Aging brings rewards and challenges. It can be a fulfilling time of rest and relaxation; enjoying respite from a life of working and raising children. It is also a time when the body starts its graceful decline. Unfortunately, this decline can bring various health problems, for instance loss of muscle mass. Age-related loss of muscle mass and strength is called sarcopenia.
Functional loss of muscle strength with age is not only associated with diminished quality of life and problems with activities of daily living; it can have serious effects including increased risk of falls, fractures, disability, hospitalisation and death. As well as aging, chronic diseases like diabetes factor among sarcopenia causes.
A recent review now suggests sarcopenia could even lead to type 2 diabetes.
Around 1 in 6 Australians over 65 suffer from diabetes, increasing to nearly 1 in 5 adults over 85. Type 2 diabetes makes up 90% of all cases, affecting one million Australians, 90% of whom are over 40. Unlike type 1 diabetes, an autoimmune disease, type 2 is associated with unhealthy lifestyle factors like poor diet, inactivity, smoking and obesity, and is therefore preventable.
Diabetes happens when there is too much glucose in the blood – either because the pancreas stops producing enough insulin (needed by most tissues to take up glucose), and/or because cells lose their capacity to take up glucose (become insulin resistant).
This can happen when the body is bombarded with too much sugar or refined carbohydrates, and the glucose receptors that let sugar into cells go on strike. The pancreas keeps producing insulin to try and lower blood sugar, and eventually wears itself out.
The body then goes into overdrive trying to keep blood sugar levels down, and the strain can cause a plethora of serious problems include heart attack, stroke, kidney damage, vision loss, nerve damage and poor wound healing – which can also result in amputation of limbs.
Sarcopenia research has been dominated by functional outcomes. But a recent review drew attention to possible metabolic consequences, focussing on various pathways that could lead to diabetes:
Therefore, the importance of preventing or reducing muscle loss and chronic disease with age cannot be understated. Prime targets are diet quality – particularly protein and vitamin D for muscle and generally a healthy diet to prevent chronic disease – and appropriately tailored physical activity.
Swallowing. Most of us perform this apparently simple act many times every day without a second thought.
Yet eating and swallowing is an extremely complex procedure that recruits over thirty different nerves and muscles to move food and liquid down the correct channels from mouth to stomach.
Malfunction in any aspect of this intricate operation can result in swallowing difficulties, or dysphagia, afflicting up to one in five older community-dwelling adults and around half of those living in aged care facilities.
It’s easy to lose heart when eating and drinking can’t be enjoyed as before, which can result in a vicious cycle of unintentional weight loss, malnutrition, and further despondency.
However, there are ways to keep the nutritional side of things on the bright side to avoid complications like pneumonia, dehydration and infection, and optimise health and recovery.
A team of health professionals helps manage dysphagia and navigate individuals through the act of safe swallowing and recovery, with speech pathologists at the helm and dietitians on board to carefully monitor a patient’s ability, progress and nutrition status.
In some cases, tube feeding through the nose or stomach (enteral nutrition) or directly into the blood (parenteral nutrition) is the best option to deliver or supplement with life-giving nutrients and fluid. But patients should be supported to eat and drink orally wherever possible.
Strategies for eating can include postural adjustments, swallow manoeuvres, trained feeding assistance, adaptive feeding equipment, distraction-free environment, swallow rehabilitation and texture-modified food and liquid.
Mildly to extremely thickened liquid or nectar is most commonly used for dysphagia. Thin fluids are avoided for fear of choking – therefore it is important to maintain good hydration, and watch out for dark-coloured urine, skin turgor and dry membranes.
Texture-modified foods, ranked according to their viscosity, have four levels of consistency depending on the patient’s swallowing and chewing ability.
Smooth pureed food is the easiest option. Much trial and error has been invested in getting this right – which would be obvious, for instance, if you’ve ever tried to puree green beans (hint: they’re stringy…).
The pureed food must have consistent thickness, be free from lumps and require no chewing. Examples include smooth, pureed cereals, meats, mashed potato, avocado, custard, and fruit-free yoghurt.
The next level is moist, semi-solid food that requires some chewing ability but is easily mashed with a fork. These foods can have a little texture and soft, smooth lumps, like cooked cereals, ground or cooked meat, and soft, canned fruit and vegetables.
Soft foods are allowed for more advanced swallowing and chewing ability, including well cooked vegetables, baked beans, soft or canned fruit, moist breads and rice, and tender, thinly sliced meat, fish or chicken.
Level four requires no texture modification – all foods are on the menu.
Some simple tricks can boost food’s nutrition density, like pureeing with milk or cream for extra protein and energy, and adding butter or milk powder.
And for those repelled by colourless, unidentifiable slop, advanced food manufacturing techniques now use thickeners and food moulds to enhance pureed food’s appeal while improving the nutrition profile.