Risk Factors for Poor Nutritional Health
According to a screening project conducted by the City of Toronto Department of Public Health, almost 60% of older people were at nutritional risk, including 23% at high risk. The consequences of poor nutritional health are increased susceptibility to infection, delayed wound healing, decreased ability to metabolize drugs, impaired physical and cognitive function, and increased morbidity and mortality. Successful aging can be a reality for many older people who eat well, exercise regularly, have a sense of control or independence, and the support of family and friends. Remaining active physically, mentally, and socially is important to our health and well being in later life. The major risk factors for poor nutritional health are described here.
1. Physiological changes with aging
As we age, changes in our body composition, systems, and organ function can affect our food choices, and ultimately our health and nutritional status. The usual physiological changes of aging include:
· a decrease in lean body tissue, reducing energy needs
· a loss of bone mass, increasing the risk of osteoporosis
· a decline in immune function, enhancing the risk of infection
· reduced taste and smell, contributing to lack of appetite
· tooth loss and dry mouth, compromising food intake
· a decline in kidney function and in the thirst mechanism, increasing the risk of dehydration
· changes in gastrointestinal function, contributing to constipation and impaired nutrient absorption (slow bowels)
Not all older adults experience these changes. There is remarkable variation in the usual aging process, partly due to genetic differences. Nevertheless, because of these changes, the requirements for some nutrients are higher after we reach 50 years of age. Nutrients with increased requirements include vitamin B6, vitamin D, and calcium.
2. Chronic illness - physical or psychological
Diseases such as chronic obstructive lung disease (COPD), heart failure, cancer, infections, thyroid disorders and uncontrolled diabetes can contribute to malnutrition. Many chronic conditions can make it difficult to swallow properly, which interferes with food intake.
Mental illness can result in a decrease food intake and can contribute to social withdrawal. Depression is the most common cause of weight loss and anorexia in the older adult. Early diagnosis is important to begin antidepressant therapy and nutritional support.
3. Multiple medications
The more prescription and over-the-counter (herbal, multi-vitamins, etc.) medicines you take, the greater the chance for side effects from drug interactions. These side effects (e.g. loss of appetite, nausea, vomiting, diarrhea) can affect our ability to consume food and our body’s ability to retain the nutrients from food. Nutrients most at risk include folic acid, vitamins B12, B6, C, D, and K, as well as the minerals phosphorus, potassium, calcium, magnesium, and zinc. Prescription drugs and over-the counter remedies may also interact with certain foods. It is important that a physician knows of all medications being taken to avoid these potential problems.
4. Chronic alcohol intake
Consuming more than 1-2 drinks per day can significantly impair the appetite. Alcohol contains “empty” calories…high calories (7 kcal per gram) with no other nutrients. Frequent consumption of large amounts of alcohol can damage many vital organs such as the brain, heart, and liver. Alcohol can also interact with medications.
5. Low income
Having a low income can make it difficult to obtain the foods required for a healthy diet. Although healthier foods are not necessarily more expensive, a person may need to cut back on the food budget to accommodate the cost of their medications. The cost of transportation and housing are also factors.
6. Social isolation
Because eating is a social event, social isolation can have a negative effect on our nutritional health. Social isolation can be increased by reduced communication abilities such as loss of hearing or sight. The loss of a loved one through death, indifference or separation can also impair food intake. Being with people has a positive effect on morale, well-being, and eating.
7. Physical disability
Many older adults, particularly those with a physical disability, have trouble walking, shopping, buying, and cooking foods. These individuals would need support from friends, family, or social services in order to achieve good nutritional health.
8. Involuntary weight loss or gain
Losing or gaining weight when not trying to is generally a red flag for poor nutritional health. Unintentional weight loss/gain of more than 3 kg (6.6 lbs) in a three-month period is an important warning sign.
9. Poor diet
A poor diet can be due to eating too little or too much, not having a varied diet, or not eating enough fruits, vegetables, and milk products. This can be the result of any of the other factors listed above.
10. Nutrition and Chronic Disease Prevention
Healthy eating can play a major role in the prevention of many chronic diseases that affect Canadians today. These diseases include cancer, cardiovascular disease (e.g. congestive heart failure, hypertension, stroke), diabetes, gastrointestinal disorders (e.g. diverticular disease, irritable bowel syndrome, constipation, hemorrhoids), and osteoporosis. A healthy diet that is well-balanced and varied reduces your risk for all of these diseases. Following Canada's Food Guide to Healthy Eating can help you achieve this well-balanced diet (to be discussed in Session 2).
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