HEALTHY EATING FOR SENIORS

Sheela Paul, Rubini S.
Dept. Of Nutrition & Dietetics

"Age is an issue of mind over matter. If you don't mind, it doesn't matter." - Mark Twain

"Nobody grows old merely by living a number of years. We grow old by deserting our ideals. Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul." - Samuel Ullman


For seniors, the benefits of healthy eating include increased mental acuteness, resistance to illness and disease, higher energy levels, faster recuperation times, and better management of chronic health problems. As we age, eating well can also be the key to a positive outlook and emotional balance.

How does the body change with ageing?

Ageing changes the body in many ways. In addition to decreasing mobility and heart function, sensory changes that affect meal intake can occur. Changes in the digestive tract affect digestion and absorption of food. Some older adults are at risk for malnutrition and unintended weight loss due to physiological changes associated with aging

Being aware that changes occur in the geriatric population is critically important. Geriatric patients are especially different due to the unique changes that occur in this population.

Advantages of good nutrition for seniors:


Live longer and stronger – Good nutrition keeps muscles, bones, organs, and other body parts strong for the long haul. Eating vitamin-rich food boosts immunity and fights illness-causing toxins. A proper diet reduces the risk of heart disease, stroke, high blood pressure, type-2 diabetes, bone loss, cancer, and anaemia. Also, eating sensibly means consuming fewer calories and more nutrient-dense foods, keeping weight in check. Remember that balanced nutrition is more than calorie counting. There are many other aspects to creating a nutritious lifestyle. Also, eating sensibly means consuming fewer calories and more nutrient-dense foods, keeping weight in check. Remember that balanced nutrition is more than calorie counting. There are many other aspects to creating a nutritious lifestyle.

Feel better –Wholesome meals give you more energy and help you look better, resulting in a self-esteem boost. It’s all connected—when your body feels good you feel happier inside and out.

Sharpen the mind – All the nutrients are essential for the brain to do its job. People who eat a selection of bright coloured fruit, leafy vegetables, fish and nuts packed with omega-3 fatty acids can improve focus and decrease their risk of Alzheimer’s disease.

Diets rich in antioxidants prevent disease and premature ageing. Antioxidants also stimulate the immune system and protect the nervous system and brain from the oxidative damage associated with age-related memory loss.

Fruits and vegetables are also gold mines of longevity-enhancing compounds called antioxidants; these include vitamins C and E and beta carotene. Antioxidants combat free radicals, oxygen fragments that attack and damage cell membranes, life-sustaining proteins and even our cells' genetic code, and in so doing bring about ageing and disease. Fresh fruits and vegetables are nutrient-packed, providing ample amounts of calcium, iron, magnesium, vitamin C, beta carotene and folic acid, and they are low in calories (a heaped bowlful of greens supplies only 30 calories)

Areas of health problems for seniors:

The elderly often present with increased number of medical problems and often have atypical presentations. For example, an initial diagnosis of dementia may actually be due to thyroid disease or minor illnesses leading to mental confusion. Unfortunately, recuperation for any illness is usually slow. Finally, "bad" ageing is that in which disease occurs.

Sensory changes

Loss of smell and taste affect the nutritional intake and status of many seniors. If food does not smell or taste appetizing, it will not be eaten. Try a variety of new food flavours. Don't cook vegetables until they are mushy. Instead, reawaken the senses to fresh, flavourful foods and new textures

Visual

99% of the elderly population require corrective lenses. Age related macular degeneration is the number one cause of new onset blindness in adults.

Loss of teeth

Improperly fitting dentures may unconsciously change eating patterns because of difficulty in chewing. As a result they may take soft, low-fibre diet without important grains, fresh fruits and vegetables so chop, steam, stew, grind or grate hard or tough foods to make them easier to chew without sacrificing their nutritional value.

Osteoporosis

It is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, low circulating Vitamin D is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased Parathyroid Hormone (PTH) production. PTH increases bone resorption, leading to bone loss. Physical activity helps maintain bone mass, and can increase it by 1 or 2%. Conversely, physical inactivity can lead to significant bone loss.

Exercise and a diet high in calcium help protect against osteoporosis.

Follow these guidelines:

* Walk and exercise at least three times a week and have fun!


* Include two to four daily servings of dairy products such as milk, yogurt or cheese.


* If digesting milk is a problem, cultured dairy products, like buttermilk and yogurt, often are tolerated well.
* Post-menopausal women may need a calcium supplement if they can't get enough through diet alone.


Coronary diseases occur more frequently in people aged 45 to 70 as do cerebro-vascular accidents. The rate of malignancies and mortality linked to cancers also increases with age. Currently, onset of diabetes is also increasing.

Cardiovascular disease:

* Cardiac output and maximum heart rate also decrease with age. 40% over the age of 75 die of cardiac disease, 15% die of cerebrovascular disease and 5% die of other vascular problems such as aneurysms.

Tips for a healthy heart:

* Have a high fibre diet. Eat fresh fruits and vegetables
* Use low saturated fat with a combination of oils for cooking
* Avoid oily deep fried foods.
* Restrict salt and salty foods items.

Older adults can feel better immediately and stay healthy by choosing healthy foods. A balanced diet and physical activity contribute to a higher quality of life and enhanced independence as you age.

Remember the old adage you are what you eat? Make it your motto. When you choose a variety of colourful fruits and vegetables, whole grains, and lean proteins you’ll feel simply marvellous inside and out.

Eating well as a senior is a lifestyle that embraces fresh, colourful food, creativity in the kitchen, and eating with friends. You are the boss when it comes to food choices and by making healthy choices you can supercharge your life and experience the joy of eating well and ageing well.

Diabetes and Oral Health

Diabetes can cause serious problems in the mouth. The most common oral health problems associated with diabetes are tooth decay, periodontal (gum) disease ; salivary gland dysfunction; fungal infections; lichen planus and lichenoid reactions (inflammatory skin disease); infection and delayed healing; and taste impairment.

If your blood glucose levels are not controlled, you are at greater risk of dental problems.


Tooth decay (cavities): Cavities are formed when starches and sugars in food and beverages interact with naturally occurring bacteria in the mouth and form a sticky film known as plaque on the teeth. The acids in plaque attack the enamel of teeth, which can cause cavities.

When the blood glucose level is high, the amount of acid formation is high.


Early gum disease (gingivitis)- or swollen gums that bleed easily. If plaque is not removed with regular brushing and flossing, it will harden and form a substance called tartar which irritates the gingiva — the part of the gum around the base of the teeth. Plaque and tartar can be removed with regular brushing and flossing.


Advanced gum disease (periodontitis). – or shrinking of gums and loosening and falling of teeth. If gingivitis is not treated, it can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support teeth. In the course of time, periodontitis causes gums to pull away from teeth; and teeth to loosen . Some people with serious gum may have painful chewing problems and could lose their teeth.

Diabetes lowers the ability to resist infection and slows down the healing process , so people who have diabetes tend to have severe cases of Periodontitis. An infection such as periodontitis may also raise blood glucose level , which makes diabetes more difficult to control. Periodontal disease may also make it hard to control blood glucose.

Diabetes can also result in other problems such as dry mouth. Saliva keeps the mouth wet, and dry mouth occurs when there is not enough saliva.

Diabetes may also raise the glucose level in the saliva which may lead to a fungal infection called thrush , which is a condition where there are painful white patches in the mouth.


Oral candidiasis: or a fungal infection in the mouth, appears to occur more frequently among persons with diabetes including those who wear dentures.

Lichen planus, a skin disorder that produces lesions in the mouth when severe, causes painful mouth ulcers that corrode surface tissue. There is no permanent cure. Medication can only relieve the condition.

Take the following steps to keep your mouth healthy, especially if you have diabetes...

1. Brush your teeth and floss every day.


2. Visit your dentist regularly and inform your dentist that you have diabetes.


3. If your dentures do not fit right, or if your gums are sore, visit your dentist.

4. If you are a smoker, stop smoking. Smoking worsens gum disease.


5. Check your mouth regularly for problems. Check for bleeding gums when brushing and flossing or for dryness, soreness, white patches, or a bad taste in the mouth. Visit your dentist when you notice a problem.

Good blood glucose control can help prevent mouth problems.




Reference:
http://www.nidcr.nih.gov/OralHealth/Topics/Diabetes/DiabetesDentalTips.htm

Prevention is Better than Cure

Diabetes is a cost intensive disease because of its chronic condition, severe complications and the means of control.

In many families, financial constraints force people to choose between health care, food or clothing. Therefore prevention seems to be a very important factor, especially in Type 2 Diabetes Mellitus (T2DM) as the increase is mainly due to lifestyle changes that have resulted in overweight, obese and physically inactive people.

Environmental changes and genetic predisposition increase insulin resistance, which, along with β- cell failure results in rising blood glucose levels.

Prevention can be carried out through health promotions, early detection of high risk individuals and timely intervention to prevent these high risk individuals from progressing to diabetes. Prevention programs are important at various stages in the natural history of the disease.

1. Primordial prevention focuses on health promotion activities such as – preventing smoking, fighting obesity, promoting physical activity and improving dietary habits.

Obesity and diabetes are linked. Weight gain leads to insulin resistance through several mechanisms. Insulin resistance places greater demand on the pancreas to produce insulin. Diabetes occurs when the body’s need for insulin exceeds the ability of the pancreas to produce it. Therefore, most cases of T2DM can be prevented by weight reduction through life style changes – diet and exercise.

The World Health Organization recommends:

Increased physical activity of just 30 minutes of moderate exercise a day to promote good health and prevent the onset of diabetes.

A healthy diet of 3 - 5 servings of fruit and vegetables a day, less sugar and saturated fats can help maintain appropriate weight ,as well as, help in weight loss.

Non- smoking: People with diabetes are at greater risk of dying from coronary heart disease, stroke, or peripheral vascular disease than those without, and smoking increases the risk further.

2. Primary prevention focuses on effective screening to detect people at risk of diabetes, pre-diabetes and also their treatment.

1. Detecting people with increased risk of diabetes – the pre- diabetics.

People with pre-diabetes show symptoms such as higher than normal blood glucose which is not high enough to be classified as diabetes. (Typically IFG: >100 mg/dl but < 126 mg /dl; 2 hr IGT value: > 140 mg/dl but < 200 mg/dl , or both.)
Detecting pre-diabetes in people is very important because appropriate treatment can prevent progression to diabetes.

3. Secondary prevention focuses on preventing complications of diabetes with appropriate and comprehensive treatment of diabetes and screening for complications.

Without timely diagnosis and adequate treatment, complications and morbidity from diabetes increases drastically. Most complications can be prevented if diagnosed early enough.

Good control of blood glucose decreases the risk of developing both micro- and macro- vascular complications Self monitoring of blood glucose is very important for proper management of the condition. A healthier life style with an increase in physical activity and a reduction of body weight based on control of calories and fat intake and quitting smoking are very basic steps in treatment and the prevention of complications.

Medical nutritional therapy is an essential part of diabetes management. Every person with diabetes should get dietary education from a dietitian.

4. Tertiary prevention focuses on rehabilitation of people with diabetes.

Preventing diabetes is a phenomenal task but it can be done.It needs a unified effort from every person or organization directly or indirectly linked to the disease.- organizations, health care workers, doctors, governments, and people with diabetes have to work together to put stop to this ‘epidemic’.

Reference:

A World Without Diabetes and Its Complications – A Preventive. Programme; Dr. Prof. A.K. Das, Dr. Maneesh Rai.