Nutrition is among the most important aspects in the health of the elderly. Between bad habits protracted over the years and new conditions of even economic fragility, nonetheless, malnutrition is widespread and exposes people to risks that affect their quality of life. However, the Italian health care system is still seriously inadequate in monitoring and managing the phenomenon.
Nutrition of the elderly, the deficiencies that make one ill
The phenomenon is well analyzed in the paper prepared by a group of experts for the Ministry of Health. (1) The text focuses on malnutrition by default, defined as ”A state resulting from reduced nutrient intake or absorption that leads to altered body composition (decreased lean mass) and body cell mass resulting in penalized physical and cognitive function and altered disease prognosis‘ (Cederholm, 2017).
This form of malnutrition is more common in the elderly who live in nursing homes/RSAs or are hospitalized. It also occurs, however, among those living in their own homes, especially those afflicted by loneliness, low income, disability, chronic illness, depression, drug treatment, and chewing difficulty. Speaking of the latter, an average of 13 percent of Italian over-65s claim to suffer from it, with peaks of 22.2 percent in Calabria. (2)
Older people, more than 1 in 5 in Italy
The elderly-understood as all those over 65-represent 22.8 percent of the population in Italy. (3) With enormous distinctions (genetic, social, economic etc.), a progressive reduction in organ and system function begins at this stage of life.
It also increases, with age, the susceptibility to so-called Non-Communicable Diseases, NCDs. Noncommunicable diseases, such as cardiovascular, pulmonary, neurodegenerative, muscle/skeletal problems, diabetes, and cancer.
Prevention is based on adopting (and/or maintaining) a ‘healthy’ lifestyle, including regular physical activity (where possible) and a balanced diet.
The guidelines for nutrition in the elderly.
The authors of the CREA Healthy Eating Guidelines explain, ‘Proper nutrition is defined as a balanced and varied diet, including all available foods in the correct amounts and frequencies of consumption.’
This diet should be supplemented with motor activity compatible with health status. ‘Muscle activity provides a mechanical stimulus that activates bone tissue production as well as improving stability and thus the ability to prevent falls.’
In practical terms, it’s perfectly fine to walk half an hour or an hour a day, even if it’s just to go grocery shopping or walking with friends and family. For those who can, it is great to add more strenuous physical exercises 2-3 times a week. And to gradually get active again after a period of immobility, ad hoc exercises are available online. (4)
The diet of the elderly
The diet of the active elderly does not vary much from that of the healthy adult, as we have seen. However, it must come adjusted to the lower energy consumption due to reduced physical activity and lean mass (with decreased baseline metabolism), penalty overweight and obesity, which affect 43.9 and 14.2 percent of the over-65s, respectively. (5)
The general indication is therefore to favor foods with more protein (to better support declining muscle mass) and less fat (extra virgin olive oil is ideal) and to enrich the diet with vegetables and fruits.
Recommended foods
Recommended protein foods are.
– Reduced-fat milk and yogurt with no added sugar,
– legumes,
– eggs,
– fish (source of omega-3),
– meat (lean and white).
These foods are also a source of calcium and iron, nutrients that the elderly often lack.
Finally, two golden rules: drink plenty of water and avoid salt, which, moreover, at any age should not exceed 5g/day.
Vitamins and minerals, deficiency risk
Due to diet and age-typical stressors (diseases, medications, infections, etc.), elderly people are more prone to vitamin deficiency, especially D, those of the B group (B6 and B12, primarily), C and E.
Other critical micronutrients are magnesium, iron, zinc, and selenium, particularly in the hospitalized elderly.
The health care system is latent
The centrality of nutrition in the health of the elderly has so far not found adequate consideration within the national health care system.
The Ministry of Health document mentioned earlier indicates how to address the main critical issues.
– Establish a national nutrition surveillance program referred to the over-65s. The only existing tool is ‘Silver Steps‘ which, however, does not pay special attention to malnutrition by default.
– Implement care and operational facilities as well as educational offerings in clinical nutrition to overcome the current insufficient sensitivity of the entire system (health professions, caregivers, media, institutions) to nutritional issues in geriatric individuals.
– Provide for the involvement of a multidisciplinary pool of physicians to examine nutritional aspects in the multidimensional assessment of the subject. Currently, there is even a lack of a nutrition card in the medical record, and nutrition services (diagnostic and therapeutic) are not included in the LEAs, the Essential Levels of Care.
– Impose the transposition of the guidelines for mass catering in long-term care, rehabilitation facilities and RSAs, so that the adequacy of the diet in relation to the patient’s pathology is guaranteed.
– Provide for the consideration of nutritional aspects in the quality criteria of care facilities.
Marta Strinati
Notes
(1) Ministry of Health. Improving the health of the elderly for nutritional aspects (with special emphasis on malnutrition by default). 10.6.21. https://www.salute.gov.it/portale/nutrizione/dettaglioPubblicazioniNutrizione.jsp?lingua=italiano&id=3074%20
(2) ISS. Silver Steps, 2017-2020 indicators. https://www.epicentro.iss.it/passi-argento/dati/vista
(3) See Eurostat, December 2020 https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Archive:Struttura_e_invecchiamento_della_popolazione&oldid=510189#La_percentuale_di_anziani_.C3.A8_in_continuo_aumento
(3) CREA. Guidelines for healthy nutrition. Revision 2018. https://www.crea.gov.it/web/alimenti-e-nutrizione/-/linee-guida-per-una-sana-alimentazione-2018
(4) Mobility exercises are available at wikiparky.tv. See also, for example, the video on YouTube https://www.youtube.com/watch?v=t1nrVkPM0pg
(5) ISS. Silver Steps, 2017-2020 indicators. https://www.epicentro.iss.it/passi-argento/dati/obesita
Those with doubts about their Body Mass Index (BMI) can check their weight-form status by entering height and weight into the calculator on the Ministry of Health website. https://www.salute.gov.it/portale/nutrizione/dettaglioIMCNutrizione.jsp?lingua=italiano&id=5479&area=nutrizione&menu=vuoto
Professional journalist since January 1995, he has worked for newspapers (Il Messaggero, Paese Sera, La Stampa) and periodicals (NumeroUno, Il Salvagente). She is the author of journalistic surveys on food, she has published the book "Reading labels to know what we eat".
