A balanced diet to grow older healthily

Written by Philippe MIGLIASSO - Senior Healthcare Executive – Director of the Monaco Gerontology Coordination Centre

Dynamics of life expectancy over the last 50 years

Whilst over the last 50 years, life expectancy has risen by 15 years thanks to medical advances, particularly in the field of cardiology, along with improvements in living and working conditions, it is important that those who live longer lives are able to retain their independence in their later years.Given the diversity of our elderly population, there is a need to revise the way we approach ageing, which is too often treated like an illness. Ageing is an entirely normal physiological process, from conception until the end of life. Chronological age, whilst it remains an important indicator, cannot be the sole basis on which we determine whether someone requires health or social care. We need to move from a curative paradigm to a more functional one, that prioritises a preventive approach to health.
Nutrition, physical activity, social interaction, and adaptation to our environment are all ways of ageing successfully.
Gerontological literature shows the important influence of nutrition on the ageing process, and in particular its benefits in preventing the onset of certain diseases (cardiovascular diseases, diabetes, obesity, etc.) and the worsening of existing conditions.

The Monaco Gerontology Coordination Centre working for the benefit of elderly persons

With 17 years of experience treating 3,115 persons and carrying out some 9,500 Gerontological Assessments of elderly people in the Principality, the Centre de Coordination Gérontologique à Monaco has confirmed the importance of diet to a healthy old age.

The CCGM’s target audience mainly consists of people who are now fragile or have already lost their independence to some extent. To reflect that, this publication will focus mainly on the malnutrition frequently observed when carrying out home independence assessments. 
The Monaco Gerontology Coordination Centre’s expertise is built on a holistic approach to the individual. The key role of diet in the elderly population must be considered in terms of each component of this global bio-psycho-social and environment approach.
Contrary to received wisdom, older people do not have fewer nutritional requirements. This is particularly true given that older bodies find it more difficult to use nutrients, as shown by a 2001 study by Martinet al. 2001.

There is also a high prevalence of malnutrition in the over 70s, observed in 4 to 10% of those living in their own home, 30 to 70% of those in hospital, and 15 to 38% of those in residential care or assisted living facilities. These statistics make malnutrition in the elderly a disease in its own right, the main causes of which are insufficient protein-energy intake due to overly restrictive diet, lower intake and hypercatabolism corresponding to increased nutritional requirements as a result of illness of any kind.

Maintaining your diet

An acute or chronic illness, a pressure sore, a fracture, oral or dental problems, swallowing disorders, or stress can increase the amount of energy the body needs. If your nutritional intake does not increase, your body will draw from its reserves (muscle mass) and you may experience weight loss, eventually leading to sarcopenia (muscle atrophy, loss of strength). This has a knock-on effect on physical performance, with a higher risk of walking difficulties and falls, and causes fragility in elderly people.

The psycho-social causes of malnutrition are as important as disease-related causes. Loneliness and social isolation play a major role in dietary deficiencies. A study by FERRY et AI* on the interaction between nutrition and solitude in people over the age of 70 found that isolated people had a 21.3% risk of being malnourished, compared with between 4 and 7.5% for those not living alone. Depression is another factor in malnutrition, but can also itself be a consequence of dietary deficiencies. 
In the same vein, a Japanese study** confirmed that eating meals alone is a risk factor for depression in elderly subjects. It also contained an extra finding: living alone increases this risk further, much more markedly in men than in women.

From a sociological and anthropological viewpoint, meals are not merely a means of taking in food. They are also a ritualised way of creating and maintaining social links, as reflected in the social, cultural, and/or religious importance of food in human societies.
As their bodies age, humans become more susceptible to malnutrition. It is therefore vital to properly understand the mechanisms and consequences, in order to prevent malnutrition and its effects. The high incidence of malnutrition requires adjustments to eating habits, not just individually but collectively.

Consistent food intake regardless of age or environment

Individually, it is important to maintain a daily intake with sufficient protein in particular, and to move past the preconception that when we age, our bodies’ nutritional requirements are lower than for younger adults. In our region, the Mediterranean diet provides quality nutrition.
Collectively, diet should be a concern for every professional working with elderly people with compromised independence. This includes general practitioners, gerontologists, nurses, psychologists, personal carers, and any other care provider.

Nutrition: a combination of dietary and social factors

A person’s nutritional condition is not merely about the contents of their plate. Mood and capacity for social interaction are also alert factors requiring close attention.
Communicating about the vital importance of nutrition for elderly people, sweeping away preconceived ideas and encouraging elderly subjects to eat together, could be effective ways to promote proper diet and nutrition into old age and enable people to remain independent.

* SOLINUT study of the relationship between nutrition and loneliness in the over 70s
M. Ferry, B. Sidobre, +1 author P. Barberger-Gateau Published 2005 Political Science Age and Nutrition
 ** Tani Y., Sasaki Y., Haseda M. et col. (2015) Eating alone and depression in older men and women by cohabitation status: The JAGES longitudinal survey, Age and Ageing ; 44: 1019-1026