International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 4 Issue 4, June 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
Review on Nutrition Based Healthy Elderly
Vithushana. T, Jeyaweera. B
Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Sri Lanka
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ABSTRACT
People whose age are over 60 are defined as elderly population. The elderly
population is increasing at a constant rate and women comprise the majority.
The sex ratio of male to female is 0.74. It is predicted that, in the year 2037, the
over- 60 population will be 20% (1 in 5 people) and by 2050 it will be 29%
(nearly 1/3rd of the population). Regular health screening programs are
lacking in the elderly population in community settings, although different
types of healthcare programs are available all over the world. Public health
professionals such as public health midwives focus on particularly maternal
and child care in the community than the elderly population. The most
common health issues of the elderly include falls, malnutrition,
neurodegenerative conditions, cognitive impairment, osteoporosis and noncommunicable diseases such as diabetes, cancer and Cardiovascular Diseases
(CVDs) is rising due to ageing.
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KEYWORDS: Elderly, Community, Health, Populationo
INTRODUCTION
According to the World Health Organization, people whose
age is over 60 years are defined as older or elderly people.
However, most developed world countries have accepted the
age of 65 years as a definition of an older person or “elderly”
(WHO, 2019). Zizza et al., (2009) states that age 65 to 74 as
young-old, age 75 to 84 as middle-old, and age 85 or over 85
as oldest-old.
The prevalence of the elderly population in the world has
increased gradually over the past few decades. The elderly
population is estimated to be more than doubled, from 841
million people in 2013 to about 2 billion in 2050.
Approximately, two-thirds of the world's elders live in
developing countries (De Silva et al., 2017). Sri Lanka has
shown an increasing life expectancy at birth, decreasing
mortality rates within the past few decades (De Silva et al.,
2017) and has the fastest growing elderly population in
South East Asia (Rajapakse et al., 2012). Women comprise
the majority (56%) of the population. In 2012, the
proportion of the population aged 60 years and older was
nearly 12.2%, which is estimated that this proportion would
rise up to 16.7% by the year 2021 and by 2041, 1 out of
every 4 people in the country will be an elderly person (De
Silva et al., 2017). Nearly, 80% of elderly people live with
their children, and many depend on their children for
financial and other support. Only 6% of the elderly live alone
(Vodopivec, 2008). During the last two decades, the number
of institutionalized elderly people has increased noticeably
in Sri Lanka (Siddisena 2005, cited in Rathnayake et al.,
2015).
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AGEING PROCESS
There are some theories of ageing which explain the
mechanisms behind loss of physical resilience, decreased
resistance to disease and other physical and mental changes.
Theories of ageing can be described from two perspectives
including programmed ageing theories and “wear-and-tear”
theories. Caloric restriction is an intervention which
combines the properties of several ageing theories to
manipulate life span and morbidity. Programmed Aging
includes “Hayflick’s Theory of Limited Cell Replication” and
“Molecular clock theory”. Wear-and-tear theories include
“Free-Radical or Oxidative Stress Theory” and “Rate-ofLiving Theory” are based on the concept that mistakes in the
replication of cells or buildup of damaging by-products from
biological processes eventually destroy the organism (Brown
et al., 2011).
PHYSIOLOGICAL CHANGES
Ageing is associated with body composition changes which
lead to loss of physical resilience. Some of these ageassociated physiological changes are due to genetic factors
or other lifestyle-related factors such as poor diets and
inactivity (Brown et al., 2011).
1. Body lean mass and fat mass
Among all age-related physiologic changes, the biggest effect
on nutritional status is the shifts in the musculoskeletal
system, which loses up to 15% of the fat-free mass (FFM)
also known as lean mass. Lean mass is important to the
mobilization of metabolic substrates and essential molecular
synthesis. Major musculoskeletal System changes due to
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ageing include reduced lean body mass (bone mass, skeletal
and smooth muscles and water), increased fat mass,
decreased resting metabolic rate and reduced strength
(Brown et al., 2011). Shrinking of muscle cells, loss of cells
due to muscle ageing and loss of elasticity (due to
accumulation of fat and collagen proteins) causes the
decrease in lean mass (Keller and Engelhardt, 2013). Loss of
muscle mass causes accumulation of fat in the body and the
reduction of muscle strength, basal metabolic rate and
energy needs. Loss of muscle mass link with premature
mortality, disability, physical frailty, and other age-related
health complications. Damayanthi et al., (2018) states that
Aging is associated with loss of muscle mass which results in
decreased muscle strength. Loss of skeletal muscle mass, or
sarcopenia, is related to decreased mobility, increased risk of
morbidity, and reduced quality of life in elderly (Kim et al.,
2016). If the skeletal muscle is depleted, there is a low
amount of protein to fuel the functionality of the body, which
improves the risk of disabilities and functional impairment
while reducing muscle power and physical function (Ribeiro
and Kehayias, 2014). The decline of muscle mass and muscle
strength leads to difficulties in performing daily activities
and increased risk of falling (Janssen et al., 2002). The
balance between protein synthesis and degradation is
important for maintaining the composition of lean mass
(Damayanthi et al., 2018).
Normally, there is a decline in lean body mass of 2% to 3%
per decade from age 30 to 70, including loss of muscle
(sarcopenia) beginning around age 40, although the weight
is stable. Body fat increases, especially in the visceral region
during this time. Males in their seventies have roughly 24
lbs. less muscle and 22 lbs. More fat compared to males in
their twenties. After age 70, weight, including fat at all sites,
begins to decrease. This causes lower levels of physical
activity, food intake, and hormonal changes in women.
Losses of fat-free mass in older people results in lower
mineral, muscle, and water reserves (Brown et al., 2011).
2. Weight gain
Weight gain tends to accompany aging. Weight and BMI
become highest between age 50 and 59, then steady and
start slowly reducing around age 70. Reasons for age-related
weight gain are uncertain, but some studies indicate that
lack of exercise might be a factor (Levitan et al., 2009).
However, the lack of estrogen in women seems to promote
fat accumulation and total weight gain. Men with the highest
physical activity slowed their total body-weight and body-fat
gains (Brown et al., 2011).
3. Teeth
Poor dietary habits contribute to caries and potential tooth
loss in the elderly, which associated with disability and
mortality. Oral health affects nutritional status and health.
Saliva becomes thicker and more viscous with age, which
lubricates the mouth and begins the digestive process. Lack
of sufficient and effective saliva slows nutrient absorption,
makes the oral cavity more sensitive to temperature
extremes and coarse textures, causing pain while eating.
Pain and discomfort with chewing foods, mouth sores,
missing, loose, or rotten teeth, or dentures that do not fit
well can result in eating low quantities of food thereby lower
nutrient intake (Brown et al., 2011).
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4. Thirst, appetite, taste and smell
Age-related nervous System changes including reduced
appetite and thirst regulation, reduced nerve conduction
velocity, affecting the sense of smell, taste, touch, cognition
and changed sleep as the wake cycle becomes shorter
(Brown et al., 2011). Diseases, medications, and covering
part of the palate with dentures also affect the taste. Hunger
and satiety signals are weaker in the elderly than in adults.
Elderly people may need to be more conscious of food intake
levels because their appetite-regulating mechanism may be
blunted or they are unable to adjust to cycles of more and
less food intake, which may lead to overweight or anorexia.
The thirst-regulating mechanism of elders was less effective
than that of younger individuals. Dehydration occurs more
quickly after fluid deprivation and that rehydration are less
effective in older men (Brown et al., 2011).
5. Visual and Hearing
Vision and hearing loss has a prominent impact on the
quality of life in the elderly. Unlike the prevalence of hearing
loss, the prevalence of visual impairment has decreased in
spite of an increasingly larger population of elderly
worldwide (Rooth, 2017).
6. Other changes
Self- perception of good health declines with age, but having
a chronic health problem does not prevent some of the
elders from having a healthy perception.
NUTRITIONAL PROBLEMS AND COMMON DISEASES IN
ELDERLY
Nutritional status is a key determinant of the quality of life,
morbidity and mortality of older people. Evidence indicates
that the elderly are at risk of nutritional deficiencies due to
changes in body composition, the gastrointestinal tract,
sensory function, fluid and electrolyte regulation, and from
chronic illnesses (Brownie, 2006, cited in Rathnayake et al.,
2015). The nutritional risk factors identified in elderly
includes hunger, poverty, inadequate food and nutrient
intake, functional disability, social isolation, living alone or
reduced social contact, widowhood, depression, dementia,
dependency, poor dentition and oral health, chewing and
swallowing problems, polypharmacy (use of multiple
medications) and presence of diet-related acute or chronic
diseases or conditions. Most of the elders who have
difficulties in walking, shopping, and buying and cooking
food are at risk for malnutrition (Brownie, 2006, cited in
Rathnayake et al., 2015; Brown et al., 2011).
1. Sarcopenia
Sarcopenia is a geriatric syndrome, defined as the agerelated loss of muscle mass and declined muscle function
which is associated with poor quality of life, falls, disability
and mortality in the elderly (Wu et al., 2016).
Sarcopenia can limit the physical activity as well as
limitations in functional status of the elderly (Doherty, 2003,
cited in Mohamad et al., 2010). According to Roubenoff 2003,
cited in Mohamad et al, (2010), muscle quantity decreases
with increasing age and this will also cause a decrease in the
functional status of the elderly. This decreased functional
ability will affect the mobility and quality of life of the elderly
(Mohamad et al., 2010). Kim et al., (2016) states that
sarcopenia, is associated with impaired mobility, increased
risk of morbidity, and reduced quality of life in elders.
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Sarcopenia is prevalent among the ageing population and
chronic disease patients. Therefore, the loss of muscle mass
and strength affect functionality through factors such as age,
sedentary lifestyle and suboptimal diet (Shahrook et al.,
2017).
2. Osteoporosis
Osteoporosis means “porous bone.” Reduced bone mass and
disruption of bone architecture can result from an imbalance
of available nutrients. Bone mass loss is greater for women,
who can lose up to 20% in the 5 to 7 years past menopause.
After age 65, rates of loss are typically less than 1% per year.
Men develop osteoporosis later than women because they
have larger frames, and their testosterone levels fall more
slowly, typically over a period between ages 40 to 70 (Brown
et al., 2011). Many studies have explained the relationship
between osteoporosis and sarcopenia, because sarcopenia
and osteoporosis have many common causal factors,
including decreased age-related sex hormones, decreased
anabolic hormones and vitamin D deficiency. The presence
of osteoporosis increases a patient's risk of developing
sarcopenia (Tanimoto et al., 2014).
3. Falls and Fractures
Fractures and falls cause injuries which make it impossible
for some older adults to remain independent. The risk is
greater for people over age 80 compared to those aged 65
and older. Moreover, 50% of older individuals who fracture a
hip have permanent functional disabilities. Some of these
complications include impaired mobility and complicating all
the activities of daily living (including eating and exercising).
If an elderly person has also had a stroke, impaired mobility
becomes the leading cause of institutionalization in the
United States (Brown et al., 2011).
4. Malnutrition
Elderly malnutrition is defined as overweight or
underweight, deficiency of more than one nutrient or
suffering from one or more chronic diseases (Cowan, 2004,
cited in Kady and Tayel, 2018). Inadequate or excess intake
of some nutrients causes malnutrition which can be a
contributing factor to chronic diseases (Mohamad et al.,
2010). There is a higher prevalence of malnutrition in the
institutionalized elderly compared with the free-living
elderly, worldwide (Rathnayake et al., 2015). Poor appetite
is much related to undernutrition and commonly occurs
among older people (Mohamad et al., 2010). The decline in
appetite is commonly observed in the elderly which has been
described as ‘anorexia of ageing’ (Chapman, 2007; Morley,
2001; Hays and Robert, 2006, cited in Mohamad et al., 2010).
Anorexia of ageing is a constant decline in appetite in the
elderly until a severe reduction in body weight occurs. It is
the consequence of protein-energy malnutrition which is
commonly experienced by the elderly (Chapman, 2007;
Wilson et al., 2005, cited in Mohamad et al., 2010).
Underweight is much critical than overweight for elders. The
consequences of malnutrition include increased incidence of
diseases, affect the immune response, muscle and
respiratory function, and wound healing. Malnutrition is
associated with ageing. Poverty, illnesses, polypharmacy,
living alone are common causes of under-nutrition which
can be identified by body mass index or Mini nutritional
assessment tool (Brown et al., 2011). Geriatric population in
Sri Lanka is a potentially vulnerable group for malnutrition
(De Silva et al., 2017). Rathnayake et al., (2015) states that
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about 30% of institutionalized elders in Sri Lanka were
undernourished.
5. Overweight and obesity
For elders, extra weight during illnesses, especially
hospitalizations, seems to be protective (Brown et al., 2011).
However, overweight and obesity are risk factors for chronic
diseases such as diabetes, cardiovascular diseases and
cancers. A study on the prevalence of adult obesity in Sri
Lanka has shown that a markedly high proportion of elders
were overweight or obese. Overweight or obesity in elderly
women (60.0%) was higher than that of elderly men (43.8%)
which indicates that the elderly women are a high risk to
experience poor health status (De Silva et al., 2017).
6. Diabetes
Diabetes is one of the most common chronic diseases in the
elderly. Individuals with diabetes are at greater risk for heart
disease and its complications, risk of amputations, macular
degeneration, visual loss, cataracts, glaucoma, and
neuropathies (nerve damage, pain, or tingling) of the hands
and feet (Brown et al., 2011).
7. Cardiovascular diseases
Cardiovascular System changes related to ageing include
reduced blood vessel elasticity, blood volume, stroke volume
output, increased arterial stiffening and blood pressure.
Heart disease (cardiovascular disease or CVD) is the leading
cause of death in elders and can be reversible by following a
healthy lifestyle (Brown et al., 2011).
8. Hypertension
Higher blood pressure puts more force on vessel blockages
and increases the chances of blood vessel breakage. An
individual who maintains the blood pressure with
medication is still considered to have hypertension (Brown
et al., 2011).
9. Gastrointestinal System
Gastrointestinal System changes with ageing including
reduced secretion of saliva and of mucus, missing or poorly
fitting teeth, dysphagia or difficulty in swallowing, lessefficient mitochondria produce less ATP, reduced secretion
of hydrochloric acid and digestive enzymes, slower
peristalsis, reduced vitamin B12 absorption, Gastro
esophageal Reflux Disease (GERD), Vitamin B12 malabsorption and constipation (Brown et al., 2011).
10. Alzheimer’s disease and Dementia
Losing the ability to function independently and becoming
dependent on others is a common aspect in getting old.
Memory impairment is a step in the loss of independence.
More serious losses of memory and cognitive function are
grouped under the term “Dementia”. These patients require
more assistance with meal preparation and eating. In later
stages of the Alzheimer’s disease, wandering and restless
movements expend energy and increase caloric need.
Behavioural, physical, or neurologic problems may obstruct
adequate food intake which leads to unintentional weight
loss (Brown et al., 2011).
ENERGY AND NUTRIENT REQUIREMENTS IN ELDERLY
Energy
Elders consume fewer calories as they age (Brown et al.,
2011). Energy expenditure mainly determined from basal
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metabolic rate (which slows with age), diet-induced
thermogenesis, and physical-activity energy needs. Genetics,
hormones, and body composition also affect metabolic rates,
resulting in broad ranges of energy needs for older
populations which reflects the heterogeneity of older
populations and the need for individualized nutrition
planning (Brown et al., 2011).
Protein
Elders who are living alone, living in poverty, or have
functional limitations are vulnerable to inadequate protein
intake which contributes to muscle wasting (sarcopenia),
weak bones, a weakened immune status, and delayed wound
healing (Brown et al., 2011). Elders who consume a lowcalorie diet leads to a proportionately greater need for
protein. Decreasing muscle mass does not lead to lower
protein requirements but someone who is losing muscle due
to inactivity requires higher protein intake. Consuming
adequate protein amount which is slightly above the RDA,
and spread throughout the day, stimulates muscle synthesis
and minimizes the risk of sarcopenia in ageing adults
(Brown et al., 2011). Adequate protein intake is important
for muscle protein synthesis and the preservation or
improvement of muscle mass and strength. Evidence
suggests that total protein intake and the pattern of protein
intake affects the balance between protein synthesis and
breakdown (Mishra et al., 2018). Bauer et al., 2018, cited in
Mishra et al., (2018) states that sufficient protein intake is
important for muscle protein synthesis and preservation or
improvement of muscle mass and strength. Based on the
age-associated decline in protein utilization for muscle
protein synthesis, Bauer et al., 2018 suggested a protein
intake for the elderly of 1.0–1.2 g protein per kilogram body
weight per day (g/kg/day), an amount which is well above
the current recommendations of 0.8 g/kg/day for all adults.
Furthermore the amount of protein intake, the protein
intake distribution might be associated with muscle mass
and strength.
Although WHO’s RDA of protein intake is 0.83 g/kg Body
weight for the adult population, higher intake has been
suggested beneficial for the prevention of sarcopenia
(Shahrook et al., 2017). Rachel et al., 2015, cited in Ten haaf
et al., (2018) states that the RDA (0.8g/kg Body Weight) may
be inadequate to promote optimal health in elderly. Current
studies suggest that elderly people should take about 1g to
1.3g of protein per kg of body weight per day for optimal
physical function (Nowson and O'Connell, 2015). In addition
to total daily protein intake, the timing of protein intake also
important to promote muscle protein synthesis, maintain
muscle mass and function in the elderly. Ten haaf et al.,
(2018) states that increasing total protein intake and
extending protein intake distribution are potential strategies
to reduce sarcopenia related loss of physical function and
quality of life. Although many research studies identified that
higher protein intake may prevent and treat sarcopenia,
there is no agreed recommended daily protein allowance for
elders. Many long-term observational studies which studied
the association of dietary protein intake with body
composition and functional outcomes have indicated that
protein intake is positively associated with preservation of
lean mass in elderly (Beasley et al, 2010).
Carbohydrate and fiber
11. Carbohydrate intake 45% to 65% of calories, added
sugars less than 25% of calories are recommended for the
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elderly population. Depending on caloric intake, 21 and 30
grams of dietary fiber daily for females and males are
recommended (Brown et al., 2011).
Fat
The high intake of saturated fat and trans-fatty acid intake is
a risk factor for chronic disease. Minimizing the total fat
intake between 20 and 35% of calories, saturated fat less
than 10% and cholesterol 300mg or less is recommended for
older adults (Brown et al., 2011).
Fluids
The proportion of water in total body weight decreases with
age and dehydration increases the resting heart rate and
susceptibility to the development of urinary tract infection,
pneumonia, pressure ulcers, confusion, disorientation, and
dementia. The recommended fluid intake is 2L or 8 cups
(Brown et al., 2011).
Vitamins and minerals
12. Food intake and energy intake decrease with ageing, but
the requirement for most minerals and vitamins do not
decrease (Tur et al., 2003). Some of them use medications
and laxatives which interfere with vitamin D metabolism.
Due to limited sunlight, institutionalization or being
homebound, the photochemical production ability of vitamin
D declines. Vitamin D influences muscle metabolism and
tropism and its deficiency is related to sarcopenia (Calvani et
al., 2013, cited in Liguori et al., 2018).
Vitamin E plays a major role in the health of elders due to its
antioxidant functions, such as hindering the development of
cataracts, enhanced immune function and cognitive status.
Vitamin B12 level in blood decrease with age. Folic-acid
deficiency could mask vitamin B12 deficiency, which is more
common in elders than folic-acid deficiency. Women’s iron
needs decrease after menopause and iron is stored more
readily in the old than in the young. Some elderly people
have inadequate iron status due to blood loss from disease
or medication, poor absorption due to antacid interference
or decreased stomach acid secretion, and low caloric intake.
Inadequate calcium intake may contribute to bone loss and
calcium supplementation reduces the rate of bone loss in
osteoporotic patients. However, taking large doses of
vitamin and minerals cause involuntary weight loss or gain
in the elderly (Brown et al., 2011).
NUTRITIONAL ASSESSMENT OF THE ELDERLY
1. Anthropometric measurements
1. Body mass index (BMI)
In the elderly population, BMI alone is not an adequate
indicator of excess body fat associated with morbidity and
mortality (Brown et al., 2011). However, it is difficult to
accurately measure body fat mass. Therefore, BMI (kg/m2)
has been widely used and accepted as a simple method to
classify the medical risk of overweight status (Kady and
Tayel, 2011)
2. Waist: hip ratio
A study on elders has suggested that abdominal obesity is a
better measure of premature death than BMI. Evaluation of
obesity as a risk factor for stroke and transient ischemic
attacks found that markers of waist circumference, waist-tostature ratios, and waist-to-hip ratio predicted stroke cases
better than BMI (Gultekin et al., 2013).
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3. Mid-upper arm circumference
A study on the prevalence of undernutrition in
institutionalized elderly living in Sri Lanka has observed that
according to the WHO cut-offs, 23 % of the institutionalized
elderly had a lower MUAC than recommended which
suggests declining muscle mass and fat stores (Rathnayake
et al., 2015).
4. Calf circumference
Calf circumference is considered as the most sensitive
measure of muscle mass in the elderly (Rolland 2003, cited
in Rathnayake et al., 2015). According to the “Mini
Nutritional Assessment tool” (Vellas 1999, cited in
Rathnayake et al., 2015), the two categories of CC were, (i)
<31 cm and (ii) ≥31 cm. Previous studies have recognized CC
as a potential indicator of physical function, which provides
useful information on muscle-related disability and physical
function. High prevalence of low CC indicated weakness in
leg strength and physical function in institutionalized elderly
(Rathnayake et al., 2015).
5. Handgrip muscle strength
Handgrip muscle strength is often measured as a proxy for
muscle strength which is a simple, noninvasive, reliable, and
low-cost screening technique (Damayanthi et al., 2018). A
study on “Handgrip Strength and Its Associated Factors”
states that muscle wasting occurring with ageing is referred
to as sarcopenia and HGS is used to assess sarcopenia
(Damayanthi et al., 2018). Muscle strength is one of the key
indicators of health status in older adults. Reduced muscle
strength and power are closely linked with loss of
independence, increased risk of mobility, disability, and
mortality (4% increase with every 1 kg decrease in grip
strength). A previous study has found that poor HGS was
associated to increased mortality risk from cardiovascular
disease and cancer, even after adjusting for body
composition, multiple chronic diseases and multi-morbidity,
in both men and women. A cross-sectional study done in
Taiwan discovered that muscle mass had a stronger
correlation with handgrip strength than walking speed (Wu
et al., 2016).
HGS is frequently measured as a proxy for muscle strength
(Reijnierse et al., 2017) and a good indicator of nutritional
status as well as a risk differentiating method for all-cause
death and cardiovascular disease including increased health
recovery time after illness or surgery (Moy et al., 2011). HGS
is commonly used as an indicator of muscle function and
rapid, cost-effective method for nutritional assessment.
Many researchers have indicated that HGS is significantly
correlated with nutritional status. These previous studies
indicated that people at nutritional risk have lower HGS. This
may be due to poor nutrient intake result in reduced protein
synthesis, which causes muscle fibre atrophy and decreased
muscle mass and leading to impaired muscle function.
Research on the association between dietary protein intake
and grip strength has summarized that consuming equal or
higher than 25g protein at 2 or more eating occasions was
not associated with grip strength but higher daily protein
intake was positively associated with grip strength in
women (Mishra et al., 2018). A study conducted in Kandy
district, Sri Lanka was observed that age, MUAC, diabetes
mellitus, vegetarian diet, and alcohol consumption were the
factors associated with HGS among community-dwelling
elderly (Damayanthi et al., 2018).
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2. Dietary assessment
1. 24-hour dietary recalls
Protein intake was assessed using two 24-h dietary recalls
which is a reliable, most common and validated method for
determining the amount and distribution of protein intake
(Ten haaf et al., 2018). A 24-h dietary recall comprises a
logical approach to examine the nutrients that influence
muscle strength and the underlying mechanisms because it
takes actual food consumption. Recent studies suggest that
HGS can be used as a predictor of nutritional status. Most of
the sarcopenia and nutrition-related studies have
investigated the effects on muscle strength of single
macronutrients (e.g. protein) and micronutrients (e.g.
vitamin B12, vitamin D, antioxidants). Therefore, to examine
the role of nutrients in determining muscle strength
thoroughly, a 24-h recall dietary questionnaire is effective to
consider the overall diet which consists of complex mixtures
of different foods.
2. Mini nutritional assessment (MNA)
Mini Nutritional Assessment is a valid, reliable and easy-touse tool which can identify the risk of malnutrition. The MNA
combines six screening questions in part 1 with 12
assessment questions in part 2 and does not require
biochemical tests, for the assessment (Fernando and
Wijesinghe, 2010). MNA can identify elderly people who are
malnourished and at risk of malnutrition in short time (Kady
and Tayel, 2018). MNA should be recommended as the basis
for nutritional screening in older people due to its specific
geriatric focus (Kady and Tayel, 2018). A study on the elderly
in Galle district, Sri Lanka has revealed that nearly one-third
of the study sample (N=396) were at risk of malnutrition
which is identified by MNA (De Silva et al., 2017).
Living alone and Institutionalisation in elderly
According to the World Health Organization, the definition of
quality of life is individuals’ perception of their position in
life in the background of the culture and value systems in
which they live and in relation to their goals, expectations,
standards and concerns (Kumar et al., 2016). Therefore, the
quality of life depends on a person's physical health,
psychological condition, level of independence, social
relationships and personal beliefs (Kumar et al., 2016). Some
common problems in the elderly include lack of income to
purchase food, lack of skills to select and prepare nourishing
meals, limited mobility affects shopping and meal
preparation and feelings of isolation and loneliness reduce
the willing to eat (Brown et al., 2011). Those problems are
more
frequent
among
institutionalised
elderly.
Institutionalisation of elderly people occurs due to the lack
of family care which affects the nutritional status of elderly
people. Institutionalisation causes a series of modifications
in terms of lifestyle and food habits changes that may induce
changes in health status, nutritional status and body
composition. Poor nutritional status is related to poor body
composition which leads to poor functionality of the elderly
(Mohamad et al., 2010).
Being with people has a positive effect on well-being, and
eating (Brown et al., 2011). Elderly subjects who were living
alone were more likely to have a poor appetite. Elders eat
more when taking meals with their family members,
relatives, or friends rather than eating alone (Mohamad et
al., 2010). It is assumed that elders who are living alone have
lower nutrient intake and lower health status than other
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elderly groups. However, Kumar et al., (2016) states that
there is a significant difference in the quality of life between
elderly people from old age homes and free-living.
Furthermore, institutionalized elderly have better physical
health compared to the free-living elderly. In Sri Lanka, the
quantity and quality of diets were below the national
recommendations and the prevalence of undernutrition, as
verified by BMI, in the institutionalized elderly was high
(Rathnayake et al., 2015). Therefore, institutionalized elderly
require specific attention and should be the main concern in
public health nutrition intervention programmes
(Rathnayake et al., 2015).
Social relationships of elderly population
Previous studies have identified that positive social
relationship with family, friends, and neighbours promotes
quality of life and decreased social relationships could
associate with poor quality of life. Higher levels of social
support have been linked to a reduced risk of mental
disorders, diseases, mortality and improved quality of life.
Studies conducted in developing countries have found that
the quality of life of institutionalized elderly is poorer than
community-dwelling elderly (Malveiro et al., 2017).
Conclusion
The physiological changes due to ageing cause a risk to their
health if the nutritional status is poor. Therefore, adequate
and balanced diet is important for maintaining proper
nutritional status in the elderly. Most of the elders are
relatively sedentary. Low activity levels, deteriorating
strength, endurance, and sense of balance are associated
with increasing age. Elderly people benefit from physical
activities because they can maintain and build muscle mass
and prevent muscle loss. Training exercises results in
increases in lean mass, decreases in total, subcutaneous, and
visceral fat mass and weight loss while resistance exercises
increase lean muscle mass. Increased muscle mass rises
caloric needs which improves the chances of optimal
nutrient intake. Physical activities help to retain balance and
flexibility, contributes to aerobic capacity, improves
cognitive performance and psychological well-being. The
combination of high protein intake and active lifestyle is
related to a better quality of life in the elderly. Diverse diets
have been shown to protect against chronic diseases such as
cancers, as well as being associated with prolonged longevity
and improved health status.
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