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Nutrition a key weapon in the fight against illness in old age

As the average age of the western population creeps up, European health services are grappling with distinct age-related health issues. The smart research funding is spent on projects that foster healthier old age across the bloc.

One in five Europeans is aged 65 years or older. By 2080, this will rise to almost one in three. With this ageing population comes declining health status and disease, leading to disability and dependence. One such challenge is the risk of malnutrition in older adults. It impacts on health, cognitive and physical functioning and quality of life.

It is within this context that researchers at the UCD School of Public Health, Physiotherapy and Sports Science and UCD School of Agriculture and Food Science have been working on a Europe-wide project to gain a better understanding of malnutrition in older populations.

The Healthy Diet for a Healthy Life Joint Programming Initiative, Malnutrition in the Elderly (MaNuEL) is designed to create a knowledge hub on malnutrition in older adults. The project has four main objectives: to gain knowledge; to strengthen evidence-based practice; to build a better research network and to harmonise research and clinical practice across Europe. The research consortium comprises 22 research groups across seven EU member states.

”Once an older person goes down the road of deteriorating nutritional status it’s hard to bring them back,” says Associate Professor Clare Corish of the UCD School of Public Health, Physiotherapy and Sports Science. “We know that between 5% and 12% of older people in the community are malnourished and that the figure is as high as 50% in residential and clinical settings. This leaves many older people less able to fight infection. If we can prevent malnutrition in the first place, it promises better outcomes and reduced requirement for hospital admissions.”

Associate Professor Corish and her team are engaged in a broad project to look at prevention and treatment, screening and determinants of malnutrition. “We looked at groups of 1,800 people over 65 in Ireland over two years, to see if we could link aspects of their lives or health history to the later development of malnutrition. We identified risk factors for becoming malnourished.”

The research surfaced some key risk factors. “If a subject in the study had difficulties walking 100 meters or climbing stairs or was hospitalised in the previous year, they were more likely to be malnourished two years later,” she explains. Falls during the follow-up period also predicted the development of malnutrition in males, and receiving social support and cognitive impairment predicted malnutrition in females. “Deterioration in simple functional markers was a better risk predictor than clinical indicators. If someone can’t go out, buy food and prepare it themselves, they are likely to become malnourished. It seems so obvious, but these functional markers are not necessarily the questions that clinicians are asking their patients when enquiring about their nutritional status.”

If a subject in the study had difficulties walking 100 meters or climbing stairs or was hospitalised in the previous year, they were more likely to be malnourished two years later

Another key area that required study was the screening process for malnutrition in older people. This is an underdeveloped area, and needs to be further examined, says Associate Professor Corish.

”We are pooling the information that is already there – creating a database of tools already in use. We have been able to make specific recommendations about the appropriate way to screen for malnutrition in this distinct group. The consensus is that there is no single tool that suits screening in the community, in residential care and in hospital and rehab settings.”

The risk analysis and the screening review are just two in a basket of projects underway in UCD on the subject of malnutrition in the elderly. Associate Professor Eileen Gibney at the UCD School of Agriculture and Food Science describes the bigger picture.

A recent local project involved a review of the nutritional profile of ‘Meals on Wheels’ delivered in a North Dublin community. “One of our final year students analysed all the meals provided to assess their nutritional value,” says Associate Professor Gibney. “The results were fed back to the service with recommendations to help volunteers make simple alterations to improve the nutritional intake of the older people they worked with. Much of the food is provided by donations and selected by volunteers. We were able to provide some guidelines on how to make the best decisions when preparing and packaging meals.”

Other ongoing projects in UCD include NUTRIMAL, a study of the loss of muscle function associated with malnutrition, and interventions to maintain healthy lean body mass in older people using diet and exercise.

“All of these initiatives combine to contribute to our understanding of malnutrition in older people,” says Associate Professor Corish. “It’s not only about reducing hospital admissions and health service costs. If we’re going to live longer, we need to find ways to preserve good health for as long as possible, so that we can enjoy the best possible quality of life.”

Associate Professors Clare Corish and Eileen Gibney were in conversation with Louise Holden (MEd 2007), Director FH Media Consulting and journalist with the Irish Times.

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