Elderly and malnourished (by JOAN CHEW in )

The following is areport by JOAN CHEW in Mind Your Body of the Straaits Times dated 16 September 2010, Wednesday.

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Madam Chia Joo Sin does not really pay much attention to what she eats.

The dietary habits of the 66-year-old widow and mother of five grown children are far from ideal.

When Mind Your Body visited her this week, she was preparing a simple one-dish meal of fried rice with eggs, two prawns, salt fish and a few pieces of Chinese sausages for dinner. She did not include fruit, vegetables or milk in the meal.

She described the dish as typical of what she would normally eat.

Apart from having meals that are not nutritionally balanced, the widow, who spoke in Mandarin, also admits skipping lunch occasionally because she is 'too lazy to prepare it'.

Madam Chia lives with her 17-year-old grandson in a rental flat in Toa Payoh, where she often eats alone as her grandson has his meals in school.

She said that she is not fussy about food and even accepts meals from her neighbours occasionally. This is because she has difficulty going out to buy groceries due to health problems and depends on her daughter to shop for her.

Madam Chia has high blood pressure and osteoarthritis and her medicines make her hungry. However, she bears with the hunger pangs sometimes because she finds cooking troublesome. Having dentures also make it harder for her to chew food.

The eating habits and nutritional deficiencies of the elderly here were highlighted in a recent survey.

It found that a dismal 1 per cent of 421 respondents aged 50 years and above have a balanced diet that meets the recommendations of the Health Promotion Board.

This means that the majority were not eating enough of rice and other carbohydrates, fruit, vegetables, meat and diary products. Almost three in 10 were found to be at moderate or high risk of malnutrition.

The survey affirms doctors' observations that many malnourished elderly people often have existing medical conditions and problems swallowing or chewing. As a result, they may become even more averse to eating.

Citing an example, a consultant for the survey said that an elderly person with high blood pressure, who when told to take less salt, may refuse salt totally in his food.

As a consequence, his body's sodium level drops and he feels nauseous, lethargic and confused and may even have to be hospitalised.

Medical conditions which affect the eating habits of the elderly are not uncommon.
They are one of the top three reasons contributing to nutritional risk among the respondents, according to the survey released this month.

The other two are eating fewer than two meals daily and eating few fruit, vegetables or milk products.

The survey, commissioned by health-care firm Abbott Nutrition, and carried out over two months this year, also captured a portrait of the type of elderly person who is at moderate or high risk of malnutrition.

He or she is likely to be 65 years old and above and lives alone in a one- or two-room HDB flat. The researchers noted that living alone, and thus typically eating alone, affects the mood of the elderly.

However, even those who live with their better-off families in private housing can suffer from nutritional deficiencies, they added.

Dr Chan Kin Ming, 51, the founding member of the Society for Geriatric Medicine and a consultant for the survey, explained: 'Eating alone is not a pleasurable activity.
'The aim is now to just fill the stomach and some elderly people may turn to easily prepared meals like instant noodles and neglect their nutritional needs.'

Dr Chan, a senior consultant geriatrician at Gleneagles Medical Centre, added that the elderly may view eating as a chore when they cannot swallow or have trouble chewing their food.

This is especially so if the person has had a stroke or has a degenerative disorder like Parkinson's disease.

Having to cope with chronic conditions and the use of medication often reduces an aged person's appetite. As a result, they often associate eating with unpleasant symptoms like nausea and feelings of indigestion, said Dr Chan.

To combat this lack of interest in food, he advised the aged and their caregivers to alter the texture of food so that it is more palatable.

For instance, minced meals and pureed food can be prepared using a blender or food processor.
Eating such food minimises chewing while allowing the elderly to maintain an adequate food and nutrient intake.

For a senior citizen who complains of poor digestion, Dr Chan recommends five smaller meals be eaten throughout the day, instead of the three main ones of breakfast, lunch and dinner. This is to avoid overloading the stomach, he explained.

Mr Derrick Ong, a dietitian from nutrition consultancy Eat Right, said that the optimal diet may not be practically achievable by the aged. To 'bridge the energy gap', senior citizens may take nutritional supplements, he said.

Dr Chan said that having meals that are nutritionally deficient or imbalanced may eventually lead to problems like diabetes and osteoporosis.

He said: 'Instead of fire-fighting when problems arise, we should look at nutrition as the foundation on which our health rests.'

To help you track your nutritional risk, get the checklist 'Determine Your Nutritional Health', available at some 1,000 GP clinics this month.

Distributed by Abbott Nutrition, it includes 10 questions covering dietary, general and social habits to assess nutritional risk in the elderly.

You can get it online at www.abbott.com.sg/ensurelife_determine