Mauritius too has witnessed a surge in its elderly population: between 1972-2015, the percentage of people aged 60 and over has risen from 5.9% to 14.8%, representing a remarkable 2.5-fold increase (Le Mauricien, 2017). Data from more recent 2017 versus 2016, demonstrate a 4.5% increase with 202,233 people aged 60 and over compared to 192,789 in 2016 (Express.mu, 2017). According to figures provided by Statistics Mauritius, generally life expectancy has increased to 77.8 years for women and 71.4 years for men in 2018.
Whilst the prolongation of longevity is suggestive of significant improvement in the healthcare provision, it has not been supported by specific strategic changes for a healthy life expectancy. As a result, most countries have seen an increase in the number of healthy life years being lost to age-associated disability (Bauer et al, 2013). Whilst it is clear that societal measures such as lifestyle changes need to be implemented to address this gap in morbidity, a clinical solution to address the physiological requirements for healthy ageing is also impending. One such requirement which ranks very high up is adequate nutrition. Accumulating evidence from various studies shows a clear association between adapted nutrition and the healthy ageing process (Bauer et al., 2013). Along with declining activity levels, age-related reduction in food consumption are well-documented, with significant differences in energy intake across adulthood. In a recent analysis of energy intake data in healthy older (70 years) and younger (26 years) adults, a difference in energy intake of 16–20% was reported between the groups, amounting to a reduction of roughly 0·5% per year (Giezenaar et al, 2016).
There are a number of physiological changes associated with ageing which may impact on overall nutritional status of an older person. These include more rapid and longer satiation, dental and chewing problems, reduced hunger and thirst, and impairments in smell and taste, that can all affect eating behaviour. Older adults may eat more slowly, consume smaller meals and snack less, leading to lower food consumption and ultimately, weight loss (Shlisky et al., 2017; Nieuwenhuizen et al., 2010). Described as the ‘anorexia of ageing’, and arising from the loss of appetite coupled with diminished food consumption, this is common in older adults, and known to be an independent predictor of adverse health outcomes (Landi et al., 2016). Consistent with the possibility of an increasing nutritional risk, many studies in older adults report insufficient intakes of a range of essential nutrients, including proteins, fibres and micronutrients (Shlisky et al., 2017). Following reduced food consumption, and changing nutrient requirements, consumption of nutrient-dense foods and an adequate diet are key to ensuring older adults meet the nutrient needs.
Ageing is a core part of physiology. Immunosenescence during ageing is a major challenge which weakens the ability of older individuals to respond to infection or vaccination (Robinson, 2018). There has been significant focus on dietary strategies to improve immunity in older people, but potential changes in modulation of the immune response during ageing have been essentially overlooked as it is wrongly assumed that it is based on the same principles as for younger adults. Recent evidence suggests that ageing fundamentally alters the impact of nutrition on immune function. As a result, interpretation of data from studies investigating the impact of diet on immune function is highly dependent on the subject age. Study design is critically important when investigating the efficacy of dietary components, and most studies involving older people include rigorous inclusion/exclusion criteria based on medical history, laboratory tests, general health status and often nutritional status. However, immunological status is rarely accounted for, but can vary significantly, even amongst healthy older people. There are several clear examples of age-related changes in immune cell composition, phenotype and/or function, which can directly alter the outcome of an intervention. A review by Robinson (2018) resorts to two case studies to illustrate how the effects of n-3 PUFA and probiotics differ in young versus older subjects. The results suggest that baseline differences in immunosenescence can markedly influence the outcome of an intervention, highlighting the need for detailed immunological characterisation of subjects prior to interventions.
Proteins, along with carbohydrates and lipids, are needed by the body to function normally. Proteins generally make up 10-15% of the body’s energy needs. Since the body is not able to store amino acids in the same way as carbohydrates and fats, a daily intake of amino acids through protein are needed in the diet to make new protein. Reports from the scientific community and health authorities such as the European Food Safety Authority (EFSA) indicate that dietary proteins have a beneficial effect on the whole lean body mass, including muscle mass (European Food Safety Authority, 2010). The recommended Reference Nutrient Intake (RNI) for an adult is 0.83g of protein per kilogram bodyweight per day (Houston et al, 2008).
According to nutrition experts, it is recommended that men and women in their 50s increase their protein intake (Bauer et al., 2013). An intake of 1-1.2g of protein per kilogram of body weight per day is recommended for the 50+ (European Food Safety Authority, 2011). Whilst proteins can be found in a variety of food items, if it is not possible for an adult over 50 to get adequate protein through the normal diet, high quality nutritional supplements enriched with essential amino acids, may be advisable.
This article is intended for medical professionals.
Prepared by:
Dr Reshma Ramracheya
Diabetes UK RD Lawrence Research Fellow
Senior Research Fellow at Wolfson College
University of Oxford, UK
Reshma.ramracheya@ocdem.ox.ac.uk
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