Nutrition, Exercise, and Active Aging Among Older People in Australia - Essay Example

?Nutrition, exercise and active aging among older people in Australia Introduction The growing number of the older population in Australia has given rise to a number of concerns with regard to their health care, nutrition and exercise. The society often tends to perceive older people as a dependant group who burden the society with increased expenditures on health and aged care. On the other hand, the concept of active aging has been emphasized by many as the older population is still able to contribute positively to their families, societies and nations. As pointed out by Borowski, Encel and Ozanne (2007, p. 13) old age should be perceived as “a transition rather than a crisis, with opportunities as well as challenges” and the major challenge before the governmental agencies and the nation as a whole is “to promote healthy and productive ageing and to adjust social structures to include older people as contributors to society.” This call for a radical change in the social construction of older people as well as conducive economic and social policies and practices aimed at making the older population healthy, active and engaged. This paper seeks to explore the major barriers experienced by the older population in Australia with regard to their nutrition, exercise and active ageing. The paper also reviews contemporary governmental policies on aged care and throws light on how factors such as health, socio-economic status, gender, ethnicity, and current policies relate to the older population in the nation. The case study of Jack Andrews, a seventy year old man from the rural Queensland, is also employed in the paper to show the depth and seriousness of the issue. Case study of Jack Andrews Jack Andrews is a seventy year old man from the rural Queensland who suffers from cardiovascular diseases and visual impairment. He is negated of opportunities for active ageing because of his rural background. Born in a poor family in the rural Queensland he fails to receive adequate health care, transport facilities, nutrition or guidelines on healthy exercises. During conversations with him, he disclosed that in rural Queensland there was not even a single nursing home or hospital nearby. The nearest hospital facility was about two hours away and due to poor public transport facilities it was difficult for him as well as his relatives to have easy access to healthcare. While Jack was quite unaware of nutritious diets required for a cardiovascular patient he was unhappy that there were no facilities for structured or group exercises in rural Queensland. Even though there are many in his community who are eligible for a community aged care package the inequity in funding often negates them their opportunities. There is also a great amount of staff shortage when it comes to home visits or rural health services. There are also no acute care centers in the vicinity where the older villagers could easily get medication and support systems. Public transport or taxi services are very rare in small rural communities whereas in Central Queensland there are community bus services offering free transport for older people to attend medical appointments which clearly reveal the unequal treatment in the state. Jack’s personal experiences throw light on many of the issues surrounding the older population in Australia-health barriers, barriers based on socio-economic status, lack of access to healthcare, lack of nutritious diets, lack of opportunities for active ageing and lack of facilities for group or structured exercises. Ageing in Australia It is worthwhile to analyze the statistics and proportion of ageing in Australia. With the advancements in science and medical technology life expectancy in Australia has increased considerably whereas the mortality rates were at a decreasing rate. Similarly, since the 1970s deaths from chronic diseases affecting older age groups have also decreased considerably. On the other hand, the fertility rates of the nation have also diminished steadily which resulted in a greater number of older people in the nation. Borowski, Encel and Ozanne (2007, p. 18) point out that in 1981 the older people in Australia formed only 9.8 percent of the total population whereas it has risen to 11.3 percent and 13 per cent in 1991 and 2004 respectively. Similarly, as per the ABS (Australian Bureau of Statistics) projections, “the aged will comprise 18-19 per cent of the population in 2021, 26-28 per cent in 2051 and 27-31 per cent of the population in 2101” (Borowski, Encel & Ozanne, 2007, p. 18). These projections clearly demonstrate the growing number of older population in the nation. It can also be noticed that both morbidity and disability are positively associated with old age and as such a large number of older population are aged 85 years and more. It has been pointed out that out “of the 2.6 millioin Australians who were 65 years of age and over in 2004, 298300 people (1.5 percent of the total population) were aged 85 years and over” (Borowski, Encel & Ozanne, 2007, p. 20) and these older people are greatly in need of sufficient nutrition, easy access to transport and healthcare. It is thus evident that the remaining workforce of the nation needs to care for this aged population of the nation. The proportion between the aged population and the size of the working-age population is significant as far as the aged care of the nation is concerned. This has well been pointed out by Borowski, Encel and Ozanne (2007, p. 30) when the authors emphasize on the working-age population’s responsibility to pay taxes to sustain society’s non-working members and to offer government-funded support systems for the aged. The rapid growth in the older population of the nation has raised concerns regarding the capability of the working class population to pay for the healthcare, nutritional and social needs of its growing older population. The decreased number of tax payers to fund for the healthcare of the older population poses a great threat to the economy. While in 2007 there were ‘16.3 people of working age (aged 15 to 64 years) for every person aged over 80’ this will considerably be reduced to ‘5.5 people of working age for every person aged over 80’ (Ageing and Aged Care in Australia, 2008, p. 2). These statistics are quite alarming and calls for radical measures as well as competent governmental policies such as the active ageing policies. The concept of Active Ageing and Policy concerns The concept of active ageing has been emphasized as a possible solution for the growing rate of the older population of the nation. The concept is strongly rooted in the positive thought that the older population is capable of rendering positive contributions to the nation. One can trace back the origin of the concept of active ageing to the early 1960s in the United States of America where successful ageing was related to old age activity patterns and financial success. During the 1980s a new strategy for ageing named ‘productive ageing’ was introduced in the United States which held that “communities, workplaces (and older people themselves) have much to gain from older people being active well beyond the usual retirement age” and this also emphasized such alternatives to retirement as continued full-time or part-time employment (The Healthpact Research Centre for Health Promotion and Wellbeing, 2006, p. 7). During the 1990s, active ageing policies were promoted by the WHO, OECD, and EU. These policies addressed such issues as human rights, socio-economic conditions, health outcomes and disparities, the specific needs of older people, their cultural and ethnical differences, and the various social determinants of health. The term ‘active ageing’ is defined by the WHO (2002, p. 12) as “the process of optimizing opportunities for participation, health, and security in order to enhance quality of life as people age.” The WHO and most of the international community has today recognized active ageing as a competent policy initiative and social determinant of the health of the older generation. Most of the OECD (Organization for Economic Co-operation and Development) nations including Canada, New Zealand, Sweden, the United Kingdom, and the U.S.A. have successfully implemented active ageing policies. The WHO’s definition on active ageing “stresses that activity refers to the continuing participation of seniors in social, economic, cultural, spiritual and civic affairs, not just on their ability to remain physically active or participate in the workforce” (WHO, 2002, p. 12). In the same way, the European Union conceptualizes active ageing as “adopting healthy lifestyles, working longer, retiring later, and being active after retirement” (The Healthpact Research Centre for Health Promotion and Wellbeing, 2006, p. 10). The basic objective of active ageing policy initiative is to offer the older population sufficient opportunities for being productive. The ACT (Australian Capital Territory) Health Action Plan in 2002 released by the Department of Health identified ten determinants of health and wellbeing: “the social gradient; stress; early life; social exclusion; work; unemployment; social support; addiction; food and transport” (The Healthpact Research Centre for Health Promotion and Wellbeing, 2006, p. 29). The concept of active ageing presupposes that the older people are never negated of these determinants of health and that their dignity is valued, they have access to healthcare services, public transport and housing. The Australian Government Department of Health and Ageing (DoHA) holds that the older people in the nation are to be offered opportunities, adequate services and support systems to remain active socially, mentally and physically and to acquire financial Security and to indulge in workforce participation (The Healthpact Research Centre for Health Promotion and Wellbeing, 2006, p. 45). However, the DoHA’s policies on active ageing have failed to represent the gender and culturally and linguistically diverse backgrounds of its older population. One can also notice that in Jack Andrews’ case he was negated of most of these determinants of health and wellbeing. Socio-economic status acts as a key barrier to equal healthcare services for the older people in Australia. Poor social and economic conditions can prevent people from gaining quality healthcare. The WHO (2003, p. 11), while offering its guidelines on the social determinants of health, rightly points out that “societies that enable all citizens to play a full and useful role in the social, economic and cultural life of their society will be healthier than those where people face insecurity, exclusion and deprivation.” As per the WHO guidelines stress, social exclusion, lack of work or employment, lack of social support, addiction, lack of nutrition and transport act as socio-economic factors that hinder one’s health and well-being. One can also notice disparities in healthcare and access to healthcare among the older people in rural and remote areas of the nation n comparison with the metropolitan areas (Aged & Community Services Australia and the National Rural Health Alliance, 2004, p. 6). The rural aged population including Jack Andrews suffers from poverty, lack of access to healthcare and public transport and these adversely affect their prospects of receiving quality healthcare and other support systems. The World Health Organization’s Active Ageing: A Policy Framework (2002) is a seminal document on ageing and active ageing policies. The policy framework recognizes the human rights of older people and advocates that “older people who retire from work and those who are ill or live with disabilities can remain active contributors to their families, peers, communities and nations” (WHO, 2002, p. 12). For this, it is imperative that older people live in age-friendly environments and intergenerational solidarity and that they are specially trained to display personal responsibility in self-care. The determinants of health or active ageing consist of cross-cutting determinants such as culture and gender; health determinants (equitable access to quality primary health care and long-term care); behavioral determinants such as engaging in appropriate physical activity, healthy eating, not smoking and using alcohol and medications wisely in older age; determinants related to personal factors such as biology and genetics; psychological factors; determinants related to the physical environments including safe housing, falls, clean water, clean air, and safe foods; determinants related to social environments such as social support, education and literacy; and, economic determinants such as income, social protection and work (WHO, 2002, pp. 20-26). Active ageing policies cannot successfully be implemented until the older generation of the nation is guaranteed these determinants of health or active ageing. Challenges of an ageing population The older population is quite vulnerable towards illness and disabilities. The major challenges faced by the ageing population consist of the double burden of disease, increased risk of disability, lack of quality healthcare, inequities and discrimination in health care, lack of effective support systems, unequal distribution of money and access to healthcare and ‘dilemmas linked to long-term care and the human rights of poor and disabled older citizens’ (WHO, 2002, p. 43). The Australian government has undertaken a large variety of steps for the well being of the older population of the nation. Governmental initiatives consist of “superannuation and retirement income support, workforce, housing, social inclusion and lifelong education, as well as medical, health and aged care services” (Ageing and Aged Care in Australia, 2008, p. 2). The government has also made employer superannuation contributions compulsory to protect its older population. The number of older people in labor participation has considerably increased owing to active ageing policies and many of them remain as active contributors to the society. Active ageing policies should also take into account the increasing ailments and illnesses among the older population. One needs to always bear in mind that “promoting good health throughout life and preventing illness are equally important to encouraging independence and continuing workforce and community participation” (Ageing and Aged Care in Australia, 2008, p.3). It is expected that active ageing policies can find solutions for many of the challenges as the aged population themselves can become both active contributors as well as beneficiaries of the changes brought out by these policies. Nutrition and the older population in Australia Malnutrition or nutritional frailty is a common problem faced by the older population and this paves way for many other negative health outcomes as well. Unless and until the nutritional needs of the old population are adequately addressed this would lead to further health related issues. The nutritional status of the older population is strictly related to their socioeconomic status and nutritional frailty can be understood as “the disability that occurs in old age due to the unintentional physiological or pathological loss of body weight and sarcopenia” (Visvanathan, Newbury & Chapman, 2004, p. 800). Nutritional deficiency will lead to polypharmacy among older people, making them more vulnerable towards multiple medical illnesses. Social isolation and depression can also contribute towards poor nutritional intake among the older population. While mini-nutritional assessments have been beneficial for the older people a detailed assessment of nutritional status should consist of an assessment of dietary intake, anthropometric measures, a more detailed body composition analysis, and laboratory markers” (Visvanathan, Newbury & Chapman, 2004, p. 800). It is therefore imperative that the older people are offered timely screening and diagnostic tests. It is also significant to educate and create awareness among older people regarding the need for sufficient nutritional intake. In the case of jack Andrews he was not even aware of the nutritious diet he had to follow. As pointed out by Visvanathan, Newbury and Chapman (2004, p. 802) patient education results in “improved nutritional intake and empowering older adults with the necessary knowledge may be the best way of preventing malnutrition.” However, the nutritional needs of each patient vary considerably and this emphasizes the need for individually tailored nutritional education programs. Studies have shown that individually tailored nutritional education programs “increase the consumption of fruit, vegetables and calcium rich food in community dwelling, functionally impaired, elderly people with consequent weight gain over 6 months” (Visvanathan, Newbury & Chapman, 2004, p. 802). Similarly, referral to ‘meals on wheels’ (MOW) also are necessary for those older people who are in need of certain meal supplementation to make up for their nutritional deficiency. The advantages of macronutrient supplementation for the older people have also been proved. Visvanathan, Newbury and Chapman (2004, p. 803) purport that macronutrient supplementation “produce small but consistent weight gain, increased energy intake, reduced mortality, shortened hospitalization, improved functional status, and reduced postoperative complications, especially in institutional or hospital settings.” The major chronic conditions affecting older people worldwide are cardiovascular diseases, hypertension, stroke, diabetes, cancer, chronic obstructive pulmonary disease, musculoskeletal conditions, mental health conditions such as dementia and depression, blindness and visual impairment (WHO, 2002, p. 16). Most of these chronic conditions can be controlled through appropriate nutritious diets as well as adequate exercises. Exercise and older people in Australia It has been widely accepted that physical activities and exercises can keep people away from unwanted illness and ailments. An increased level of physical activity and exercise can reduce the risk of chronic diseases among old people whereas sedentary lifestyle increases the likelihood of unhealthy conditions of various sorts. Melzer, Kayser and Pichard (2004, p. 641) regard exercise as “a subset of physical activity that is planned, structured, repetitive, and purposeful in the sense that improvement or maintenance of physical fitness is the objective.” Being physically active promotes the physical health and well being of the older population to a great extend. Similarly, it can also help older people for drug management and reduction of medication. Sims, Hill, Hunt, Haralambous, Brown, Engel, Huang, Kerse and Ory (2006, p.11) address physical activity for older people at three levels: individual, societal and structural and it is worthwhile to analyze the recommendations put forwarded by the authors. They recommend the older people to engage in some sort of physical activity irrespective of their age or health problems to maintain fitness, strength, balance and flexibility and the frequency of moderate exercise or physical activity should gradually be built up (Sims et al., 2006, p. 11). For this, an expert workforce that is capable of delivering population-level exercise interventions with adequate ‘skills in development and delivery of group exercise programs and prescription of individually targeted exercise’ is very much essential (Sturnieks, Finch, Close, Tiedemann, Lord & Pascoe, 2010, p. 59). However, the researchers also found that current training in exercise science in Australia is insufficient to meet the large scale exercise needs of the older population. Very often, the older people are quite aware of the various benefits of physical activity and exercises. However, when it comes to actual practice many are reluctant to resort to exercises and this calls for the need for effective interventions in this regard. There are many others who start physical exercises in enthusiasm but ail to continue the momentum. As Sims et al (2006, p. 12) have rightly pointed out, “interventions incorporating the principles of behavior change are needed, both to maximize the reach of physical activity promotion initiatives and programs across the older community and to minimize attrition once people begin to be physically active.” Exercises that have a community extension or connection have been identified as more effective than that of individual exercises. In the same way, the social and physical environments of older people also exert a great influence on their exercise patterns. The physical environments of older people should be adapted carefully “to enable safe and enjoyable physical activity options to be readily accessible to all older Australians” (Sims et al., 2006, p. 12). Exercises and physical activity for the older people can vary from incidental activities, structured activities or group exercises, leisure time activities or exercises, to supervised physical activity or exercises that aim at progressive resistance training, aerobic, endurance exercise, mobility promoting and balance maintenance (Sims et al., 2006, p. 65). It has also been pointed out by Young, Masaki, and Curb (1995) that the exercise related interventions among older population should incorporate aerobic, strength, flexibility, and balance training. The advantages and health benefits associated with increased levels of physical activity and exercises are many and varied: these contribute towards “lower incidence of hypertension, heart disease, osteoporosis, degenerative arthritis, colonic cancer and diabetes mellitus, improved mood and memory function, and a better and maintained social network” (Sims et al., 2006, p. 13). The American College of Sports Medicine also highlights the benefits of exercise and physical activity for older adults. For them, “the benefits associated with regular exercise and physical activity contribute to a more healthy, independent lifestyle, greatly improving the functional capability and quality of life of this population” (The American College of Sports Medicine, 1998, p. 992). Sturnieks et al (2010, p. 59) also are of the opinion that participating in appropriate exercise will ‘help reduce the risk of falls and falls injury in older people.’ On the other hand, becoming sedentary in older age results in multiple illnesses or diseases. Conclusions The older population no longer needs to be regarded as a dependant group that burdens the society with increased expenditures on health and aged care. On the other hand, they should be given ample opportunities for active ageing whereby they can contribute positively to their families, societies and nations. Nutrition and exercises play pivotal roles in the lives of the older population and as such there needs to be efforts to universalize facilities for these in all parts of the nation. One needs to bear in mind that Malnutrition is a common problem faced by the older population which paves way for a host of diseases and illnesses. In the same way physical activity or exercise has the potential to reduce the risk of chronic diseases among old people while sedentary lifestyle leads to multiple illnesses. Therefore, it is imperative that the older population of the nation is offered adequate facilities for individual, group and structured exercises. Issues such as health barriers, barriers based on socio-economic status, lack of access to healthcare, lack of nutritious diets, lack of opportunities for active ageing and lack of facilities for group or structured exercises are to be addressed at the earliest. Rural healthcare services and home visits among the older population in remote areas needs to be one of the policy priorities of the nation. References Ageing and Aged Care in Australia. (July 2008). Retrieved September 24, 2012 from the Department of Health and Ageing website http://www.health.gov.au/internet/main/publishing.nsf/content/BFE46F21A3241ECBCA2574BE001A6E06/$File/Ageing_and_Aged_Care.pdf Aged & Community Services Australia and the National Rural Health Alliance. (July 2004). Older People and Aged Care in Rural, Regional and Remote Australia. A Discussion paper. Retrieved September 24, 2012, from http://www.pc.gov.au/__data/assets/pdf_file/0013/14053/sub012.pdf American College of Sports Medicine. (1998). Exercise and physical activity in older adults. Medical Science, Sports and Exercise, 30, 992-1008. Borowski, A., Encel, S., & Ozanne, E. (2007). Longevity and social change in Australia. Sydney: UNSW Press. Melzer K, Kayser B & Pichard C. (2004). Physical activity: the health benefits outweigh the risks. Curr Opin Clin Nutr Metab Care, 7(6):641–647. Sims J, Hill K, Hunt S, Haralambous B, Brown A, Engel L, Huang N, Kerse N, and Ory M. (2006). National physical activity recommendations for older Australians: Discussion document. Canberra: Australian Government Department of Health and Ageing. Sturnieks, D.L., Finch, C.F., Close, J.C.T., Tiedemann, A., Lord, S.R & Pascoe, D.A. (2010). Exercise for falls prevention in older people: Assessing the knowledge of exercise science students. Journal of Science and Medicine in Sport, , 59–64. The Healthpact Research Centre for Health Promotion and Wellbeing. (September, 2006). A Review of the Literature on Active Ageing. Retrieved September 24, 2012, from http://www.canberra.edu.au/centres/healthpact/attachments/pdf/active-ageing.pdf Visvanathan, R., Newbury, J.W & Chapman, I. (2004). Malnutrition in older people: Screening and management strategies. Australian Family Physician, 33(10), 799-805. World Health Organization. (2003). Social determinants of Health: The Solid Facts (2nd ed.). Ed. Richard Wilkinson and Michael Marmot. Retrieved September 24, 2012, from http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf World Health Organization. (2002). Active Ageing: A Policy Framework. Retrieved September 24, 2012, from http://whqlibdoc.who.int/hq/2002/who_nmh_nph_02.8.pdf Young, D., Masaki, K., & Curb, D. (1995). Associations of physical activity with performance-based and self-reported physical functioning in older men: The Honolulu Heart Program. Journal of the American Geriatrics Society, 43, 845-854. Read More