Heart Failure - overweight is better than underweight in later age.

Among older adults with heart failure, there have been a number of studies over the past decade or so that have identified people who are “at risk of malnutrition” or who are malnourished as having a higher chance of three things: dying in hospital, being readmitted soon after discharge and/or suffering greater disability than those who are well nourished. Here is one example of an article discussing these findings.

But, what was also found in this study might surprise you: These researchers found that people who were identified as obese on admission to hospital with a heart failure diagnosis were less likely to die in hospital and less likely to be readmitted soon after discharge. In comparison, those identified as being at risk of, or having, malnutrition were much more likely to die and to end up back in hospital soon after discharge.

This is important work because it is commonly believed that losing weight and aiming to be lean is essential in people facing cardiac issues (or for health more generally). But, while that is certainly true for younger adults, the situation is quite different for those older. For those beyond about 65, a bit of extra bodyweight is thought by many to be protective against frailty - a debilitating condition experienced by many in later age and something that is associated with heart failure in older people.

We need to remember that almost every health message we hear on a daily basis is for people of 30, 40 or 50 and that many of those same messages just don’t apply to older people - in fact, they can be harmful. Weight loss is partly caused by some processes occurring in heart failure and weigh loss at later age, as you will well know if you read my blog, can be dangerous, rather than beneficial.

In the study mentioned here, its not clear how obesity was measured, but there is increasing worldwide agitation for public health advice to set ideal weight ranges for older adults at levels that better reflect ongoing physical capacity and health: those are slightly higher than younger adults. The ideal weight for someone of 70+ is a bit heavier than that for someone of 50. In this study, it may be that at least some of those identified as ‘obese’ would instead be in the healthy weight range for older adults, if we were using more older age-appropriate healthy weight range guidelines. (BMI 23-28 is often suggested in the scientific literature, while the ideal for the 18-65yr olds is 19-25)

Remember that exercise is always key and that weight loss can only safely be achieved at later age by combining good resistance exercise with a high protein diet. For those with heart failure, cardiac rehabilitation programs include exercise components, but exercise for those with heart failure must be carried out under medical advice.

What is clear is that - heart failure or not - eating to maintain weight as much as possible, and maybe even to gain a little if you have lost any is absolutely vital to living as well as possible in the years ahead.

An excellent, but sobering, article from Prof Joe Ibrahim on the Royal Commission into Aged Care

This article in The Conversation is both sobering and insightful.

There are many aged care homes doing great work and there is an army of aged care workers who are committed to providing compassionate, empathetic care to our wonderful elders. Aged care staff are awesome people who often endure challenging work conditions to give care to the most vulnerable in our society. Unfortunately, the system too often lets both aged care workers and residents down.

When it comes to food, if residents are not achieving ‘adequate nutrition and hydration’, that means an aged care home fails accreditation. But its more than that - it is surely abuse by neglect? Achieving adequate nutrition and hydration takes BOTH good food AND enough staff with enough time and resources to make sure that food is eaten. Good chefs are of benefit of course, but dietitians are essential to ensure that food makes it into the mouths needing it.

The RC may be too late for many now in care as Prof Joe suggests, but the many, many wonderful people who work in aged care never give up doing the best for residents, despite the challenges the current system imposes at times.

Just one extra meal prevents death in half of older patients with hip fracture!

In the UK, the NHS (Northumberland) has been researching how to achieve better outcomes following hip fracture (the so-called HIP QIP NHS Northumberland project).

They have recently shown something we dietitians have been saying for a long time - that providing better nutrition supports repair and recovery following accident or illness, especially in older people. In fact, they have showed that providing just one extra meal, and having someone sit with a patient to make sure meals are eaten, can halve the rate of death following a hip fracture!

This is an excellent finding. I would go further of course and assert that age-appropriate nutrition advice for seniors helps prevent the falls which cause fractures in the first place, as well as reducing the chance of illness and infection generally.

here is a news report on the study findings.

Stay strong to avoid pureed meals in later life!

This is not a big study, but its so important; these researchers in Japan showed that the strength of muscles in your torso was related to the strength of the muscles that help you swallow your food.

Now, swallowing is a very complex process, perhaps evidences by the fact that there is a whole profession dedicated to the study of speech and swallowing (speech pathology). Whether you are easily able to chew and swallow food depends on more than just muscle strength, but loss of muscle and poor muscle function is certainly part of the picture when people have to modify the texture of their meals in order to be able to eat them safely. 

So, everything you can do to keep up strength in the muscles that help you get food from your lips, safely into your stomach, is valuable in allowing you to continue to enjoy the foods you like into your later years.

In later age many people can find themselves being recommended to some sort of texture modified diet - having to have foods minced or pureed/ blended in order to be able to eat them safely. There are lots of chefs in aged care now working hard to improve the quality of texture modified food and I applaud them, but its so much better if you can avoid needing to have the texture of your meals altered it in the first place.

I don't know about you, but I want to avoid having to eat puree every meal , no matter how well its made, in my later years if at all possible!

So here is an answer: do physical activity that requires the muscles in your trunk to stay strong. That's really anything that keeps you upright because your trunk muscles are the ones that hold your spine upright. You can also do abdominal strength work, but its enough to keep yourself doing plenty of activity that keeps you fighting gravity and standing as tall as possible. 

So stay active and also get to keep enjoying food the way you like it best. 

Medications and cognition? Some to discuss with your doctor

All medications have side effects: some are minor, some more of an issue, but as you age, side effects that might have been only annoyances earlier in life, can instead cause bigger problems. In Eat To Cheat Ageing and in Eat To Cheat Dementia, I list and discuss many medications which can impact appetite, can increase the chance of developing a delirium or having a fall, affect cognition and more.

But as well as that, the College of General Practitioners (RACGP) in Australia recently revisited a discussion from a few years ago on a class of medications called anticholinergics which can have negative impacts on cognition, especially for those who are already experiencing some cognitive decline. Here is a link to a discussion paper on the RACGP website and a general information sheet provided by Dementia Australia 

There are many different anticholinergics, prescribed for many different conditions including urinary incontinence, respiratory conditions, Parkinsons and more; and there are even a few 'over the counter' medications for cold & flu or allergy conditions they contain these. 

Check this info sheet, but the best way to know if any of your current medications have anticholinergic action, is to ask your pharmacist. Then, if you have concerns, don't just stop taking something your doctor has prescribed, but do ask whether the medication you are taking could be changed or adjusted in any way. 

New physical activity guidelines for those affected by memory loss

A collaborative effort of a number of universities: including the Universities of Melbourne, Newcastle, Western Australia, Curtin University, ANU and NARI (National Ageing Reesearch Institute) have developed this practical guide to exercise the benefit people living with memory impairment and cognitive decline. 

Its an excellent guide for anyone heading towards their later years actually!

12 Eggs a week - finally commonsense prevails!

Researchers ate the University of Sydney have proven what many of us have been saying for years! That eating eggs is NOT linked to heart disease. 

This study, published in the American Journal of Clinical Nutrition, found that eating 12 eggs a week did not increase cardiovascular risk factors such as blood cholesterol levels in people with pre-diabetes or type 2 diabetes.

Eggs contain excellent protein as well as antioxidants, vitamins and minerals, so enjoy them!

For people in their later years, choosing egg based breakfasts especially can be a good way to get that extra protein at a time of day when common breakfast options based around fruit/cereal  can be lower in protein than is ideal.  


Therapeutic lollipops?

Let's face it, lollipops can be pretty appealing, and for those now living with later stage dementia they are very likely to be remembered as a rare and treasured treat.

So reported here is a clever way to use that to the advantage of people living with dementia.

We know that issues with coordinating swallowing are very common as people move into the later stages of dementia. Swallowing might seem simple as, for most of us, there is no need to give it much conscious thought, but in fact, it's an extremely complex series of steps for the brain to coordinate and those often become mixed up in dementia. 

And, like all coordinated muscle activities, its 'use it or lose it': swallowing gets worse more quickly than it should if people reduce the amount of food they eat. And that can happen as a consequence of dementia itself, or if they have experienced it not going down easily, or when food textures need to be altered (think minced or puree meals) making people less inclined to eat. The end result is not only inadequate nutrition, but the muscles in the mouth and throat don't get the exercise they need to help out, so it continues....

So using sucking lollipops to 'train' oral musculature is a really great idea! 

They were actually devising a way to measure changes in swallowing ability by determining how much the lollipop reduced in size in a specific time period. And while this was a relatively small study, the people whose sucking ability did improve also gained some weight and were able to eat more food. Training and rebuilding swallowing capacity can mean that those who have needed to eat only pureed food for example, could possibly be able to safely swallow a greater range of food textures. That is just so important in dementia when weight loss is a debilitating problem and when being able to eat 'normal' (not texture modified) foods is paramount to quality of life. 

One thing that is important to note is that swallowing ability can decline in dementia (due to progression of dementia itself) to such an extent that even sucking a lollipop and swallowing the mix of saliva and dissolved lollipop can be a problem - the liquid can end up in the lungs instead of the stomach - so, that needs to be considered. If an individual is already needing to have the liquids they drink thickened, you will need the advice of a speech pathologist about trying it, but for others who are not eating as well as they could do, it might be worth a try. Also, lollipops are sugary treats: but this is not about sucking them all day - maybe one a day or every couple of days to 'retrain' oral muscles - and if the end result is a greater ability to eat all sorts of food, in my opinion that's a plus that outweighs a bit of sugar!

If you are in any way concerned about swallowing ability, check with a qualified speech pathologist who can assess individual capacity and discuss this research with them. 

Lift Weights, Eat More Protein, especially if you are over 40

This research, discussed in this article in the New York Times, found that people as young at in their 40s were not getting the protein their bodies needed to make the most of their muscles as they age.

And remember, you need your muscles for more than getting you around - they also support your immune system,  help keep your body organs up to scratch and bolster brain fuel supply.

Its never too late or too early to start thinking activity, protein and colours. 

Food in Residential Aged Care

Recently I was asked, along with my colleague Cherie Hugo, to present a webinar to the aged care industry on food. 

We wanted to put a case for the value of management, nursing, care and food service staff working with experienced aged care dietitians to maintain the quality of the lives of those living in residential aged care with food.

This is not only food that looks great and makes for an enjoyable meal, but also supports the nutritional needs of residents - helping them remain as independent as possible, reducing falls and pressure ulcers and keeping boy and soul together. 

Here is the link to the webinar if you would like to listen. Cherie is up first, then the CEO of an aged care home doing great work in this area and I sum all that up. 

Never too late to ward off insulin resistance and diabetes!

Type 2 diabetes can develop as people age into their later years for many reasons, but one contributor can be gradual loss of muscle. This happens with age but there is lots that can be done to minimise its effects. This study from Brazil showed that training with weights to increase muscle strength in the older adults tested reduced the effects of metabolic syndrome (one aspect of which is insulin resistance and potentially type 2 diabetes). The participants had been taking a medication (a type called  a biguanide) to help avoid the impact of metabolic syndrome and those who had done the training were able to reduce the amount of medication taken - a good sign the increased strength they had experienced was doing more than making them feel stronger and healthier.

Eating more protein and less carbohydrate helps reduce Metabolic Syndrome and Insulin Resistance

This recent study of 245 women over 60 found that those eating proportionally more protein and less carbohydrate in their diets had a reduced chance of having Metabolic Syndrome. This is a syndrome in which the combined effect of a number of health issues, including Insulin Resistance, create significant health risk to individuals, so it's a good thing to avoid.

It's worth remembering that there could be many reasons beyond just the food choices made that contributed to a reduced risk of Metabolic Syndrome: maybe people eating more protein were also more health conscious and doing more physical activity.  Another possibility is that those eating more carbohydrate were getting that from high sugar foods and drinks. In older people sugar in foods is not always a problem in itself, but the most nutrient dense carbohydrate foods are things like potatoes and other starchy vegetables, grain foods and dairy foods - all of which also offer lots of important nutrients that are lacking in high sugar convenience foods, beverages or confectionery: so that could be part of the picture also.

What is clear is that this is more support for a protein food at the centre of every meal - surround that with plenty of colour from veges, salad, fruits, nuts, seeds and grains and you cant go wrong!

Frail or not, everyone benefits from exercise!

Researchers in this paper have looked at both frail and physically stronger seniors and proven that exercise programs are of benefit to all. 

It makes sense of course, but sometimes people think that, for those who have become frail, its too late: that's just not true. That's proven in some good residential care homes where gyms and active exercise programs are encouraged for all residents (yes, there are some great initiatives out there!)  In these forward-thinking care homes, plenty of previously frail residents enjoy great benefits from gyms -  but its always excellent to have the research to back up.

People who continue to stay active into their later years, or who work to regain lost strength no matter their condition to begin with, benefit in so many ways - physically, cognitively and socially. But never forget that eating good protein food along with getting the exercise, and getting enough to assist in maintaining or regaining muscle strength, must also be part of that plan.

This research just proves again that it's never, ever too late!