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Diet and lifestyle information for the elderly living in homecare

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                Nutrition has been recognized as an important factor in influencing the functional outcome of ageing as well as impacting on the nutrition of the elderly (Munro, 1992).

        It has been established also that undernutrition rather than overnutrition seems to be the main concern specifically for those who are in home-care. Medical experts point out that

undernutrition “impacts on both physiological and biochemical systems leading to impaired immune response and respiratory function, delayed wound healing and overall increased complications (Windsor et al, 1988).It is therefore crucial that menus offered by such home-care facilities be scrutinized to see if they meet the nutritional requirements for the elderly (DOH).

        To begin the analysis, let us first consider the macronutrient content in the menu; macronutrients of course are carbohydrates, proteins and fats in larger amounts. It has to be noted that even as there is an expected limitation of physical activity among the elderly, it is encouraged that they increase it- in this regard, it is important that macronutrients provide the appropriate energy requirements (Mercola, 2005). Carbohydrate sources present in the menu include rice, pasta, breads, cereals, vegetables, beans, nuts and baked products and sweets. There should be more complex carbs present such as those found in potatoes, or beans, nuts and other vegetables. The pasta and the bread are unfortunately refined which is not good; the emphasis should be more on wholemeal or wholewheat which has three times more beneficial non-starch polysaccharides than white flour (proven to lower cholesterol, prevent heart disease and slow down glucose absorption) (BNF, 2004).

        While it has been urged that senior citizens who have poor appetites be given “generous” doses of sweets to perk up their appetites, the menu has an alarmingly too large amount of “empty carbohydrates” and far too much refined sugars; the deserts alone are enough to make anyone obese (Black Forest, Apple Crumble, Bread and Butter Pudding). Since there is a noticeable lack of fresh fruits, the menu could serve these instead of these pastries and cakes in the form of fresh fruit salads, smoothies or parfaits. Even the breakfast cereals are sugary regardless of the fact that they have whole-wheat in them or bran (BBC, 2008).

        In terms of fat, saturated fat is a no-no, but as a rule, fat is encouraged to maintain strength and weight gain among the elderly who have trouble keeping them. In this regard, fat content in the menu is plentiful; there is plenty of cream (appears in all the deserts!) as well as being present in the form of mashed potatoes and in dairy products such as cheese. Significant sources also appear in beef and in fried foods. Thankfully, it has been noted that healthy sunflower oil is used for cooking.

        There is an alarming lack of fiber in the menu. It is improbable to believe that a few prunes for breakfast, hardly any whole wheat enriched food and boiled vegetables will suffice. Again, it is urgent that vegetables, preferably steamed or fresh and in the form of salads and as well as fresh fruit be incorporated into the menu. It will not be surprising to discover if the majority of the elderly who are served this menu experience constipation.

        Water could help digestion, but there are far too much caffeinated drinks which don’t bode too well either for good digestion.Generally, the vitamin and mineral intakes of institutionalized elderly were lower than those of free-living elderly, with the exception of calcium, riboflavin and vitamin A (DOH, 1992).

        Again, because as there is a glaring lack of fruits and vegetables in the diet, with the variety limited to starchy vegetables, there is a strong possibility of a lack of important micronutrients or vitamins as well as phytonutrients in the diet (CC, 2006).

        This is alarming if one considered studies which show that digestive cancers according to a U.K.-based Institute for Food Research report can happen among those who have insufficient amounts of micronutrient, fiber- and phytonutrient-rich fruits and vegetables such as apples in their diets. Fresh apples (not baked!) have flavonoids may significantly reduce the risk of developing digestive or “gut” cancers (Johnson, 2004).

        Minerals such as Iron: sufficient amounts in the cereals and the meats; good sources however are leafy green vegetables which are not present. Efficient absorption through Vitamin C, but there is no evidence on the menu to suggest viable vitamin c sources! No fresh fruit or even fresh or tinned fruit juices in lieu of the tea and coffee. Trace minerals such as zinc which help in the immune system can actually be provided through a supplement, but it would be nicer if there were more wholemeal breads and shellfish on the menu which are good zinc sources (BBC, 2008).

        There is adequate calcium on the menu obviously from the cream and the cheeses. No problems with Vitamin D (can be sourced from supplements or increased sunlight exposure) although there could be Vitamin B deficiency because there is generally a lack of sufficient vitamins and minerals available from the menu.  In terms of flavor and variety there is much to suggest that it does appeal to the clientele, however, this is not a restaurant where individuals make their own choices based simply on flavor. There is a greater responsibility to provide the necessary dietary requirements in a health-care setting. In summary, the important points are the following; 1) More fresh vegetables and fruits to replace at least half of the snacks and deserts which have far too much sugar; 2) Too much saturated fat in the deserts as well which offsets the use of sunflower oil; 3) Explore the grilling of food instead of baking and frying which can introduce healthier and fresher side-fare such as fresh vegetables; 4) Additional whole-wheat products; 5) More fresh produce such as shellfish, fish and healthier meat alternatives like lamb or venison.

References

BBC (2008) Nutrition- Life stages, (online). Available at

http://www.bbc.co.uk/health/healthy_living/nutrition/life_over501.shtml#nutritional_considerations

BNF (2004) Starchy foods in the diet, (online). Available

http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=796&parentSection=341&w        hich=

Changing Currents (2006) Not all vegetables and fruits are equal, (oline). Available at

http://alternatingcurrents.info/health.html

Department of Health (1992): The nutrition of elderly people. Report of the working group on

        the nutrition of elderly people of the committee on medical aspects of food policy. Report         on Health and Social Subjects No 42. London.

Johnson, I.T. (2004) Mutation Research: Fundamental and Molecular Mechanisms of         Mutagenesis 2004, (online) Available at         http://www.sciencedirect.com/science/journal/00275107

Mercola, J.(2005) Carbohdyrates, (online). Available         http://www.mercola.com/nutritionplan/beginner_carbs.htm

Munro HN (1992) Nutrition of the elderly. Eds Munro H, Schlierf G, Nestle Nutrition Workshop

        Services. Vol 29 Nestle Ltd Vevey/Raven Press Ltd, New York

Windsor JA, Graham MB, Hill GL (1988). Risk factors for post operative pneumonia. Annals

        Surgery.

BBC (2008) Nutrition- Life stages, (online). Available at

http://www.bbc.co.uk/health/healthy_living/nutrition/life_over501.shtml#nutritional_considerations

BNF (2004) Starchy foods in the diet, (online). Available

http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=796&parentSection=341&w        hich=

Changing Currents (2006) Not all vegetables and fruits are equal, (oline). Available at

http://alternatingcurrents.info/health.html

Department of Health (1992): The nutrition of elderly people. Report of the working group on

        the nutrition of elderly people of the committee on medical aspects of food policy. Report         on Health and Social Subjects No 42. London.

Johnson, I.T. (2004) Mutation Research: Fundamental and Molecular Mechanisms of         Mutagenesis 2004, (online) Available at         http://www.sciencedirect.com/science/journal/00275107

Mercola, J.(2005) Carbohdyrates, (online). Available         http://www.mercola.com/nutritionplan/beginner_carbs.htm

Munro HN (1992) Nutrition of the elderly. Eds Munro H, Schlierf G, Nestle Nutrition Workshop

        Services. Vol 29 Nestle Ltd Vevey/Raven Press Ltd, New York

Windsor JA, Graham MB, Hill GL (1988). Risk factors for post operative pneumonia. Annals

        Surgery.

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