Canada's Seniors at Nutritional Risk - Term Paper Example

? Canada's seniors at Nutritional Risk: Undernourishment in the Elderly due: Introduction The Canadian aging population is increasing at a rapid rate. As witnessed, in the last decade alone, the rate of increase has been higher than 30 years earlier. The trend is expected to rise even higher by 20% or more by 2020. Demographic trends provide an insight on the support and care requirements and services which variably increase with age. Inappropriate dietary intake in old age contributes to ill health and compromises the body’s resistance in fighting diseases. Concerns have been raised over the impact of nutrition on the health, economic and social status of the elderly Canadian population. This paper will discuss undernourishment as a nutritional risk in the elderly population. Nutritional concern Nutrition plays a critical role in the quality of life of the elderly. Under-nutrition is now widely associated with higher risk of death and morbidity. The physiology of aging and nutritional status affects both metabolic and energy requirements. The age related changes in the body composition results, in a decline in lean body mass, and use of a multi-vitamin supplement for seniors is recommended. Cardio-vascular, pulmonary and other neurological illnesses also alter energy requirements in the elderly through muscle loss caused by inactivity. According to Krahn, Lengyel & Hawranik (2011) common infections cause weight loss decreasing albumin and proteins to lead to under-nutrition (p. 261-273). Oral, dental issues and gastritis affect the nutritional status and impact negatively on the immune system of patients over the age of 65 years. The situation is further worsened by exposure of the elderly to other potential risk factors such as physical and mentality disability, loss of spouse, loneliness, weight loss, the use of multiple medications, poverty and the uncontrolled use of alcohol. A reduced level of physical activity and a low energy requirement may lead to a proportionate reduction in micronutrient intake affecting the nutritional status of elderly Canadians. This also causes progressive depletion of lean body mass. Muscle loss results in decreased functional ability hence the need for assistance with daily activities. The risk of severe malnutrition among the elderly Canadians is particularly high among those hospitalized and those under institutional care. Medication predisposes the elderly to loss of appetite leading to a poor diet in nutrients (Keller, 2013). Simple tests like a general physical examination including subjecting blood samples to a number of tests will confirm the presence of nutritional disorders among the aged. It is essential that physicians, dieticians and other health practitioners receive proper training on nutrition; the need to take both preventive and corrective measures in order to contain these common geriatric illnesses (Pamela et al, 2013). There has been limited research with regards to the actual nutritional requirement for the elderly. According to the report released in 1990, the recommended nutrient intakes relate to a younger population and is therefore revised and adjusted to reflect age-related changes such as lowered metabolic and physical activity. The recommendation only factors healthy people hence may not be appropriate to serve the ailing aging population and those under institutional care. Recent reports have put greater emphasis on higher portions of Vitamin D due to less exposure to sunlight. This guidance together with adopting proper lifestyle changes will significantly reduce the risk of chronic ailments including heart disease and certain forms of cancer (Esmayel & Walid, 2013). Studies done by Pamela et al, (2013) indicate that a third of Canadians aged 65 years and above were faced with nutritional risk. Women are more likely than men to be at nutritional risk. The majority confessed to skipping meals on a daily basis, taking little or no serving of fruits or vegetables and found cooking a meal a hard chore to perform. Women in this age group were more vulnerable than men. A lower education and consequently income among the elderly have also been significantly associated with nutritional risk. Low income seniors especially men may cut back on the basic necessities including quantity and quality of food that they consume. Living alone may be a sign of social isolation. Senior Canadians faced with isolation lack social support including practical help in running chores and errands like cooking, transport for shopping and social activities. Living alone and lowered morbidity including less participation in social activities such as sports and volunteer activities have been associated with a rise in nutritional risk. Those with low support hardly participate in social activities hence likely to be at nutritional risk. The transition of losing a spouse to living alone and change of earlier living arrangements due to either death or divorce may lead to grief, loneliness or depression. It therefore follows that this results to reduced social support and participation even lower income all affecting the nutritional status of the elderly (Heather et al, 2013). Physical and mental health including depression, use of medications and disability exposes the elderly to nutritional risk to even cause impaired appetite, absorption or metabolism of food and eating disorders. Lack of proper support systems in meal preparation and help in shopping for meal items also have a negative impact on nutrition. The ability to chew, quality of teeth or gums, tooth loss, reduced salivary flow and dental caries can limit food selection hence nutritional intake (Krahn, 2013). Dietary assessment There are several methods or techniques used in the review of dietary assessment each having advantages, disadvantages and validity or relevance. The dietary record approach accounts for foods and beverages in the form of units consumed either one or more days. The assessment is ideal and effective when taken at the time of eating meals hence avoids reliance on memory. The food is measured using a scale or household cups and tablespoons. It is advantageous to collect records on non-consecutive single day in order to increase representation of the individual diet. It may be essential to describe methods, recipes, food mixture portions and sizes. This method has the potential of providing quantitative and accurate information on food consumed. Problems of omission are lessened, and foods are more fully described in terms of portions and sizes than if the elderly were to recall the food items previously eaten. A potential disadvantage of the dietary record is that it is subjective in terms of sample selection and number of days recorded. It also requires that the respondents or their proxies be motivated and literate thereby limiting the use of method in population groups like low literacy, immigrants and elderly groups. Unless records are collected in an electronic form, the data may be burden-some to code and can lead to high personnel costs. Maintaining overall quality of control can be difficult since information is not recorded consistently. Technological advances are however in use to allow easier data capture which includes internet based programs, mobile phones with cameras which are developed and now readily available. Thereafter, food items are identified and quantified in order to arrive at accurate estimates for food volumes linked to the relevant databases. Other approaches have been suggested to over-come under-reporting in dietary record technique such as enhanced training of respondents, incorporating psycho-social questions in order to assess the level of under-reporting (Esmayel, Reda & Wael, 2013). A better approach is the calibrated dietary record which includes body mass index, age and ethnicity to accurately predict individual energy and protein intake. Findings According to the study conducted by Krahn, Lengyel & Hawranik (2013) the 24 hour dietary recall entails that elderly respondents or their proxies remember, and report all the foods and beverages consumed in the preceding 24 hours or previous day. It is done typically through interview session, either on face-to-face or telephone; either in paper and pencil form, self-administered and involves the use of probing questions. Primarily, the interviewer will be a dietician trained in food and nutrition even though non-nutritionists trained in the use of standardized instruments are also effective. It is mandatory that they are also knowledgeable and aware of the foods available in the marketplace, preparation practices, the prevalence in regional and ethnic foods (p. 261-273). The interview is structured with neutral probing questions to avoid leading the respondent to answers when they either do know or cannot remember. The advantage of this technique is that the literacy of the respondents, the majority who are frail and incapacitated is not required. Because of the immediacy of the recall period the proxies are able to recall most of the dietary intake hence lessening the respondent burden. In contrast to records method, dietary recalls taking place after the food has been consumed mitigating the risk of interference with dietary behavior. A technological advance in the 24 hour dietary recall approach is the use of automated self-administered data collection systems; which vary in the number of food items in their databases portion sizes including probes on food consumed and possible additions. The main weakness with this technique is that individuals may not provide accurate information on food consumption for reasons centered on knowledge, memory and interview situation. Studies show that other factors for instance obesity, gender, social desirability, restrained eating, education, literacy and perceived health status may further lead to under-reporting. The food frequency approach entails that the elderly Canadians report their usual frequency of consumption for each food from a list of pre-determined food groups for a period of time. It may not be possible to fully capture a finite food list including food items, brands and preparation practices. This method has some substantial amount of measurement error caused by incomplete listing of all possible foods and estimations based on frequency and size of serving. Another technique includes the brief dietary assessment instruments also known as screeners appropriate where the goal is to achieve or promote health education. It entails assessing vegetable, fruit, beverage and fat intakes as food or category groupings and portion of serving information (Maher & Eliads, 2013). Diet history involves the respondents providing information relating to their past diet and closely linking the 24 hour recall assessment. A more refined approach is the use of blended instruments that combines the information gathered from different assessment methods in furthering the ability to accurately assess diets. Measuring diet among the elderly Canadians may present special challenges where memory and cognitive functioning of the respondents are impaired. Self-administered tools may also be inappropriate where physical disability such as visual and hearing problems are present. Techniques like direct observation for those under institutional care facilities and shelf inventories for the elderly who are at home have now become useful. And because of chronic illnesses in this age group and limitations brought about by recommended diets like low sodium, low fat and high fiber this leads to biased reporting. Maintaining interest and concentration among the elderly may also lead to incomplete information. In 2008/2009, Senior in the Community Risk Evaluation for Eating and Nutrition among other approaches was developed and adopted for use in the 2008/2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA) by Dr. Heather Keller of the University of Waterloo in Ontario. Computer assisted personal interviews including telephone interviews were also applied to accommodate the respondents language needs. Where physical or mental ill health impairment was present, respondents lacked the capacity to complete the survey and proxy respondents were allowed to respond on their behalf. Socio-demographic features included in the survey covered age, highest level of education and all sources income amounts. Social characteristics comprised living arrangements, social support, social participation and driver or non-driver status. Pointers measuring mental and physical well-being included questions relating to signs and symptoms of depression such as emotions of sadness, loss of concentration or interest, unexplained tiredness, weight change, trouble sleeping, feelings of unworthiness and recurring thoughts about death. Disability was based on the Health Utility Index (HUI) developed by McMaster University covering functional health, vision, hearing, speech, mobility, agility, cognition, pain and discomfort. Oral health was based on responses about the health of the mouth including teeth, denture, tongue, gums, lips and jaw joints. A higher level of education impacts may lead to greater positive healthy behavior, more informed and greater control over choices on nutrition and better access to financial and informational resources (Heather et al, 2013). Recommendations Dietary recommendations and counseling are necessary and effective aspects of preventing and treating a variety of malnutrition conditions in elderly Canadians. Following a careful evaluation through nutritional assessment guidelines have been developed to improve and maintain their nutritional status. The Canadian Food Guide recommends a daily nutritional intake of: 1) 5-12 servings of grains; 2) 5-10 servings of fruit and vegetables; 3) 2-4 servings of milk products; 4) 2-3 servings of meat or meat alternatives A low intake of meat and meat alternatives results in inadequate intake of proteins which consequently increases skin fragility, decreased immune function, reduced healing and longer recuperation from illness. Intentional weight loss among old people will often lead to loss of muscle mass and sarcopenia. It may further increase the likelihood of falls, disability and osteoporotic fractures. Other factors like skipping meals or limiting intake of dairy products and proteins compromise on nutritional health and quality of life. Foods high in fiber, complex carbohydrates such as whole grains, a low fat intake and nutrient dense foods for nutritionally compromised senior citizens are preferred. Mal-nourished patients should be recommended and monitored through counseling towards effective and improved dietary habits. Dietary Reference Intakes (DRI) guidelines have now been adjusted to cater for the needs of older adults aged 50-70 years and those over 70 years. Studies show that citizens randomized to vitamin, and mineral supplements experienced less nutritional deficiency, improved immunity, cell function and reduced infection hence less use of antibiotics (Maher & Eliads, 2013). There are now increased allowances for the elderly for calcium, magnesium, vitamin D, fluoride, niacin, folate, vitamin B12 and vitamin E. A high fiber dietary intake is useful in the treatment of constipation, glucose intolerance, lipid disorders, colon cancer and obesity. There is also evidence that a reduction in sodium consumption reduces blood pressure and also the risk of developing hypertension. A supplement of Vitamin D counters the seasonal vitamin D deficiency and is known to reduce hip fractures, non-vertebral fractures and the risk of developing osteoporosis. Use of omega 3 fatty acids including consumption of the rich foods like salmon, cold water fish, cruciferous vegetables including broccoli, cabbage and cauliflower is now associated with stroke prevention. Conclusion A healthy eating attitude and good nutrition are the basis to aging well and staying independent. Inadequate nutrition leaves Canadian older adults vulnerable and at risk of poor nutritional status. It also increases the risk of hospitalization, disability and mortality. Identifying and screening older Canadian adults with nutritional risk factors is necessary even before the onset of malnutrition and weight loss which become difficult to reverse (. Keller et al, 2013). Health professionals should advocate for health education and health promotion approaches to older people. Dietary advice for the elderly at risk should pay emphasis to a healthy balanced food intake and exercise rather than dietary restrictions. The Canadian government in private-public partnerships should encourage through welfare incentives and initiate bringing older people together to share meals; which would prove effective in improving nutritional health and health outcomes. Meal programs can improve and maintain nutritional risks of vulnerable seniors. A community based approach in planning and delivering meals would lead to the development of diverse and appropriate nutrition education activities for Canadian seniors. Formal and informal health promotion through activities in recreation centers and religious places may impact positively on the nutritional status of the elderly (Maher & Eliads, 2013). References Daniel Maher & Carol Eliads, London Press. 2013. Malnutrition in the Elderly-An Un recognized Health Issue. RN Journal of Nursing. Emam M.M. Esmayel, Walid M. Reda & Wael Mahmoud, Hindawi Publishing Corporation.2013. Nutritional & Functional Assessment of Hospitalized Elderly Canadians. Journal of Aging Research. Vol. 2013, Article ID 101725. Heather H. Keller, Truls Ostybe & Richard Goy, Oxford Press. 2013. Nutritional Risk Predicts Quality of Life in Elderly Community-Living Canadians. The Journals of Gerentology. Series A. Vol. 59, Issue 1 M-68-M74. Krahn VM, Lengyel CO, Hawranik P. 2011.  Healthy eating perceptions of older adults living in Canadian rural and northern communities. Journal of Nutrition in Gerontology and Geriatrics. 30:261-273. Pamela L. Ramage Morin & Didier Garriguet, Oxford Press.2013. Nutritional Risk among Older Canadians.A Canadian Peer Review Journal of Population Health Services, 82-003X. Vol.24 No.3 Read More