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Supporting seniors at higher risk of poor nutrition

The Bottom Line

  • Many older Canadian adults are at risk of poor nutrition, which can cause serious health issues.
  • Inadequate available services, physical, social and financial limitations, and a lack of awareness about how to get help are among the many challenges that can put people at risk of poor nutrition.
  • Members of a citizens’ panel suggest that access to food and nutrition information, finding ways to identify people at risk, and better coordination and delivery of available services can help to improve nutrition among older adults.

Just like a car, our body works best when it is well maintained and receives the proper amount of quality fuel. Also like a car, the older our body gets the more likely it is to break down in some way or another. That’s why proper nutrition is so important and why older adults need to be particularly careful about including enough vitamins, minerals and other nutrients in their diet to fuel a healthy, active lifestyle in their senior years.


But that’s easier said than done. Most people make poor food choices occasionally and some may not always eat well for various reasons. Most worrisome are the many people who are at serious risk of poor nutrition: they simply do not get enough of the nutrients necessary for good health. Older adults are especially vulnerable due to one or more factors including a lack of appetite or sense of taste, low income, isolation and physical disability (1).


It’s a serious problem: approximately one third of Canadians aged 65 or older are at risk of having poor nutrition (1), which in turn puts them at greater risk of health problems like diabetes, hypertension and heart disease (2). To make matters worse, the support that is available – from community organizations to health care providers, hospitals, dietitians and doctors – often lacks the coordination, monitoring and training necessary to meet the needs of older adults who could use help (3, 4).


The McMaster Health Forum – a leading hub for improving health through collective problem solving – prepared a summary of the latest high quality evidence on the topic and shared this with a panel of 11 older adults in Ontario affected by the problem of nutritional risk among older adults. The panel shared their ideas and experiences on the issue and discussed options to address the situation.


What the research tells us

Programs and initiatives aimed at teaching people about healthy eating can have great benefits. For example offering nutrition education to older adults – face to face, by telephone or through the internet – can improve their health and well being (5). Delivering education and advice in groups (6) or through other media can also help older adults maintain better diets (7, 8). Boosting motivation through behavioural counselling (6) and financial rewards for healthier eating behaviour (9, 10) have also been successful in changing eating habits.


When it comes to identifying and advocating for older adults who may be at risk of poor nutrition, dietitians, doctors, nurses, community health care workers and informal caregivers make up the “front line” team. As familiar and trusted care providers, they are able to provide necessary care (11) while offering advice and education on nutrition (14-17). They can also play a role in improving awareness of poor nutrition in care settings such as hospitals, nursing homes and residential facilities (12, 13).


Major barriers to improving older adults’ nutrition are a lack of awareness among the general public and even in the health system about the importance of ensuring older adults are getting proper nutrition. Other obstacles include older adults’ distrust or difficulty understanding important nutritional information (18), and a lack of awareness of available resources for people at risk (17).

What the panel members told us

The panel maintained that nutrition education and awareness programs may help older adults make wise food choices, provided the campaigns are designed to be easily understood, relevant and respectful of various groups and cultures. The panel members agreed that accessibility is key; initiatives need to focus on improving access to food, not just access to information.


Many older adults are socially isolated, distrustful of new information and/or unwilling to change long held behaviours. Therefore, a priority is finding better ways to identify people who may be at nutritional risk so they can receive the help and support they need. This will require the proactive involvement of doctors, nurses and other health care providers, some of whom may need specialized training themselves in order to be able to pass on accurate information about diet and nutrition.


But it shouldn’t stop there. Members of the panel believe that everyone has a responsibility to protect the health and well-being of older adults by reporting or referring family members, friends or neighbours who they believe to be at risk.  While such referrals may be in the best interests of older adults, they also could be seen as a breach of their privacy and right to make their own decisions. The panel members stressed the need to carefully consider whether referrals are justified and that the benefits of intervening outweigh any potentially damaging consequences.


The panelists believe more cooperation among all parties, a more holistic health systemand a more  compassionate attitude toward seniors are first steps to addressing the barriers listed above and ultimately providing effective help to vulnerable older adults.

What do you think?


Eating well is not always easy.  Share your thoughts about diet challenges you or your loved ones face in the comments box at the bottom of the page.


Learn more

Lifestyle counselling programs help people make healthy choices and beneficial changes


 


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References

  1. Ramage-Morin PL, Garriguet D. Nutritional risk among older Canadians. Canadian Social Trends (Statistics Canada, Catalogue 82-003) 2013; No. 3, March 2013. Available at http://www.statcan.gc.ca/pub/82-003-x/2013003/article/11773-eng.pdf. Accessed December 2015.
  2. Drummond, D. Commission on the Reform of Ontario's Public Services. Toronto, Canada: Government of Ontario; 2012
  3. Keller H, Hedley M, Hadley T, Wong S, Vanderkooy P. Food workshops, nutrition education, and older adults: A process evaluation. J Nutr Elderly 2005;24(3):5-23.
  4. Ontario LHIN. Senior Friendly Hospital Care Across Ontario: Summary Report and Recommendations. 2011.
  5. Young K, Bunn F, Trivedi D, Dickinson A. Nutritional education for community dwelling older people: A systematic review of randomised controlled trials. Int J Nurs Stud 2011;48(6):751-80
  6. Taggart J, Williams A, Dennis S, Newall A, Shortus T, Zwar N et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract 2012;13:49.
  7. Desroches S, Lapointe A, Ratte S, Gravel K, Legare F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database Syst Rev 2013;2:CD008722.
  8. Aalbers T, Baars MA, Rikkert MG. Characteristics of effective Internet-mediated interventions to change lifestyle in people aged 50 and older: A systematic review. Ageing Res Rev 2011;10(4):487-97.
  9. An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutr 2013;16(7):1215-28
  10. Purnell JQ, Gernes R, Stein R, Sherraden MS, Knoblock-Hahn A. A systematic review of financial incentives for dietary behavior change. J Acad Nutr Diet 2014;114(7):1023-35
  11. Ball L, Johnson C, Desbrow B, Leveritt M. General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease. Journal of Primary Health Care 2013;5(1):59-69.
  12. Jefferies D, Johnson M, Ravens J. Nurturing and nourishing: the nurses' role in nutritional care. J Clin Nurs              2011;20(3-4):317-30.
  13. Marshall S, Bauer J, Capra S, Isenring E. Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence. J Nutr Health Aging 2013;17(8):645-51.
  14. Thompson RL, Summerbell CD, Hooper L, Higgins JP, Little PS, Talbot D et al. Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol. Cochrane Database Syst Rev 2003;(3):CD001366.
  15. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Int J Nurs Stud 2014;51(1):14-27.
  16. Keller H, Hedley M, Hadley T, Wong S, Vanderkooy P. Food workshops, nutrition education, and older adults: A process evaluation. J Nutr Elderly 2005;24(3):5-23.
  17. Keller H. Promoting food intake in older adults living in the community: A review. Appl Physiol Nutr Metab 2007;32(6):991-1000.
  18. Keller H, Carrier N, Duizer L, Lengyel C, Slaughter S, Steele C. Making the most of mealtimes (M3): Grounding mealtime interventions with a conceptual model. J Am Med Dir Assoc 2014;15(3):158-61.
  19. Gauvin FP, Mahendren M, Lavis JN. Panel Summary: Addressing Nutritional Risk Among Older Adults in Ontario. Hamilton, Canada: McMaster Health Forum, 24 January 2015.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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