Nutrition and Older Adults:
Issues among Community and
Long-Term Care Residents
Jean Helps, RD1 and Christina Lengyel PhD, RD2
1Clinical
Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food Services
Professor, Human Nutritional Sciences, Faculty of Human Ecology,
University of Manitoba
2Assistant
Outline
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Canadian Demographics
Factors affecting Nutritional Intake
Long–Term Care Setting
Rural and Urban Communities
Nutritional Guidelines and
Recommendations
Take Home Messages
Demographics……..Now
Demographics……..Future
Osteoporsis
Diabetes Celiac Disease Malabsorption Palliative Care
Syndromes
Congestive
Pressure
Superbugs
Heart
GERD
Ulcers
ALS
Failure
Obesity
Renal Disease
Falls
Malnutrition
Anemia
Parkinson’s
Constipation
Disease
Alcohol
Stroke
Abuse
Pneumonia
Dementia
Multiple
System Issues
COPD
Sclerosis
Dysphagia
Family Related
Mental Illness
Cancer
Osteoarthritis
Issues
Nutrition
Issues
For Older
Adults
Nutrition and Quality of Life
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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:
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Poor nutritional status
Decreased quality of life
Functional disability
Increased health care costs
Greater risk for morbidity and mortality
Factors Affecting
Nutrition Status
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Physiological
– Declining digestion and absorption
– Reduced sensory perception
 visual, olfactory, taste acuity, thirst
– Anorexia of Aging
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Physical
– Chewing and swallowing difficulty
– Affects on body systems
 Integumentary (skin), renal,
musculoskeletal, cardiovascular
Factors Affecting
Nutrition Status (cont’d)
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Psychological
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Depression
Loneliness
Dementia
Food likes/dislikes
Social and Economical
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Poverty
Transportation availability
Lack of knowledge of nutrition
Inadequate cooking knowledge (men)
↓ Social support
Factors Affecting
Nutrition Status (cont’d)
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Cultural beliefs
– Provision of culturally appropriate food
and setting are both important
(Wu and Barker, 2008)
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Others
– Medical conditions
– Prescribed diets
– Medication side effects
The Continuum of Care
Long-Term Care Setting
Malnutrition
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Inappropriate amount of, or quality of
nutrients comprising a healthy diet are not
consumed for an extended period of time
Undernutrition:
 Often thought to be a problem of third world
countries
 Inadequate consumption, poor absorption, or
excessive loss of nutrients
Overnutrition:
 Excessive intake of specific nutrients
Prevalence of
Malnutrition in the Elderly
Hospitalized Patients:
 32% to 50%
Long Term Care:
 5% to 85% (Average= 30%)
Causes of MalnutritionOrganizational
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Failure to help residents eat or recognize
malnutrition
Importance of nutrition not realized
Absence of Dietitian
Lack of staff, lack of communication,
inadequate training and education
Monotonous diet, inappropriate diet or
mealtime environment
Inappropriate medication prescribing
(Cowan et al., 2004)
Liberalization of the
Diet Prescription
Therapeutic diets may contribute to malnutrition
through restriction of:
 preferred food & beverages
 components in food which promote intake
(e.g., salt)
 Culturally significant foods
* A balanced approach is needed in assessment
Combating Malnutrition –
Dining Room Set-up for
Residents with Dementia
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Simplify the environment
Simplify the food – Provision of too
many foods at one time leads to overstimulation, agitation and reduced
intake
Communicate
Provide flexible care
– Self-feeding if possible (i.e., finger foods)
Nutrition Based
Interventions
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Oral Nutritional Supplements
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
Nutritional Issues in Rural
and Urban Communities
Prevalence of Malnutrition
Undernutrition:
 5% to 20% prevalence of malnutrition
 ~40% are at risk of malnutrition
Overnutrition:
 Increasing in all age groups
 25% obesity among adults 65+ and older
Baby Boomer and
Nutrition Study
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10 focus groups conducted in rural
and urban Manitoba communities
8-12 participants/group recruited by
MAFRI GO Team Representatives in
specified areas
All participants completed a focus
group questionnaire
Moderator facilitated the sessions for a
2 hour period
Preliminary Key Findings
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Distrust in nutrition labeling
Misleading advertising on packaging
Importance of locally grown foods, their
availability in local markets and supporting
the local economy
Portion control on packages
Costs associated with healthier products
Environmental concerns
More nutrition education needed
Importance of flavor, texture, taste and
variety in food products
Nutritional Guidelines
and Recommendations
(www.healthcanada.gc.ca/foodguide)
Reading Food Labels
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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.
(http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/educat/info-nutri-label-etiquet-eng.php)
(Canadian Diabetes Association and Dietitians of Canada, 2007)
Dietary Fibre
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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
Increase fibre slowly to prevent excessive
bloating, cramping, flatulence and diarrhea
Drink adequate amount of fluids
Examples: oat bran, psyllium, legumes,
fruits, vegetables, wheat bran, flax seeds
Fluid Intake
Dietary Reference Intake (DRIs) (51+ years)
 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)
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NOTE: these values may be difficult to
achieve for older adults due to reduced food
intake. Aim for 6-8 cups per day.
Vitamins and Minerals
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Vitamin D
– Current DRI’s are:
Males and Females 51-70 years: 10 ug (400 IU)
 Males and Females 70 +years: 15 ug (600 IU)
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– 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
Canada’s Physical Activity Guide to Healthy
Active Living for Older Adults
(www.phac-aspc.gc.ca/pau-uap/paguide/older/index.html)
Take Home Messages
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Nutrition is one of the major determinants of
healthy aging
Individualized care
– Ensuring effects of aging are considered
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High quality diet is important across the lifespan
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
Enjoy your meals!
Resources
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Dietitians of Canada
– www.dietitians.ca
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Eating Well with Canada’s Food Guide
– www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
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Canada’s Physical Activity Guide for Older Adults
– www.phac-aspc.gc.ca/pau-uap/fitness/pdf/guide_older_e.pdf
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Nutrition Labelling
– www.healthcanada.gc.ca/nutritionlabelling
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Alzheimer Society of Canada
– www.alzheimer.ca/english/care/dailyliving-mealtime.htm
“If we knew what it
was we were
doing, it would not
be called research,
would it?”
Albert Einstein
Any Questions?