Physical activity in any form is good, but when it comes to maintaining bone health, research suggests moderate exercises like walking and water aerobics are not enough.
A recent study by Deakin University researchers finds that a variety of weight-bearing exercises is necessary for both bone and muscle health, to help reduce risk of falls, fractures and osteoporosis in older adults.
“Your bones are there to support your muscles to create movement, so if you have low bone strength, you’re at increased risk of having a fracture,” explained Professor Robin Daly to Community Care Review.
Around 90% of older people who fall over end up with osteoporotic fractures. In 2011 more than a million Australians were diagnosed with osteoporosis and nearly five and a half million had osteopenia, putting them at risk of fragility fracture.
With an aging population, it’s estimated that by 2021, fractures will occur every three and a half minutes and three million Australians will have osteoporosis-related conditions, leading to a downward spiral of poor health and quality of life along with mounting health care costs.
Prevention is therefore critical.
Daly’s team created an 18-month community program called Osteo-cise: Strong Bones for Life for community dwelling adults aged 60 or older, providing 12 months of structured, multi-modal exercises along with education and behaviour change modules.
Half of the 162 volunteers were randomised to take part in group fitness sessions at a health and fitness centre three times a week. The other half were given information about osteoporosis and both groups received vitamin D and calcium supplements.
After 12 months, those taking part in the Osteo-cise program had vastly greater improvements in bone density, muscle power, strength and balance. Daly says other programs tend to improve one of these but addressing them all is important to prevent risk of falls and fractures.
Their multifaceted program focussed on weight-bearing exercises and a method of resistance training that optimises muscle power – the body’s ability to do fast and forceful movements which is needed for balance, mobility and reaction time to prevent falls.
“Such rapid and forceful movements also place high loads on bones which may help to improve their strength,” co-author Dr Jenny Gianoudis told The Senior.
Daly explains, “Bones are alive and they like to be stressed, so when you do activities that put strain on them, the bone cells get excited and form new cells.”
As noted by America’s National Institute of Health, the best exercises to stimulate bone cell growth involve weight-bearing and resistance.
Weight-bearing exercises such as hiking, jogging, climbing stairs, playing tennis, skipping, stair climbing and dancing make you work against gravity.
Resistance training for bone health involves weights, particularly focussing on the muscles around the hips and spine during fast, short sessions twice a week rather than one long session.
Gentler exercises such as swimming, walking and riding can help strengthen muscles and are good for heart health, but are not as good for bones.
It’s important to build up to more rigorous workouts under trained supervision, and work to a level that suits the individual.
And it’s never too late; even people with limited range of movement and dementia can derive significant benefits from physically tailored exercise programs.
Posted by ProPortion Foods Blog on Oct 15, 2019 in Uncategorised
A 10-minute educational video for aged-care staff could help pave the way to better understanding about nutrition and enriching diets for older adults with dementia.
That’s the goal of MENU – a project to promote Meaningful Engagement in Nutritional Understanding and improved care for people living with dementia, with staff as agents of change.
Dr Emma Lea, a researcher at the University of Tasmania, is leading the study to address malnutrition, a silent epidemic that afflicts around half of older Australians in nursing homes.
The project is part of a broader spotlight on aged care, sparked by revelations of appalling conditions in residential facilities including low food budgets, poor quality diets, understaffing and ineffective feeding practices.
People with dementia are particularly prone to malnutrition and dehydration and have special needs to ensure adequate food and drink intake.
Lea’s team first collected data about obstacles to nutrition care through documents, resident files, observations of seven residents with dementia and interviews with family and staff members.
They identified five key barriers.
Most basically, body mass index was not measured to identify underweight residents. Staff also knew little about how nutrition is related to clinical health indicators such as healing wounds and warding off disease.
Although staff were attentive, their attempts to encourage residents to eat were ineffective. This was compounded by a dearth of meal choices and the perception that eating is a chore rather than a pleasurable event.
As the survey revealed, tackling malnutrition in older adults is in dire need of attention to the complexities involved in eating well.
The next step is a two-year study in two aged care facilities in Tasmania to promote nutritional strategies, in which Lea’s team is working closely with staff to put effective nutrition and eating practices in place, seeking staff feedback along the way.
Strategies include doing more to help residents eat, like positioning drinks within reach, offering snacks throughout the day and improving the quality of the food and the eating environment.
These insights came from nurses themselves during the pilot study.
One said, for instance, “The tea menu is appalling and needs a major overhaul… [it] is quite inappropriate for elderly people; party pies, sausage rolls, wedges, deep fried food, pikelets, jam and cream are not a satisfactory evening meal.”
Others highlighted the need to keep snacks available and continually offer drinks to promote hydration.
Another understood the importance of environment. “Quite a significant number of staff don’t understand that social interaction that’s needed with food and that’s why you have people [staff] around having some social conversation instead of interacting with the resident.”
“Good nutrition is about more than just the nutritional content of food, it’s about the whole food experience like the dining room setting, the environment and social interaction,” Lea told Australian Ageing Agenda.
The project also emphasises the importance of staff involvement and empowerment to drive change.
“I’m hoping that by engaging staff, it will sustain change and that if we can fine tune this model, we can get it out there and maybe other aged care homes can implement similar models.”
“There is an importance of getting staff to be engaged so they feel empowered to make change and ensure it is sustainable.”
Posted by ProPortion Foods Blog on Oct 1, 2019 in Uncategorised
People tend to become more fragile with age. But frailty syndrome – functional decline that makes simple everyday activities a challenge – is not a normal part of aging. Rather, it is associated with lifestyle factors such as diet.
In a recent study, poor quality diets were associated with greater risk of becoming weak and fragile. Challenging conventional wisdom, the US research found that diet quality was more important than food quantity or protein intake.
The study involved more than 2,000 adults aged between 71 and 80 years who were categorised as “robust” or “pre-frail” at the study’s outset. Over four years of monitoring, 277 of overall participants became frail, and 629 of those who were robust became frail or pre-frail.
While protein and energy intake made no difference, eating poor quality diets almost certainly led to frailty (92% higher incidence) while medium quality diets conferred a 40 percent greater risk of becoming frail compared to good quality diets.
With aging, muscle mass and strength and bone density naturally wane to some degree. But this can be accelerated by inadequate mobility and poor nutrition, leading to sarcopenia, osteoporosis or a combination of these – now named osteosarcopenia.
This can result in frailty syndrome. It has been proposed that the syndrome can be identified if someone experiences three or more of the following: weight loss, exhaustion, weakness, slowness and inactivity (some of which can also be signs of malnutrition).
Recognising frailty syndrome can help inform treatment, but ideally it’s best for people to take measures to avoid going downhill so quickly and compromising quality of life rather than aging gracefully.
What causes it has been a subject of debate; nutritional factors typically linked to lower risk of sarcopenia, osteoporosis and frailty have included high protein intake, energy (calories), and vitamin D and calcium levels.
Accordingly, treating the conditions and underlying malnutrition has traditionally been treated first and foremost by increasing protein and energy intake – which may include recommending custards and other sweet desserts that are otherwise nutritionally bereft.
Given that the new research on diet quality suggests that attention to healthy foods is paramount for prevention, what does this mean?
The paper cited four other studies that found the Mediterranean diet reduced frailty risk. This is an eating pattern high in plant foods such as fruit, vegetables and legumes and healthy fats contained in extra virgin olive oil, nuts and seeds. It is low in processed foods, confectionary and red meat.
There is plenty of scope to include healthy energy and protein options in this type of diet – also providing an abundance of other nutrients such as calcium and vitamin D (although supplementation may be needed to boost vitamin D in any event – best to check levels with a GP), thereby ticking all boxes.
This includes generous amounts of extra virgin olive oil for cooking and salads, a handful of nuts every day, avocado, salmon, eggs, and full fat dairy products such as yoghurt and cheese.
Posted by ProPortion Foods Blog on Sep 24, 2019 in Uncategorised
Dysphagia, or failures with swallowing, can range from mild to severe, acute to chronic, and short- to long term. It can result in unintentional weight loss, malnutrition and dehydration, social and psychological challenges, complications with other conditions, and, more seriously, life-threatening problems like choking, suffocation and lung infections or pneumonia.
The most common form is oropharyngeal dysphagia – difficulty with the reflexive act of swallowing itself which involves moving food or liquid from the mouth through the pharynx and into the oesophagus. The other main type is oesophageal dysphagia, which produces the feeling of food being stuck in the throat or chest and possibly chest pain.
The most frequent causes of dysphagia are neurological disorders including stroke, dementia and Parkinson’s disease. Other triggers include head injury, motor neuron disease, depression, chronic obstructive pulmonary disease, frailty, cancer and postoperative problems involving the head and neck. Weakened muscles and sarcopenia can also impact swallowing. Pills themselves – which 40% of adults find hard to swallow – can cause dysphagia through medication side effects.
It is very important to identify swallowing problems and their cause as early as possible. People who have experienced stroke are at high risk and should be immediately screened for swallowing problems before ingesting anything. People with other high-risk medical conditions as outlined above should be asked if they have experienced any issues with swallowing.
Apart from obvious difficulties, other signs to look for include coughing before swallowing, during or after eating, heartburn or reflux, drooling, frequent chest infections, storing food in the cheeks, taking a long time to eat, or reluctance to eat or swallow anything. Changes in facial features, speech or voice, like slurring or gurgling, could indicate silent aspiration. Family members should look for these signs and seek professional help if concerned.
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