Issue 134 nutrition in a growing ageing population

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NUTRITION IN A GROWING AGEING POPULATION Aliya Porter Registered Nutritionist Aliya is a regional rep for the Association for Nutrition (AfN) on a voluntary basis. The NorthWest Regional Network consists of 149 UKVRN Registrants working across a variety of fields in nutrition. Aliya also runs her own freelance practice www.porternutrition. co.uk www.association fornutrition.org

On 3rd February this year, the Association for Nutrition Regional Network (North West region) held their study day to look at the needs of older adults and the current knowledge base we have in this age group. Over 70 Registered Nutritionists (RNutr) and Registered Associate Nutritionists (ANutr) spent a workshop session discussing how we as a profession need to adapt. This article shares some of the discussions.

Over the next 20 years (2015 to 2035) The terminology we use is also the number of people in the UK aged important. ‘Older adults’ is the over 65 is projected to grow by 4.75 recognised term, but this group has very million (an increase of 50%) (ONS, diverse needs. We require compassionate 2016). As the population of older terminology which is clear and nutrition adults increases in the UK, nutrition students require support in the professionals will have to adapt to development of skills around cultural their requirements and the needs of sensitivity and positivity around older the ageing population as a whole. adults also.

As a profession, we should all educate ourselves about the needs of THE IMPACT ON RESEARCH older adults, from protein and vitamin Looking at the current research base, there is a dearth of D requirements, to research into the the challenges of There is a need for nutritional status and dysphagia, memory the requirements of loss and difficulty further research into the the over 85s. carrying shopping.

The University of We will all come nutritional needs of older Newcastle, amongst across older adults others, is conducting in our day-to-day adults more broadly, research in this area lives, even if we don’t at the work directly with prevention of ill health and and presented study day.1 SACN them, whether it is a recognise the need relative, or friend of treatment too. for specific RNIs the carer of one of our to be developed, patients. Therefore, knowledge in this area will always be particularly for the over 85 age group. It is essential that we champion research advantageous.

The challenges of meeting increased in this area. There is a need for further protein requirements, taste changes, or research into the nutritional needs of the need for finger foods in dementia older adults more broadly, prevention patients who have an increased of ill health and treatment too. likelihood to wander during meals, Within the research conducted, give us increased challenges as we the black and minority ethnic (BME) seek to help meet the needs of older populations should not be forgotten as adults. We need to be prepared for their needs and the necessary response questions and prompt discussion when to their requirements may well be appropriate. different. www.NHDmag.com May 2018 - Issue 134

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Support for care home chefs to make meals which meet their residents’ needs, but are also acceptable to the eye and the palate, is crucial.

Research is also needed to establish whether the findings of studies into the nutritional status and needs of the current 85+ age group will indeed be the same for those who will reach that age in 20 or 30 years’ time. It is important that this modelling is done in order to inform the prevention work necessary now for those population groups. Researchers also need to consider how older adults will be able to access their research findings.

health needs to focus resources on informing older adults about their different nutritional needs, as well as general health promotion.

Change in circumstances, should be considered when promoting health, for example, caring for a relative or the death of a spouse. As in all health promotion, it is essential to ask the population what they want so that messages have the greatest impact. We need to think smarter as resources are so tight.

THE NEED FOR PREVENTION OF ILL HEALTH

COLLABORATION IS KEY

We all know it, but an ageing population brings more challenges to the NHS to meet the medical needs of older adults with proportionately fewer people paying into the NHS. We must therefore focus on prevention.

Prevention of ill health, should start at school level (with education, physical activity, cooking and school meal provision), but should also continue in the workforce so that retired people go into retirement healthier.

There is an opportunity for employers to invest in their workforce to reduce days off sick and potentially to get more working years out of their experienced staff. Alongside this, public 40

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All nutrition professionals need to be working in collaboration with researchers and other professionals to ensure that the evidence base is not only sound, but also disseminated.

There is an opportunity to raise the profile of nutrition. There needs to be cross-functional working to gain better understanding of needs.

Collaborations between nutrition professionals and other healthcare professionals, including nurses, GPs, OTs and physios, are essential in order to ensure clear consistent messaging.

Nutrition needs to be a major part of falls prevention and the management of medical conditions, such as hypertension and high

. . . industry could consider creating a range of ready meals which are nutritionally tailored to the needs of the older adult . . . cholesterol, in line with NICE guidance. Nutrition should be an integral part of the operations of all care homes and care providers, in both training of staff and delivery models. Support for care home chefs to make meals which meet their residents’ needs, but are also acceptable to the eye and the palate, is crucial. The work of The Soil Association’s Better Care programme for Food for Life2 was highlighted at the study day.

Although work with care homes is essential, we must not forget that over 70% of over 85s live in their own homes, so, in order to reach this group, collaboration with leisure providers, hairdressers, barbers, clubs and workplaces is essential for consistent messaging and greater support around nutrition. In order to assist partnership working, clear nutritional advice for older adults is required in an acceptable format.

THE ROLE OF THE FOOD INDUSTRY

The food industry is essential for meeting the nutritional needs of older adults. Nutrition professionals working within the food industry adhere to a commonly held ethical framework, to demonstrate that they advise in the public interest and are not unduly influenced by their employer’s profit motive. For UKVRN Registered Nutritionists, this ethical framework is the Association for Nutrition’s Standards of Ethics, Conduct and Performance, which apply to all professionals whether employed in the public, private or commercial sectors.

With a growing ageing population, industry needs to respond too in order to meet the demands of its customer base. Increased protein requirements with protein as part of each meal gives the opportunity to develop products which would meet this need, but are also nutritionally balanced, low in sugar and salt.

With the increased demand for convenience meals (including by older adults looked after in their own homes with very short carer visits), industry could consider creating a range of ready meals which are nutritionally tailored to the needs of the older adult in terms of portion size and nutritional content.

Such ranges could also include finger foods which are nutritionally balanced and which tailor for the older adult who is not able to sit down and eat a meal with a knife and fork.

Creating such a range is a challenge because the needs of older adults are so very different, but a variety of different options within a range could meet those needs. Packaging is important with larger fonts and easier-to-open packaging - perhaps an increased challenge as we move away from plastic packaging which is often, although not always of course, easier to open.

Industry could also think about issues of accessibility. Older adults with limited mobility, or limited ability to carry shopping, may have to rely on smaller shops for their nutritional needs. Providing a good range of food which is accessible is essential. We need to promote the use of Dial a Ride and Age UK services for shopping too (so we need to know about our local services). With the increase in online grocery shopping, older adults can get food delivered, but certain companies now charge extra if your total is less than £40. Perhaps this could be waived, or a lower minimum order be required for the over 65s.

There was much to discuss at the study day and there is plenty of food for thought here, whichever part of the profession you fit into.

We all need to do our part. Perhaps it is time for a national campaign on Ageing Well.

References 1 1 Antoneta Granic Nuno Mendonça, Tom R Hill, Carol Jagger, Emma J Stevenson, John C Mathers and Avan A Sayer (2018). Nutrition in the Very Old. www.mdpi.com/2072-6643/10/3/269/pdf 2 www.soilassociation.org/our-work-in-scotland/scotland-news/2017/good-food-in-care-homes/

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