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Nutrition & Health

Staying healthy at home

Not withstanding the physical limitations of older age, basic guidelines can be followed which can help to maintain the healthiest existence – in every sense of the word. Fundamentally, we should all aim to close the gap between ageing’s inevitable changes to our bodies and those changes caused by disuse or poor diet.

For a variety of reasons many ageing people fall foul of a vicious circle of pain, lack of mobility, loneliness, depression and, often most critically, malnutrition. The effects of malnutrition, such as fatigue, weight loss, light-headedness and loss of appetite, are commonly incorrectly ‘diagnosed’ as illness, whereas many of the problems can be corrected simply by eating better.

In addition to looking after dietary needs, some form of exercise or movement encouragement can have a variety of benefits as you grow older. Exercise can make you feel better and enable you to perform tasks better. Oxygen flow to the brain is increased and mental alertness improved. Better general fitness and muscle strength will mean you are better prepared to cope with unexpected situations – and better prepared to avoid accidents and debilitating falls.

 

Eat better, age better

Elderly people need less energy because they tend to be less active and have less active muscle tissue. For this reason, they will tend to eat less food generally than in their earlier years. There are, however, other reasons why an older person will cut back to eating levels which do not maintain a nutritious diet.

There may be difficulty with chewing or swallowing. You may be unable to shop. You may be depressed, or suffering continual pain. You may experience a certain loss of taste and smell. Perhaps you cannot be bothered to cook for one. Men particularly may lack essential cooking skills.

Whatever the reason for eating less, elderly people must be careful to select highly nutritious foods to combat the lack of quantity consumed. Additionally, normal changes of ageing will necessitate higher requirements for some specific nutrients, such as Vitamin D – which is essential for proper calcium absorption and the maintenance of bone strength. For example, elderly housebound people often miss out on sunlight, the key source of Vitamin D. It should be noted that evidence shows that, even when older people are exposed to sunlight, their skin will absorb vitamin D less well than younger people. Dietary sources of vitamin D, such as oily fish (tuna, salmon, sardines, herring, pilchards), cod liver oil, eggs, liver and margarine should, therefore, be eaten regularly – albeit that the ability to absorb vitamins from foods also decreases with age. Dietary sources of Vitamin D, such as oily fish (tuna, salmon, sardines, herring, pilchards), cod liver oil, eggs, liver and margarine should therefore be eaten regularly.

To increase your defence against loss of bone mass and osteoporosis, additional vitamin D and calcium can be absorbed through high strength supplements. You would be well advised to consult your GP in this respect.

 

A little of what you fancy does you good

Older people, particularly those with arthritic conditions, should avoid too much fat, salt, sugar and red meat. This will help to keep their weight down and reduce the stress on their joints. Every lost pound can make a difference!

It is best to eat several small meals and healthy snacks a day, rather than one large, daunting daily meal. A cheese sandwich with a tomato and apple can be just as nutritious as a hot meal of meat and two veg. Plenty of wholegrain bread, cereals, fresh vegetables, fruit and fish form the basis of a healthy daily diet. Buying and cooking smaller food packages also reduces the temptation of relying on repetitious left-overs.

You should go easy on tea and coffee, because the caffeine content may lead to disturbed sleep. Some drugs interfere with the absorption of nutrients, so consult a doctor about your diet if you are taking medications.

Whatever you do, try to eat regularly. Why not make a habit of asking friends in to eat with you and vice versa.

 

The water of life

Gradual, steady loss of body water is a factor of ageing and older people do become dehydrated more easily. Dehydration can then be a major complicating factor of illness and can have a negative effect upon recovery prospects.

Fear of the likelihood of urinary incontinence and the need for visits to the toilet, will also mean that many older people will be reluctant to drink as much as they should. This frame of mind is, of course, made worse when diuretic medications (‘water tablets’) have been prescribed.

Whatever the reluctance to drink, the effort really must be made. Water intake is vital, as dehydration can result in illness, mental confusion, and can speed the ageing process generally. It is recommended that older people should drink at least 8 cups of fluids a day.

It is worth noting that tea, coffee, fizzy drinks or worse, alcohol, actually contain dehydrating agents. Indeed, for every alcoholic drink you consume, you will lose the same volume of water from your body!

 

Meals-on-Wheels

Nutrition is very important for the maintenance of health and general wellbeing. Choosing to remain at home is more likely to be successful and sustained if regular nutritious hot meals are available.

However, shopping and cooking a proper meal may become difficult or impossible as a result of illness, frailty, or lack of mobility. Local authorities, therefore, provide ‘Meals-on-Wheels’ services – although in most cases, the meals are actually provided by another organisation, under contract to the local authority.

Hot meals may be delivered in a van with a heating unit. Alternatively, frozen meals may be delivered – usually a week’s supply at a time, previously selected from an illustrated menu. These meals can then be heated up at your convenience. A freezer may also be supplied in order that meals can be stored safely.

What is on offer will vary depending on your local authority. Some authorities will offer meals daily, but it is more usual that you will be offered meals on a few days each week. Nowadays local authorities are also concerned not to encourage people to become too dependent on supplied meals. You might, therefore, be offered this service for a short time only while you are recovering from an accident or illness. In all cases there will be an assessment of your need for the service and there will be a charge. For more information see The Role of the Social Services.

On the days you are not receiving ‘Meals-on-Wheels’ the choice of good quality chilled or frozen prepared meals now available in supermarkets can provide an acceptable alternative. If chosen carefully, it is possible to achieve a reasonably well balanced and varied diet from pre-prepared meals. Remember, however, that if chilled or frozen food is not to be consumed on the day it is bought, it is essential that it is stored in a fridge or freezer as appropriate.

Finally, it is important to note that anyone who is largely dependent on pre-prepared ‘Meals-on-Wheels’ or frozen meals, should supplement their diet with fruit, vegetables, bread etc. wherever possible.

There is information on shopping services in our Help from Technology section.

 

Keeping your body moving

Increased physical activity in the elderly has been shown to improve brain functions and increase life expectancy, even into advanced old age. Exercise can protect against joint damage, keep joints and muscles working and helps to prevent disability. There is even new evidence that exercise helps prevent depression.

Unexercised joints lose muscle strength and can become unstable and painful. Even where joint inflammation and pain has to be treated with medication, it is possible to maintain the strength of those joints through gentle exercising movement.

Range of Movement (ROM) exercises gently take your joints through their full range of movement. This can be done just sitting in your chair. Your GP can be consulted regarding the specialist physiotherapy assistance you may need to start a programme.

The worst thing is to give in to the seeming inevitability of immobility and dependence. Recent research in the USA has shown that, with simple strength training, even 90 year olds could increase muscle strength by 160% and muscle mass by 10%! It appears that muscles are just as responsive to training in this age group as in younger people.

It should also be noted that exercises to improve balance, strength and co-ordination have been shown in trials to reduce the risk of falls’ injury that older people invariably face. It is shown that half of all fallers, fall again and, after a fracture, one in two older people can no longer live independently. More worryingly, it has been shown that a third of those who fracture a hip do not survive for more than a year. Such deaths should be preventable.

Bone strength and, therefore, improved balance and stability in older people can be maintained by regular, but not excessive, weight-bearing exercise. Walking and ROM activities as previously described are excellent.

Finally, whatever you decide you want to try, ask your doctor to give you a thorough check up. Remember, all doctors are required to offer an annual health check to all their patients aged 75 and over – and that you can ask for a home visit if it is difficult or impossible to get to the surgery.

 

Your General Practitioner

GPs can be a very important source of support to people who are becoming dependent, but who choose to remain in their own homes. Apart from providing primary medical attention when necessary, your GP may also be the ‘gateway’ to other specialist services. Your needs may entail referrals to consultants such as neurologists, geriatricians, orthopaedic specialists etc. and to other services like community physiotherapists or occupational therapists, which may be needed to help maintain or improve the situation at home.

Whilst the majority of GPs will provide an excellent all-round service, you should not be afraid to ask questions about help you might need, the treatment you are receiving or the drugs you have been prescribed. Do not feel that you are a nuisance. You should always ask questions. If you wish to change your GP you can find out about other local GPs, by contacting your Primary Care Trust.

 

NHS Direct

By telephoning 0845 4647 you can speak to a qualified nurse (counsellor) who will be able to offer advice concerning your current health problem.

 

Chiropody and Other Specialist Services

These services are known as Community Health Services and are provided by the Health Service in all areas. Your GP should be able to give you access to them, but it will be helpful if you are aware of what should be available. It is probably also fair to say that although the services should be available everywhere, there may in some cases be a wait before you can get an appointment.

The main services are:Community Nurses
Health Visitors
Community Psychiatric Nurse
Chiropody
Continence Advisor
Physiotherapist

Most of these services will visit you at home, but you might be seen more quickly with, for example, chiropody if you can get to a clinic. Social workers may also be able to refer direct to some of these services.

In some areas there are also specialist nurses such as the Parkinsons’ Disease Specialist Nurses, Admiral Nurses who specialise in dementia care, and Macmillan Nurses or Marie Curie Nurses, who provide care for the termianally ill. Access to such specialist resources would be through the hospital consultant who deals with your condition, through your GP or through the District Nurse.

 

Your Pharmacist

Another important source of health information, although not formally part of the Community Health Team, are pharmacists – the chemist’s shop. It is always helpful to stick with one pharmacist, who will get to know your needs and the regular medications you receive. They will be in a good position to advise you or to query medications prescribed. Many pharmacists will now undertake to deliver prescriptions if you are housebound. Some will also prepare a week’s supply of medication in carefully labelled daily doses.

Some pharmacists will also be able to supply aids and appliances, stoma care products and your incontinence needs. There is likely to be a specialised Incontinence laundry service in your area. If you or somebody you care for needs this service, enquire through the Community Nurse of Social Services.

All pharmacies should have a leaflet describing their range of services. Most of them will also be able to provide leaflets on specific diseases or conditions, plus a range of other health information.

 

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Dental Care

Dental care can become a real problem if you are finding it difficult to get out and about. Problems with teeth or with ill fitting dentures can make eating very difficult and may well lead to poor diet and nutrition. Poor dentures can also detract from any pleasure in meals or in social occasions.

Firstly, be sure that you are keeping your registration with your regular NHS dentist up to date, every 15 months. You need to be registered for CONTINUING CARE.

If you are receiving treatment your dentist should provide a plan of the intended work and discuss it with you, so that you have an opportunity to refuse any specific item – or the whole plan if you wish.

If it is impossible for you to get to the dentist’s surgery he/she should visit you at home. There is a contractual requirement to do this, if you are registered with the practice for CONTINUING CARE and if you live within 5 miles of the practice.

If you need emergency dental treatment and you are not registered for CONTINUING CARE or your dentist is not available or willing to provide the treatment you need, telephone your Health Authority. It may be able to put you in touch with an emergency dental service.

There are charges for many categories of dental treatments and older age, in itself, is not sufficient to obtain exemption. After paying for your treatment you will need to complete and send a ‘Remission of Charges’ claims form to The Benefits Claims Office. Ask your dentist for the relevant forms.

 

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