6. Healthy Eating and Healthy Aging

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• Benefits of Healthy Eating and Risks of Poor Nutrition
• Costs Associated with Unhealthy Eating
• Healthy Eating Among Older Canadians
• Healthy Eating and Healthy Weights
• Knowledge Gaps
• Promising Practices
• Directions for Policy and Practice

Benefits of Healthy Eating and Risks Related to Poor Nutrition

Healthy eating patterns are integral to healthy aging. Healthy eating provides essential energy and nutrients for general well-being, the maintenance of health and functional autonomy, and a reduced risk for chronic diseases at older ages (Health Canada, 2002b; BC Ministry of Health, 2005; Dietitians of Canada, 1998).

Seniors have unique nutrition and energy requirements. Specifically, they require fewer calories but more nutrients to promote and protect health, contribute to independence, self-efficacy and quality of life (Dietitians of Canada, 1998; Health Canada, 2002b). For example, a healthy diet consisting of a high intake of fruits and vegetables is associated with protection against visual loss, cataracts, respiratory disease, and some cancers (BC Ministry of Health, 2005). A recent survey found that 62 percent of seniors who reported consuming fruits and vegetables at least five times a day were in good health compared with 52 percent of seniors who consumed fewer fruits and vegetables (Shields and Martel, 2006).

Poor nutrition in older age can result in many adverse and synergistic complications. Poor nutrition exacerbates declines in immune and sensory functions (such as macular degeneration), and worsens symptoms related to chronic diseases such as cardiovascular disease, diabetes, osteoporosis and cancer (Dietitians of Canada, 1998). Inadequate intake of B vitamins may also have a negative effect on cognitive functioning and even dementia among older adults (Calvaresi and Bryan, 2001). Skipping meals or not eating enough can cause dizziness and weakness, which, in turn, can precipitate falls with sustained injuries that may eventually lead to a loss of independence.

Poor oral health negatively affects seniors' ability to eat and digest healthy foods. This increases their vulnerability to health problems such as heart disease, pneumonia, stroke and diabetes (National Advisory Council on Aging (NACA), 2005c). Smoking also modifies the absorption of nutrients (NACA 2004).

Social isolation and eating alone, as many seniors do, is often related to unhealthy eating and poor nutrition. Older adults may develop positive attitudes towards healthy eating and nutrition through the development of supportive relationships (Dietitians of Canada, 1998).

Costs Associated with Unhealthy Eating

There is not a lot of research available on the cost burden of unhealthy eating. In an attempt to generate some estimates, however, American researchers considered proper nutrition as a "risk removal" feature for morbidity and mortality. They found that improved diets could reduce chronic heart disease and stroke mortality by at least 20 percent; cancer and diabetes could be reduced by at least 30 percent (U.S. Department of Agriculture, 1999).

Based on a similar logic, Health Canada researchers developed a rough picture of the economic burden of unhealthy eating in Canada. Using figures from 1998, they estimated that some $1.3 billion are attributable to direct health costs resulting from unhealthy eating; $5.3 billion are indirect costs, making the total estimated economic burden of unhealthy eating in Canada around $6.6 billion (Health Canada, 2003).

Healthy Eating Among Older Canadians

Based on results from several national studies, the National Advisory Council on Aging (NACA) reported that some 50 percent of Canadian seniors rate their eating habits as "excellent" or "very good"; 16 percent as "fair" or "poor". Just over 40 percent of seniors eat the recommended servings of fruits and vegetables each day and 4 percent of seniors were hungry during the year because they did not have enough money to buy food (NACA, 2004).

Many adults over age 50 do not have an adequate intake of nutrients, such as vitamins D, folate, calcium and iron . Most seniors do not get enough vitamin D from their diet. Moreover, approximately, 10 to 30 percent of people over the age of 50 have difficulty absorbing vitamin B12 found in food. A supplement of vitamin D and a synthetic source of vitamin B12 (supplement or fortified food) may be necessary (Institute of Medicine, 1998).

Not surprisingly, independent seniors who live in the community and who enjoy general good health have the lowest rates of poor nutrition. The prevalence of poor nutrition increases for hospitalized seniors who are already experiencing compromised health and functional status. Older adults who are functionally dependent in activities of daily living are also at a higher risk for poor nutrition (Health Canada, 2002b).

A range of interacting factors at the individual and collective levels affect the food choices of older adults in Canada. These include macro-level factors such as income, transportation, sociocultural norms, oral health, food production and marketing, and support networks (Raine, 2005; Payette and Shatenstein, 2005). Addressing these underlying determinants is critical in encouraging healthy eating patterns (Payette and Shatenstein, 2005; Health Canada, 2002b). How seniors access, prepare and consume foods are important factors in healthy eating and do not function in isolation of one another.

Healthy Eating and Healthy Weights

Like younger Canadians, the prevalence of overweight and obesity is increasing in the older population as a result of an excess consumption of calorie-rich foods combined with physical inactivity. Obesity rates among older adults aged 75-plus have surged, reaching 24 percent in 2004, compared to 11 percent for this same age group in 1978/79 (see Figure 6.1). However, obesity rates did not increase significantly among adults aged 65-74. Overweight tends to be higher among middle aged and older men as compared to women; however, women have higher average obesity rates compared to men (Tjepkema, 2005).

Excess body weight increases one's risks for chronic diseases, injuries and compromised health (Tjepkema, 2005; Shields and Martel, 2006). In 2005, 55 percent of seniors whose weight was in the normal weight range were in good health, compared to 46 percent of seniors who were obese. New research suggests that obesity is predictive of dependency in midlife and older age, which in turn, is predictive of eventual institutionalization. The association between obesity, disability and dependency is stronger among women than it is for men (Wilkins and de Groh, 2005).

At the same time, there is still limited consensus on optimal weights for seniors in Canada. The association of higher weight with negative health outcomes among seniors, especially over age 80 is less clear (Dietitians of Canada, 1998). Underweight seniors are less likely (37 percent) to be in good health (Shields and Martel, 2006). There also remains a significant association between underweight and dependency among seniors (Wilkins and de Groh, 2005). Weight loss amongst seniors is often unintentional, goes unnoticed, and is the result of muscle and bone loss, which can negatively impact strength, balance and endurance, subsequently escalating one's risk of injuries. For example, the percentage of seniors in the normal weight range increased with age from 40 percent among the 65-74 year age group to 62 percent for the 75-plus age group. The authors suggest that this weight loss may be attributed to declining health and frailty associated with older age (Shields and Martel, 2006).

There are questions as to whether or not the same measurements and standards for determining overweight and obesity (e.g., body mass index) should be applied in adults over age 65 given that weight is distributed differently as one ages (i.e., less muscle and more fat).

Figure 6.1 Obesity rates, by age group, household population aged 18 or older, Canada excluding territories, 1978/79 and 2004

* Significantly higher than estimate for 1978/79

Data Sources: 2004 Canadian Community Health Survey, 1978/79 Canada Health Survey. In Tjepkema (2005). Nutrition: Findings from the Canadian Community Health Survey.

Knowledge Gaps

As mentioned above, we need a better understanding of the relationship between weight and health, and in the application of healthy weights measures and indicators among seniors. The evidence on nutrition and healthy eating for older adults is slow to emerge. There is a dearth of evidence around nutrition monitoring and evaluation systems, the determinants of healthy eating for seniors, and links to health outcomes to inform policies and program development (Payette and Shatenstein, 2005). Intervention and best practice research is also needed to further explore how older Canadians can minimize risk and ensure proper nutrition while maintaining a healthy weight and practicing routine physical activity (NACA, 2004).

Promising Practices

Limited information is available on the effectiveness of nutrition-related interventions with seniors. Upstream interventions such as nutrient fortification in foods (Health Canada, 2005) and ensuring food security¹ (World Health Organization (WHO), 2002) have the potential to enhance the nutrition status of all ages, and seniors in particular. For instance, the addition of folate to flour and grain products, which was implemented to reduce birth defects, may also have benefits in reducing homocysteine levels in the aging population. High homocysteine levels have been associated with heart disease and an increased risk for developing Alzheimer Disease (Tucker et al, 2005).

Nutrition education interventions directly targeted to seniors are scarce, and their evaluation rare. Preventing undernutrition through the promotion of optimal nutrition and/or screening in populations at risk shows promise.

Directions for Policy and Practice

The evidence implies that policies and practices to encourage healthy eating among older adults need to:

• Invest in further research and knowledge development to address the gaps in our understanding around the determinants of healthy eating and healthy aging, and uncover and evaluate effective interventions for seniors
• Address the multiplicity of factors and barriers that affect older adults' food choices; their nutritional needs; the determinants of nutrition status (e.g., underlying health conditions and consumption patterns); and vulnerability to deficiencies and nutritional problems
• Promote awareness around the linkages between healthy eating, healthy weights, and physical activity for Canadian seniors. This is important not just for today's seniors, but for middle-aged Canadians who will enter into older adulthood in the next 10 to 20 years
• Increase senior's access to oral health services as a means of improving the nutritional status of older Canadians, especially those living in rural areas and long-term care facilities
• Prioritize healthy eating in long-term care facilities

Healthy eating and nutrition policies should aim to promote and enable healthy choices for seniors, who have unique nutritional needs.

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¹ Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. (World Food Summit, 1996)

 

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