- [Announcer] Coming
up on Aging Matters, Nutrition and Aging.
(gentle music) - [Patti Henegar] I think am I
eating a balanced diet? Am I putting enough
food in my body, the right combinations
to keep my health and my energy up? - [Dr. Ron Aday] You talk about
aging matters, nutrition
certainly matters as far as having a healthy
lifestyle and being able to continue to pursue one's
activities in later life. - [Narrator] Baby boomers
are aging with more nutrition related
health problems than
previous generations, according to America's
health rankings. A 55% higher
prevalence of diabetes, a 25% higher
prevalence of obesity, a 9% lower prevalence of very good or
excellent health status. - [Dr. Nadia Pietrzykowska]
Stress, individuals work more
hours, longer hours. We travel by car, we
don't walk as much, we don't have a lot
of energy expenditure, and what we eat also matters. There's areas in the United
States where it's very hard to find a store
with healthy foods. - [Joe Evans] I think
people don't realize that
we have the need in this country that we have. Your neighbor could be
starving and you may not know. - [Ron] They may have
food in their cabinets, but they may not be
able to prepare it, or they may have money
but not be able to get to the grocery store, or walk
around the grocery store, or have transportation. - [Man] That's what people want. They want food.
Yeah. That liter of Coke,
liter of Pepsi, stuff like that goes real quick. One out of every four
older adults in our nation have some form of malnutrition. - [Nadia] I have to tell you
that you can be overweight and malnourished
at the same time. The takeaway here is really that food is medicine, and
the perversion of food should be central to
provision of healthcare. It should be a routine
part of healthcare. Food is just the
most basic of needs. Everybody has a right
to not be hungry. So it's really scary
to be facing this wave of the booming
population at this age, and us scrambling
to fill that need. - [Announcer] Major
funding for NPT Reports' Aging Matters is provided by: the West End Home Foundation, improving the quality
of life of seniors through the support of
non-profit organizations in Middle, Tennessee; the HCA Foundation, on
behalf of TriStar Health; the Jeanette Travis Foundation, dedicated to improving
the health and wellbeing of the Middle,
Tennessee community; and Cigna-HealthSpring. Additional support provided by Lisle Parham Wealth
Management of UBS Financial Services,
Incorporated; Jackson National Life
Insurance Company; The Community Foundation
of Middle, Tennessee; and by member of NPT. Thank you. Of all diseases that
can affect how we age, you probably don't
think of malnutrition. But researchers
say more and more older adults are malnourished, even though they look healthy,
or can even be overweight. It's not always because
of poor eating habits. As we age, our bodies
simply do not process foods and nutrients
the same way. Some functions like
swallowing and digestion change as we grow older. And medications can
affect how nutrients are absorbed by the body. In addition, many older adults
face practical challenges to good nutrition. They can't get around easily,
or can't afford health foods. Malnutrition, or under
nutrition, is now considered a hidden epidemic among older
adults in the United States. How do you know if
you're malnourished if you can't tell by looking? Can we change our diet to
improve our health as we age? What resources are available
to help older people get access to quality
foods and nutrients. I'm Kathy Mattea. Join my for this addition
of Aging Matters, as we learn how to
identify who's at risk of malnutrition, and
strategies for using food and nutrients to
help with healthy aging. (gentle piano music) I believe in nutrition. I try to eat balanced diets. I have had some nutritional
issues in the past, so maybe I'm just more attuned
to it than some people are. - [Narrator] As she nears age
70, Patti Henegar is focusing more than ever on what
she eats and drinks as key to healthy aging. I would say it should
be your top priority. The old expression is:
Why would you do anything to a new car but put
the best fuel in it? The body is aging, and
we need to offset that, if at all possible,
through nutrition. Should it be ranked
as high as exercise? That's almost comparing
apples and oranges, but it is very important
because, without the fuel, your body is not
going to stay healthy. You're not going to be able to
function up to your maximum. - [Narrator] It sounds so
simple, basic, that nutrition can affect how well our
bodies function as we age. But the concept is more
complex than many people realized before the current
wave of Baby Boomers began to age and cause a spike in nutrition-related
diseases and disabilities. The connection is redefining
how health professionals think of malnutrition. 25% of community dwelling
older adults have malnutrition. That means one out of every
four older adults in our nation, at minimum, have some
form of malnutrition. And so, this is not
just a problem that
occurs in hospitals, or in nursing home facilities,
or in assisted living. This is our older adults
in our nation in general that have a condition that
puts them at greater risk. - [Narrator] Dr. Heidi Silver
is a Vanderbilt University professor and
nutritionist who studies malnutrition and aging health. Most often when we think
about malnutrition, we're thinking about
it occurring more often in less developed, less
resource-rich countries where we see starvation,
extreme weight loss, extreme hunger, and chronic
inadequate food intake. But that's only one
form of malnutrition, and the malnutrition we see
here in the United States takes a different form. And it's less obvious
in its physical signs, and it's easily masked
by other conditions like illness or
injury or inflammation or even higher body weight. I have to tell you that
you can be overweight and malnourished
at the same time. In the aging population, it
requires even additional effort to understand if that excess
weight is a problem or not. - [Narrator] Dr. Nadia
Pietrzykowska sees people who are malnourished everyday
in her New Jersey clinic, as a specialist in
obesity medicine. There is many, many reasons,
and there's a lot of things we know and a lot of
things we don't know. Genes, our genes are changing. The environment is
changing our genes. The way we eat, society has
been affecting what we're doing. Stress, individuals work
more hours, longer hours. We travel by car, we
don't walk as much, we don't have a lot
of energy expenditure. (checkout scanner beeping) What we eat also matters. A lot of foods are processed. There's areas in the United
States when it's very hard to find a store
with healthy foods. - [Narrator] Food deserts
are parts of the country without access to fresh
fruits, vegetables and other healthy
foods, mainly due to a lack of grocery stores
and farmers' markets. The USDA has mapped the
nation's food deserts. This one of Nashville-Davidson
County shows low-income urban areas that are
more than a mile away from grocery stores; rural
areas that are 10 miles away; and areas where residents
don't have access to cars. At the same these areas
often have quickie marts that sell mostly processed,
sugar and fat-laden foods, contributing to obesity
and malnutrition Malnutrition isn't
marked by low weight. It's not marked by these
normal things that we would associate
with malnutrition. Malnutrition is not getting
proper dietary requirements met by the foods
that you're eating. I think that doctors and
healthcare professionals are going to start to
encounter a lot more people who are malnourished that
don't necessarily fit the normal definition
of malnutrition or the normal look of what
malnutrition would look like. - [Woman] If you can have
a seat right up here. - [Narrator] Healthcare
professionals often overlook or ignore key signs
of malnutrition, in part due to lack of training,
according to Dr. Silver. I think there's just less
emphasis on nutrition as a component of medical
school and nursing school curriculums than other
factors that are part of the curriculum
like pharmacology or cardiology or endocrinology. And there has been a
consensus statement recently from the Academy of
Nutrition and Dietetics and the American
Society for Parenteral and Enteral Nutrition
who have identified six prominent clinical
characteristics of malnutrition in today's patient. - [Narrator] Those 6
characteristics are: Weight loss, energy intake, fat loss, muscle loss fluid accumulation,
handgrip strength. So is that malnutrition?
Or is that normal aging? It's a fine line, isn't it? It's a fine line between
what's normal aging and when it becomes
malnutrition, and it's really how severe. So one of the things we
start with is your hair. Is it coming out easily? Is there a larger amount
coming out easily? Is it becoming brittle
and breaking off? At the sides of the head,
the temporalis muscle, we look at is it
becoming indented, is there a depression
there, which tells us that you might be losing muscle
mass as you get older. So muscle is built by
eating protein, correct? Eating protein
and by exercising, particularly
resistance exercising. As in weights?
As in weights. We often see something
called pitting edema when there's malnutrition
and dehydration. So if you press either
on the foot or the ankle, so we expect to see a little
bit of indentation like that. But when the
indentation stays there, that shows that there's not
enough fluid and fat mass behind there to recoil back up. Oh my god, he pulling out. - [Narrator] Identifying
malnutrition is important to healthy aging-
especially when it comes to certain conditions
associated with growing old that might result
from poor nutrition. For example, falls,
fractures, infections, even minor memory
loss can be linked to nutrition-related issues. You can also have other
types of malnutrition, for example, you
can be deficient in
vitamins or minerals and have a micronutrient
type of malnutrition. You can have
inflammation-related
malnutrition. And so there are multiple forms,
and they should be treated differently in order to be
able to resolve the problem and then promote
growth and repair. (gentle guitar music) There is often social isolation that promotes
inadequate food intake or less enjoyment for consuming. - [Woman] Hey, sweetie. - [Woman] Hey, Mary,
where have you been? - [Woman] I'm 96, soon be 97. - [Narrator] Madeline
Jeans is proud of her age and that still lives in her
own home, eating her own food, even if it's not the pleasurable
experience it once was. It don't taste as
good as it used to. When you get older,
everything changes. So you to accept it, and be happy, be
happy what you got. - [Narrator] Like many older
adults, Jeans finds eating more of a chore-due to natural
changes in her aging body. For example, the sense of
taste and smell may weaken; digestive systems may slow; chewing and swallowing
problems can develop; mobility can make it hard
to shop, cook and eat; and medications to
treat certain conditions can reduce appetite. Despite the challenges,
Jeans tries to eat a healthy meal each day. I'm a farm girl. I know what a good
meals are. (chuckles) I feel like it's necessary. My children tell me, I'll
get back in the hospital. I think I eat good but
sometimes when you get old, it don't do you no good maybe. - [Narrator] Her observation
is backed by growing evidence that aging influences how
nutrients are absorbed by the body. For example, Vitamin D may
be low in an older person because aging skin is less
able to change sunlight into the vitamin. Same for vitamin B-12, which
is harder for our bodies to absorb after age 50. While dietary guidelines
established by the USDA still apply to older adults, recommended daily caloric
intake decreases with age as the metabolism slows down. High fiber, high protein
diets become more important as does calcium. The takeaway here is really
that food is medicine, and the provision of
food should be central to provision of healthcare. It should be a routine
part of healthcare. - [Narrator] Sarah Downer is
with the Harvard Law School Center for Health, Law,
and Policy Innovation. She led a study on the impact
of medically-tailored meals for patients with
chronic diseases. And they compared people that
were receiving the meals, and people who were medically
similar had the same medical profile, so
they were also very ill that weren't receiving the
meals, and what they found was that as that hospitalizations
decreased by half for the population that was
receiving the intervention, and that when those
patients were hospitalized, the length of the
hospitalizations were shorter by about 37%. They were more likely
than the comparison group to be able to return to
their homes rather than going to another acute
long-term care facility. And so there were savings
on that end as well, and especially if
they're challenged by not being able to travel to
the source of healthy food. (gentle guitar music) - [Narrator] Never has healthy
food been so available, yet so unattainable for
many seniors in Tennessee. National reports consistently
show this state is among the worst when it
comes to percentage of adults age 60 and older who face
the threat of hunger, what is known as
food insecurity. Food insecurity is
not simply hunger. Food insecurity is actually
the thoughts and the feelings of not knowing where your next
meal is going to come from, not knowing how you're going
to get to that next meal, which can be very overwhelming. - [Narrator] The Nutrition
program of the Tennessee Commission on Aging &
Disabilities has one main goal: to make sure older
residents receive at least one nutritionally-balanced
hot meal each day for at least five days a week. - [Lacy] We wanted to know
what the specific barriers were for our older
adults in Tennessee. - [Narrator] To get that
information, the department launched a statewide study on
food access among residents age 60 and older with household
incomes of $35,000 or less. The findings were stunning
even to the researchers. About 30% of them
are either marginally or very low access to food. And so I think we can say
there is a considerable vulnerability among
this age group. - [Narrator] Dr. Ron Aday
is a gerontology professor and former director of
the Aging Studies program at Middle Tennessee
State University. As we discovered, people
have access to food. They may have food
in their cabinets, but they may not be
able to prepare it. They may have money, but
they may not be able to get to the grocery store, or
walk around the grocery store, or have transportation. So it's very complicated
in terms of narrowing those factors down. Some people may have
several factors that they're dealing with and other
people may have one or two. - [Narrator] The study found
that among older Tennesseans who are food insecure,
22% didn't eat because they didn't
want to eat alone; 47% couldn't get
food due to health; 39% teeth or mouth problems
that made it hard to eat; 63% had to choose
between medicine or food; 58% had to choose between
utilities or food. (gentle music) More revealing were
the personal interviews conducted confidentially
with more than 400 seniors across the state. [Woman's Voiceover] You see
something that looks so good and other people
are snatching it up, but it's too expensive,
you know? And I can't. [Woman's Voiceover] And you
run out of bread, coffee, sugar, and you just don't
have the money to get it. [Woman's Voiceover] Oh yeah! Girl, for years, I
would run out of money, and all I would have to eat
for, say, seven or eight days in a row for lunch and
dinner would be pinto beans-- - [Man's Voiceover] Back in
'04 when my wife passed away, I would go a day without eating, and I had plenty of
food in the house. We were kind of surprised,
I think, in terms of looking at that, by both the
psychological issues as well as sometimes the social issues
of just the lack of desire or motivation really to
eat healthy food choices. - [Narrator] At senior
centers like this one in Fayetteville, Tennessee,
lunch time is more than a social outing. It can be key to
nutritional health. - [Woman] They're all
the same, Mr. Hues. All the same? Okay.
All the same. If this person didn't
have this hot meal, they would probably
live on snacks or cereal or something very, you know,
maybe at times healthy, but for the most part not. And how that can help not just
their own personal nutrition, but keeping them
out of the hospital, keeping them in their homes, and it just goes so much
further than the hot meal. - [Narrator] This center is
funded by the state nutrition program as a congregant
meal site for seniors. If they're over 60, they show up and can eat for free
or offer a donation. - [Woman] Appreciate that. - [Narrator] Many seniors
face barriers in getting to the meal sites,
especially in rural areas like Lincoln County. (knocking) Ms. Harris
I have your lunch. - [Narrator] Home-delivered
meals through this same state-funded program
is one solution, but participants must meet
medical and income criteria, and there is a long waiting
list throughout the state. I've already delivered six
so I've got about eight more. I like to meet the
people, be nice to 'em. I'm the only person
they see sometimes. So I just love doing it. (soothing piano music) It's true that we often
think of different types or forms of malnutrition
occurring in the oldest old, in people who are in their
late 70s, in their 80s, and in their 90s. But what's really interesting
in today's hospital patients, we found that 40% to
50% of our hospital patients had sarcopenic obesity. Sarcopenia really has
two key components. One is the loss of
the muscle mass, and the other is the loss
of the physical strength from having less muscle mass. We are in the middle
of an aging boom. Our older adult population
is living longer, and more and more of them do
have overweight and obesity. And so we have a wider
prevalence of illness related to malnutrition and
injury related to malnutrition. - [Narrator] The paradox of
obesity and malnutrition in aging has prompted
medical experts to revise how obesity is determined. Basically, the most
common measurement used is called the Body Mass Index. The Body Mass Index is a
formula that takes into account height and weight
and gives us a number that can classify us
whether we're normal weight, underweight, overweight,
obese, et cetera. It doesn't take into
account body composition. So we don't know if that
weight is muscle mass or if that weight is fat tissue. We know that as we age,
we have a natural tendency to lose muscle mass
and gain fat tissue. We found that it's very
important to also determine the location of the fat. When fat is located in
the abdominal cavity, and it's called the
visceral adiposity, it tends to be more harmful. So measuring waist
circumference, and
there are criteria saying what the waist
circumference should be for men and women. That, in addition to the
BMI, help us determine if somebody's at
a healthy weight. - [Liza Gundell] I was a really
healthy fat person. I was. Other than the falls and
the injuries I've had, I don't have a whole lot
of medical conditions. - [Narrator] Liza Gundell could
barely walk and was headed for knee-replacement
surgery at age 53 when she had an aha moment: maybe changing her diet
would improve her joint deterioration and pain? Never did my primary care
physician, the orthopedist or the pain management
doctor raise the issue of weight in terms of my health. I was surprised. Hi, Liza, how are you?
Good, how are you? - [Narrator] Liza sought
help from Dr. Pietryzkowska, and has since lost 54 pounds. - [Dr. Nadia] So basically,
with her weight loss, she put herself in a better
place for healthier aging. - [Narrator] Unless more Baby
Boomers follow Liza's example, the American healthcare
system will be unprepared for the consequences of
aging overweight seniors who are also malnourished. It seems that about
maybe 20 to 30 years ago, the rates of obesity
started increasing. So patients that were
young adults at that time now are in that 50,
60 years old range, and started gaining
weight at that time and now might be
overweight or obese. We have an aging population
that's not healthy, that's sicker, that cannot
take care of itself, with more disability, with
problems with cognition. So that will have a
huge toll, I think, on just our health system. Mr. Mason?
Yeah? - [Narrator] When medical
providers pay close attention to the triggers of
malnutrition in older patients, it makes a difference,
according to Dr. Silver. She's on a mission to
develop training and tools to help doctors and nurses
intervene earlier and faster. We're working with a group of
computer engineering faculty here to develop a mobile
phone-based software, or application, that we
hope could be implemented in healthcare systems
that would help providers make diagnosis for malnutrition. - [Narrator] Silver hopes that
diagnostic tools like the app will lead providers to
ask important questions that go beyond the
doctor's office visit. They also need to be
asking the questions of, are you able to fix
your meals at home? Are you able to make it
to the grocery store? Do you need some assistance? Because we can't make
the assumption that people are just going to
leave the doctor's office and go buy healthy
groceries and go home and fix their own meals;
it's not as simple as that. N-44? - [Narrator] That's one reason
food is the real attraction at many senior centers. - [Bingo Announcer] You
got it, get your prize. - [Narrator] From bingo prizes, to take-home goodies. I eat here everyday. I love it! The food, bingo. - [Narrator] Even for those
who have the resources and awareness, eating well and
achieving nutritional health while aging is work. I think there's a lot of
factors that go into that. Monetary, the cost of
food continues to go up. Time, we all have
good intentions, but can we put it on table? I'm working at it. It's a work
in progress every single day. Do I have it down?
No, not necessarily. I'm not putting myself
up as any kind of, someone to emulate, but I try. We only live life once, so I want to make sure
that as I'm entering my sixth decade and
my seventh decade, that I'm able to do that as
healthfully as I possibly can. I want to be able to enjoy
retirement when I get there. Who wants to be ill or
incapacitated at the time when they're going to be able
to do whatever they want? Americans spend a lot of
time and money on food and diet in our
quest to be healthy. Science is now helping
us better understand why and how that changes as we age. It means re-thinking the
role of food and nutrition in healthcare and what
resources and services are most effective in providing good
nutrition for healthy aging. To learn more about Aging
Matters, visit our website at wnpt.org/agingmatters. (gentle orchestral music) - [Announcer] Major
funding for NPT Reports' Aging Matters is provided by: the West End Home Foundation, improving the quality
of life of seniors through the support of
non-profit organizations in Middle, Tennessee; the HCA Foundation, on
behalf of TriStar Health; the Jeanette Travis Foundation, dedicated to improving
the health and wellbeing of the Middle,
Tennessee community; and Cigna-HealthSpring. Additional support provided by Lisle Parham Wealth
Management of UBS Financial Services,
Incorporated; Jackson National Life
Insurance Company; The Community Foundation
of Middle, Tennessee; and by members of the NPT. Thank you.
