Singapore faces an ageing population - 1 in 7 Singaporeans now are 65 and above, and by 2050, it will rise to 1 in 3.
Getting older is not just having to deal with forgetfulness or greying hairs. There are challenges that come with ageing such as physical, biological, emotional and social changes.
Some seniors require more care in basic tasks because of ailments and chronic medical conditions. While certain conditions are unavoidable, most of them can be helped with proper care and attention to diet and physical activity.
Let’s explore the 5 most common nutritional problems that the elderly face currently.
Did you know that 50% of the elderly suffer from constipation? The figure is even higher for those living in nursing homes and dependent on care.
Constipation can be defined as having fewer than three bowel movements a week or present itself as dry and hard stools and difficulty passing the stool.
There are many reasons that contribute to this impairing condition, such as:
- Medical conditions and illnesses (such as Parkinson's and Diverticular Diseases, Colorectal cancer, Diabetes, Irritable Bowel Syndrome and Hypothyroidism).
- Taking medications (such as painkillers, antidepressants, antacids, iron supplements, allergy and blood pressure pills).
- Not getting enough exercise.
- Not drinking enough water.
- Not getting enough high fiber foods.
- Getting older. Ageing results in less activity and movement, a slower metabolism and less ability for the muscles in the digestive system to move compared to younger people.
- Postmenopausal changes in women.
Managing constipation can be both challenging and frustrating for both the person suffering from it and their caregiver because it can bring about a host of complications including:
- Anal fissures
- Faecal impaction (when there is a pile-up of too much stool in the rectum and anus
- Damage to the pelvic muscles from straining in the toilet (this can also lead to bladder and urine problems later on).
2. Sarcopenia - age related muscle loss
Sarcopenia means ‘loss of flesh’ and this condition is common in people over the age of 50.
We all start losing muscle and strength as we get older, but by the time someone reaches 80 they could have lost half of their muscle mass.
Even people who are physically active can lose muscle mass and strength over time. Scientists believe that there are several reasons that contribute to sarcopenia even in active seniors, such as:
- Less nerve cells responsible for sending signals from the brain to the muscles for movement
- Lower levels of some hormones (i.e. growth hormone, testosterone)
- A decrease in the body’s ability to turn protein into energy
- Not getting enough calories or protein daily to maintain muscle.
Over time, Sarcopenia can lead to more weakness, increased falls risk and mobility problems. However, if recognized early, Sarcopenia can be managed to improve a senior’s quality of life.
In a hot and humid country such as Singapore, staying hydrated is not as straightforward as we think.
Often we can’t even tell that someone is dehydrated as they don’t show the obvious signs such as increased thirst, dry mouth, dizziness, weakness, headache or fatigue.
In the elderly, signs of dehydration can be even more vague and deceptive. Did you know that a quarter of seniors living in their homes without a caregiver are not drinking enough water?
Why do our seniors get dehydrated so often?
To start with, as we age, the water content of our bodies goes down. Our kidneys also deteriorate with age, so they do not regulate fluid effectively. What’s more, older people just don’t feel as thirsty as younger people do as their thirst signals are not as active as before.
They can also be:
- Taking medicines like diuretics and laxatives that may cause them to lose precious water and electrolytes from their bodies.
- Unable to move around and may need help to walk. As a result, they may feel embarrassed asking for help to get water.
- Suffering from dementia or memory loss and may not remember to drink.
- Intentionally drinking less water due to problems such as incontinence.
- Having chronic conditions such as constipation, dysphagia, diabetes or kidney disease. These conditions put them at a higher risk for dehydration.
The impact of dehydration can be severe. If untreated, it can lead to kidney stones, urine tract infections, delirium, and serious imbalance of electrolytes, weight loss and ultimately death.
4. Obesity leading to chronic diseases (Type 2 Diabetes, High Blood Pressure and Heart Disease)
Improved lifestyles and social conditions of people over the last few decades have not only expanded their lifespans but their waistlines too.
People are now entering old age along with excess kilograms from their younger years. It’s scientifically proven that obesity puts us at risk for many diseases.
Common diseases such as diabetes, hypertension, high cholesterol, heart disease and certain cancers all link to excess body fat, especially the fat around the stomach called central obesity. It's this type of fat which is linked to insulin resistance, high blood pressure and high cholesterol levels.
The reasons why an elderly person may be overweight or obese include:
- Declining metabolism as we age.
- Unhealthy eating habits (such as a higher fat diet, excess calories and high salt intake).
- Less activity in daily life (elderly people tend to be more homebound)
- A decrease in hormone levels, increased inflammation, loss of bone mass.
These reasons above may mean, even with the same amount of food intake, our body fat may increase in advancing years. But it can also be misleading to assume that someone on the heavier side is healthy. They may have more fat on their body but be depleted of muscles (sarcopenia).
Advising an elderly overweight person with chronic disease can be a double edged sword. On one hand, they may end up eating a lot less which can cause nutrient deficiencies, more muscle and bone loss. On the other hand, it may improve their chronic disease markers (blood sugar levels, blood pressure and cholesterol markers) and their physical state.
For this reason, obesity in an elderly person should not be addressed separately, but as it relates to specific conditions (e.g., hypertension, high cholesterol, diabetes).
While obesity is the most concerning problem in the world currently, malnutrition is a hidden problem creeping up in the elderly. Believe it or not, an elderly person can be overweight and malnourished at the same time.
It is important for all adult children or caregivers of an ageing person to understand the signs of malnutrition and risks associated with it. It’s not just how much grandma weighs, but how much weight she has lost over time that is important in understanding malnutrition.
Malnutrition is caused by a multitude of problems such as:
- Taste, smell and appetite changes which can degrade with age.
- Illness. Being sick will most likely cause a decline in appetite and change the way our bodies absorb nutrients.
- Difficulty chewing, swallowing and poor dental health.
- Physical changes such as not being able to handle cutlery, not being able to cook their favourite meals or walk to the hawker centre and get their meals.
- Dementia/ Alzheimer’s disease. Memory problems causing someone to forget to eat, eat at irregular times or forget to buy groceries.
- Medicines. Often medicines are expensive which can leave a senior who may already have financial limitations eating a basic diet or buying less food. Some medicines can also negatively affect appetite.
- Depression. Not having enough social contact, grief and isolation can contribute to malnutrition as well.
If not addressed, malnutrition can lead to:
- Poor wound healing.
- Muscle and bone loss which leads to fractures and falls.
- More infections.
- Higher chances of being hospitalized and dying.
If you find yourself facing the above nutritional challenges, you are more likely to be admitted for complications and your recovery will take much longer than expected. You are also likely to have longer hospital stays which increase the cost of your care and emotional burden for yourself and loved ones.
Therefore, it's important to pay attention to the challenges that may arise and make positive changes to your diet and lifestyle which will ultimately improve your wellbeing.
Do you have a loved one who needs nutritious food that is easy to chew and palatable for their taste buds? Visit CaregiverAsia's E-store to view Health Food Matters' Delisoft Easy Meals that come in different textures and can be easily served by reheating in the microwave or steamer!