Unless you are suffering a prolonged midlife crisis, life really does get better after 40—we can start to enjoy the fruits of our labour, care less about what people think, and (hopefully) have life worked out. Physically, things are still okay. But the average person would have lost 3-8% muscle mass since turning 30, and this trend will continue each decade.
Nearly half of our body weight consists of muscles—over 600 different types. Muscles are made of fibres, and more fibres mean greater muscle strength. They all stretch and contract, but distinct muscle groups have very different functions.
Smooth muscles keep organs working behind the scenes (e.g. digesting food, expelling the solid and fluid by-products, maintaining blood flow, delivering babies, and even helping eyes see), and cardiac muscle works 24/7 to keep the heart beating.
Skeletal muscle contains the most tissue and is the body’s largest protein store. Skeletal muscle gives bodies their shape, maintains posture, moves the body on command and generates heat. It even mediates insulin production, supporting evidence that improved muscle tone can help control blood sugar levels.
Severe muscle loss affects 5-13% of people by 60-70 years, increasing to 11-50% of people over 80. As skeletal muscle mass declines with age, so does muscle strength, power and balance. Professor Irwin Rosenberg, of the Jean Mayer USDA Human Nutrition Research Center on Aging, proclaimed, “no decline with age is more dramatic or potentially more functionally significant than the decline in muscle mass.”
Lost muscle mass can increase risk of sudden falls, fractures and mortality. Sarcopenia—age-related loss of lean tissue mass and function—is a serious, multifactorial condition that can creep up unexpectedly. It affects an estimated 29% and 33% of older people living in the community and in long-term care, respectively—and this is likely to increase with our aging population.
Forced hospital rest can worsen sarcopenia. Some older adults may never recover from extra muscle mass lost from injury and hospitalisation, leading to accelerated breakdown of body tissues, poor clinical outcomes and increased hospital costs. When severe, sarcopenia results in 79% increased risk of disability.
Lifestyle behaviours make up much of the difference between healthy and unhealthy aging: most notably diet quality and exercise. Age-related and severe loss of muscle mass can be reduced with physical activity (especially resistance training) and nutrition.
Protein and amino acids (protein building blocks) from absorbable sources like whey are key nutritional targets for improving muscle mass, strength and physical performance. Adults with protein-energy malnutrition and unintended weight loss also need extra calories from food to prevent their body breaking down muscle protein for energy.
Vitamin D may improve muscle strength, especially in patients over 65 with low Vitamin D (<30 nmol/L). Creatine supplementation, combined with resistance training, might increase upper body strength and reduce muscle aging, and one study reports possible benefits of leucine (an amino acid that stimulates muscle protein synthesis). A recent review further identified a potential role for minerals (particularly magnesium, selenium and zinc) in preventing and treating sarcopenia.
Increased muscle strength can not only enhance treatment outcomes, morbidity and blood sugar control, it may also improve sleep and mental health—hence better quality of life with aging.
When people think about causes of malnutrition, they might consider poor appetite, chewing difficulties or illness as likely candidates. Yet many health professionals would know that even something seemingly trivial, like not being able to open food packaging, can be a major obstacle to eating well.
Opening food packaging can require strength, dexterity and fine motor skills that many vulnerable people don’t have—especially older adults.
Inaccessible food packaging is often an issue in hospitals, particularly when there is no-one to help patients open single serve and portion-controlled food items. The NSW Special Commission of Inquiry into Acute Care Services found that many patients need help to open food packaging, and reported that this can be a significant barrier to nutrition.
A Canadian study of 132 cognitively healthy nursing home residents found that 37.4% of residents were at risk of malnutrition—and food packaging was identified as one of the primary contributing factors.
Disabilities like arthritis can present a major obstacle to opening food packaging for people of all ages.
Arthritis Australia’s Consumer Director, Wendy Favorito suffers from arthritis herself and has experienced the resulting emotional struggles, like public embarrassment and lack of independence by having to rely on other people, and physical obstacles to basic daily tasks like cooking simple meals for her family.
If her husband weren’t there to help her, Favorito writes that it would just mean going without. “It is unacceptable that common items are so difficult to open for a large portion of people in our community when some simple packaging solutions exist.”
As Fergal Barry, Partnerships Manager of Arthritis Australia, stressed in a CHOICE interview, this problem will keep growing along with our aging population if it is not addressed.
Even in the general population, food packaging is not a trivial issue. Researchers at Nottingham University in the UK reported that over 60,000 people needed hospital treatment for injuries from trying to open difficult packaging, often resorting to using scissors or knives. Other injuries include wrist strain from trying to loosen jam jar lids. According to CHOICE interviews, experts believed Australians would face a similar problem.
This phenomenon has a name. ‘Wrap Rage’ is defined by Wikipedia as “the common name for heightened levels of anger or frustration resulting from the inability to open packaging’.
A healthy 30-year old male expressed frustration trying to open the plastic wrapping on crumpets, according to a more recent UK report which claimed that “Millions suffer ‘wrap rage’ battling to open modern-day packaging.”
For vulnerable people, accessible design is even more vital. The Nottingham University inquiry’s main finding was that packaging is easier to open when there is a larger surface area to grab onto. But there is much more complexity to making packaging accessible. Guidelines published by Arthritis Australia further include ease of grip and control, avoiding sharp edges, adequate grasping points on seals, texture, and salient, legible fonts.
For organisations seeking user-friendly products for vulnerable populations, Arthritis Australia set up an Initial Scientific Review (IRS) which rates products according to their accessibility. A database of these ratings is available for various pre-packaged and portion-controlled foods used by the food service industry.