
• Watch your weight and stay active
• Eat plenty of fruit and veg
• Opt for healthier fats
• Eat plenty of fibre
• Reduce your salt intake
• Eat calcium-rich foods
• Boost B vitamins through a varied diet
• Keep well hydrated
• Look after your teeth
• A little sunshine is good for you
• Go easy on alcohol
• Don’t smoke
• Get enough sleep
• Keep your brain
stimulated
• Use it or lose it – keep
active!
