What needs to be done in Indian Scenario?

Awareness

Elderly subjects should be encouraged to include iron & micronutrient rich foods Consumption of fruits, vegetables, whole grains and good hydration of at least 1,000mL of fluids/day. Fat free and low fat free dairy products, legumes, poultry, fish at least once a week, supervised medications and ensuring the drug compliance in elderly. Government, NGO, community, families, medical & social science faculties need to give greater emphasis, to provide health care, societal support & nutrition services to the elderly [9].

Training

Elderly patients are particularly at risk because more than 30% of all the prescription drugs are taken by this population [10]. At present, most of the geriatric Outpatient Department (OPD) services are available at tertiary care hospitals in India. Since 75% of the elderly reside in rural areas, it is mandatory that geriatric health care services be made a part of the primary health care services. This calls for specialized training of medical officers and other paramedics in geriatric nutrition. The elderly population has longevity on one hand and compromised quality of life on the other. The probable solution is multidimensional approach that comprises not only curative, but also non-curative methods of care that are essentially preventive which starts from the nutritional advice.

Education

The adverse health consequences of malnutrition are impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognition, delayed wound healing and delayed recovery from surgery, increased risk of falls, disability and mortality. Anorexia and malnutrition lead to muscle wasting and loss of subcutaneous fat leading to weight loss in elderly people. Malabsorption, hyper metabolism, cancers, admission to elderly home, acute illness, hospitalization, depression, various drugs, dysphagia, oral infections, dental issues, GI conditions, endocrine conditions such as thyroid diseases, poverty, reduced access to food and dehydration contribute further to weight loss. Awareness in the patients, caregivers and physicians related to this often neglected issue is important [11].

Precautions

Elderly people are vulnerable group. The care of drug nutrient interactions in elderly people is essential. The purpose of review before recommending nutrition could be the presence of multiple diseases, polypharmacy, malnutrition and impaired metabolism in elderly individuals increases the risks of adverse events related to drugfood interactions [12]. When investigating pharmacokinetic and pharmacodynamic modifications in the elderly, other factors have to be considered, such as anorexia, dementia, depression, intolerance, gastrointestinal-tract disorders, social and economic factors, reduced abilities (visual and manual) and difficulties in chewing or swallowing. In order to develop a correct drug prescription plan and nutritional intervention to avoid any kind of undesirable drug food interaction effect, it is necessary to adequately diagnose the disease and often re-evaluate the chosen treatment, identify disease stages and the ecessary therapies to minimize the number of drugs administered, and select a reasonable nutritional assessment.

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Essential Nutrients required in Elderly

A Report of the Expert Group of the Indian Council of Medical Research 2009 from NIN (National Institute of Nutrition) guideline 15 recommends including micronutrient rich foods in the diets of elderly people to enable them to be fit and active [13]. Therefore, the elderly need nutrient-rich foods rich in calcium, micro-nutrients and fiber. Apart from cereals and pulses, they need daily at least 200- 300ml of milk and milk products and 400g of vegetables and fruits to provide fiber, micro-nutrients and antioxidants. Inclusion of these items in the diet improves the quality of the diet and bowel function. Flesh foods and eggs add to the quality of diet. There is no compelling evidence that suggests that protein requirements for the elderly are increased. There have been suggestions that the elderly require more protein intake, owing to a reduced absorptive capacity, but N balance studies do not provide enough evidence to make a recommendation for an increased protein intake. However, protein and energy are inter-related. In an elderly person whose activity is maintained, there is sufficient energy intake to ensure adequate protein intake. In the sedentary elderly person, with reduced energy requirement, there is a need to consider the protein energy ratio of the diet, since protein intake can reduce if the total diet is reduced.

The dietary guidelines also mentions importance of Riboflavin in elderly quoting to the study involving elderly subjects in Guatemala in which measurement of urinary riboflavin excretion and EGRAC were used, it was concluded that the requirement of healthy individuals aged above 60 years probably does not differ from that for individuals below 51 [14]. WHO recommends the below table of essential nutrients for the elderly (Table 1) [15].

Table 1: Recommended nutrient intakes for older persons (WHO, 2002).

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Phytonutrition or Nutraceuticals: - Much more than only Nutrition

Plant foods contain thousands of natural chemicals. These are called phytonutrients or phytochemicals.”Phyto” refers to the Greek word for plant. These chemicals help protect plants from germs, fungi, bugs and other threats. More than 25,000 phytonutrients are found in plant foods. These plant compounds have beneficial effects working with other essential nutrients to promote good health.

As Nutritional status is one of the chief variables that explains differences in both the incidence and pathology of infection. Elderly people are at increased risk for micronutrient deficiencies due to a variety of factors including social, physical, economic and emotional obstacles to eating. Thus there is an urgent need to shift priorities to increase our attention on ways to prevent chronic illnesses associated with aging. Individually, people must put increased efforts into establishing healthy lifestyle practices, including consuming a more healthful diet. The present focus is on the phytochemicals of nutraceutical importance for the geriatric population.

Some of the most essential Nutraceuticals are:-

1. Antioxidants

2. Plant polyphenols and catechins: Turmeric, green tea, grapeseed etc.

3. Carotenoids: Lutein, zeaxanthin, and lycopene

4. Plant phenols/sterols (phytosterols)

5. Omega-3 fatty acids

6. Glucosamine, chondroitin, collagen and quercetin

7. Prebiotics and probiotics

8. Coenzyme Q10

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Dietary Botanicals as Geriatric Nutrition

Apart from the isolated extracts of plant chemicals as nutrition, a wide range of botanical ingredients are used as geriatric supplement to maintain healthy lifestyle. The common examples being Ginkgo biloba for neuroprotection, Vaccinium corymbosum (blueberry) for lifespan extension, Cranberry and oregano for longevity promotion,Nectarine and acai for life span extension, Rosa damascena for life span extension, Green tea as health supplement, Cocoa polyphenols and longevity effect, Olive oil as a phenolics supplement, Quercetin and tannic acid as health supplement. Curcumin (diferuloylmethane) is the pharmacologically active substance in turmeric (Curcuma longa), and has been widely used as an herbal medicine in Asia. It is well documented that curcumin possesses many biological activities, such as antioxidative, anti-inflammatory, anticancer, chemopreventive and anti-neurodegenerative properties. With its pleiotropic activities, curcumin has been considered as a potentialaging intervention compound.

Demographic evidence and statistical data support the fact that the population in the developing countries is growing older. India is evincing it. Dietary requirements change in elderly people.

A multidisciplinary approach may assist in managing this class. Tailoring nutritional advice to these individuals is very essential. Assessment and treatment of nutritional risk should be part of routine care for the elderly, just as assessment and management of cardiovascular risk factors are standard practice in adults.

References

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