Dra. Soraia Santos

Nutritionist

How nutrition can contribute 

Towards active and healthy aging

HPA Magazine 19

As defined by the World Health Organization, “active and healthy ageing” is a continuous process of optimizing functional capacity and opportunities to maintain and improve physical and mental health, promoting independence and quality of life over the years. 
Although the increase in longevity of the Portuguese population is an appreciable fact, due to the increasing rate of aging in recent decades, the quality of the years gained still has potential for improvement. 

This improvement will depend on each one’s commitment, as an agent of his own health, participation and safety, and of society as a whole, so that everyone is guaranteed the opportunity for healthy living as they grow older. 
The national health department - Direção Geral de Saúde (DGS) considers three main aspects: - Autonomy, which permits one to maintaining one’s dignity, integrity and freedom of choice; - Lifelong learning, which allows for the preservation of cognitive abilities; and Keeping active, even after retirement, it is important to maintain physical, psychological and social activity.
It is known that, aging is a natural and irreversible process influenced by several factors, some not susceptible to alterations such as genetics, and others that can be modified, including lifestyle, such as diet and physical activity.
According to data from the last National Food and Physical Activity Survey (IAN-FA) there is evidence of overweight, considerable risk of malnutrition and excessive consumption of alcohol and tobacco among Portugal’s elderly population. 
Based on these results, the importance and intervention of the nutritionist in the prevention and reduction of risks associated with health problems should be highlighted.
Therefore, the promotion of healthy eating habits, combined with maintaining an active social life and the practice of regular physical activity, are responsible for healthier aging, thus contributing to increased longevity. 
Studies indicate that a balanced diet, rich in vegetables, fruits and whole foods, is essential for maintaining a good nutritional status, preventing malnutrition and the development of diseases such as neoplasms, cardiovascular diseases and diabetes.
When food intake is inadequate, malnutrition sets in, with the elderly population being particularly subject to nutritional deficiencies due to factors related to psychosocial changes associated with loneliness, chronic illnesses and medication, as well as socioeconomic conditions. 
Physiologically, with aging, there are also changes in the ability to ingest, digest and absorb nutrients, less need for hydration, changes in taste and difficulty in chewing, resulting in specific nutritional needs. 
Not forgetting the loss of mobility, the impairment of muscle function and a decrease in bone density that occurs naturally with advancing age.
At this stage of life, it is important to highlight some of the most common problems that may arise and contribute to a nutritional decline. Here are some important tips:

A DECREASE IN TASTE AND APPETITE
Improve the flavour of food through marinades by adding aromatic herbs, spices, lemon, olive oil, garlic, onion; preparing meals with different colours, flavours, shapes, textures and aromas; take a walk before meals; use supplements to increase appetite when necessary;

CHEWING AND SWALLOWING DIFFICULTIES
Through cooking techniques adapt the consistency of food to make it softer, such as boiled, roasted and stewed food with plenty of sauce. 
Examples of dishes with a soft and smooth consistency: casseroles, bean stew, fish stew, scrambled, poached eggs or omelettes, tortillas, stews, meat or fish pasta. 
The main causes for chewing and swallowing problems are neurological and diseases such as cancer, lack of oral hygiene, loss of teeth or inadequate dental prosthesis; 

COGNITIVE ALTERATIONS (DEMENTIA) AND DEPRESSION
The key recommendation is an enriched diet, that is, prefer smaller portions of food but at the same time, with a high calory and protein density. 
Since in some cases the elderly do not eat correctly, oral nutritional supplements can be useful to meet nutritional needs. Whenever possible, these patients should not be on their own during meal times;

GASTROINTESTINAL PROBLEMS SUCH AS CONSTIPATION
Increase the consumption of fibre and water in the diet. Namely fruit, vegetables and whole grains;
 

DEHYDRATION
Increase the consumption of liquids in the diet, through water or unsweetened herbal teas or infusions, flavoured water, soups, shakes or juices;

MAJOR NUTRITIONAL DEFICIENCIES
To avoid nutritional deficiencies in the elderly, it is necessary to consider macro and micronutrient recommendations, in particular: proteins, calcium, vitamin C, vitamin D and vitamin B12. To increase the protein intake in a diet, it is recommended that a source of high biological value protein should be added to all meals (including snacks) such as: meat, fish, eggs, legumes (grains, beans, peas, lentils) and dairy products (milk, cheese and yoghurt). The DGS suggests starting the meal with food rich in protein or enriching soups with meat, fish, egg and/or legumes. Calcium is present in food such as milk and dairy products, collard greens, turnip greens, parsley, almonds, hazelnuts, or even in calcium-enriched products. Vitamin D exists naturally in food of animal origin such as fatty fish (salmon, sardines, mackerel, herring), eggs, cod liver oil, liver, semi-skimmed milk, or even in fortified foods. Vitamin B12 is only available in food of animal origin, mainly in the liver of animals and in fish such as sardines, semi-skimmed milk and eggs, and it may be necessary to resort to supplements, especially vegetarians. As for vitamin C, the main sources are oranges, kiwis, raspberries and vegetables such as kale. However, a large part of the population do not consume the recommended dose of this vitamin and therefore the use of multivitamin supplements can be beneficial.
In addition to these factors where nutrition plays a fundamental role, other tips and guidelines for becoming more active and healthy include participating in courses and workshops on healthy eating and cooking, participating in physical activity programs, joining hiking or gymnastics groups, adopting a pet – they are company and one ends up exercising while walking them - growing your own flower or vegetable garden with more natural products is another way of being more active. 
On the other hand, no other age group benefits more from physical activity than the elderly. Physical activity is one of the strongest predictors of healthy aging. Physical activity promotes physical, mental and social well-being and helps to strengthen muscle mass, preventing the risk of injuries and chronic diseases such as osteoporosis and obesity while maintaining physical independence as long as possible.
Before staring any physical activity program, prior and individual assessment is advised to know what type and intensity of exercise is appropriate according individual capabilities. 
It can be simple walks, hydro gymnastics, dancing or even physiotherapy when justified.
Last but not least, alcohol consumption should be reduced to one glass per meal while at the same time not forgetting to drink water or alternatively, alcohol-free drinks.