Nutrition & Healthy Ageing in Asia: Harnessing Science for Action
Asia will soon have the largest percentage of older persons in the world. Challenges faced in caring for older persons in Asia include the erosion of traditional family care practices, spiralling medical care costs, and in general, a low priority accorded to programmes and interventions for older persons. Against this backdrop, the ILSI-(SEA) symposium/workshop was held on 6-7 July 1999 in conjunction with the Singapore Ministry of Health. The main objective of the symposium was to identify key issues on maintenance of optimal health of older persons that are important in developing strategies and programmes to improve the care of the elderly in Asia.
Good nutrition and appropriate physical activity - as major contributors to healthy ageing - constituted the focus of many presentations. It was pointed out, however, that gaps exist in our current knowledge on several key issues including age-appropriate dietary guidelines and physical activity. In the Asian region, there is a dearth of even basic information on the nutrition of older persons such as food practices and nutrient intake. The need for age-specific indicators and standards to assess the health significance of age-associated decreases in energy intake and physical activity was emphasized by Prof. Johanna Dwyer from Tufts University (see p15). Age-appropriate dietary reference standards for older persons should also be developed and employed because of changes in lifestyle, reserve capacity and functions which results in changes in nutrient requirements. Whether the Dietary Guidelines for Americans are fully applicable to persons over 70 years was questioned. Dr. Adam Drewnowski, University of Washington, asserted that dietary guidelines restricting fat, sugar, and cholesterol may have little bearing on the health of that age group, considering that the principal risk factor for morbidity and mortality is age.
In sharing the Japanese experience, Dr Hiroshi Shabata, Tokyo Metropolitan Institute of Gerontology, attributed prolongation of the Japanese life expectancy to a dietary pattern that has not changed markedly since mid-1970s. Total daily energy intake is about 2000 kcals; protein and fat from animal and plant sources are equally balanced; and a variety of vegetables are consumed each day. Dietary supplements may have a role in the nutrition of older persons as anti-oxidant vitamins, zinc, selenium and copper, pre-hydrolyzed proteins, dietary fiber, and pre- and pro-biotics have been demonstrated to be able to restore "favourable" immune functions. Ageing brings about a marked decline in immune and gut function that can predispose elderly individuals to an increased incidence of infections and autoimmune diseases, malignancies, allergies and digestive problems, as explained by Dr. Harsharnjit Gill, Massey University, New Zealand.
Priority Research Areas: A panel shared their experiences on two major studies involving older persons in Asia. Prof. Khor Geok Lin, Universiti Putra Malaysia, highlighted the unique features of the CRONOS Study (see p53). The pilot phase of the CRONOS project had been carried out in China, Indonesia, Malaysia, Philippines and Thailand. Dr Widjaja Lukito from SEAMEO-TROPMED, Indonesia compared key findings from the IUNS Food Habits in Later Life Study which was conducted in China, Japan and the Philippines. He also presented results from the CRONOS Study in Vietnam. Dr Corazon Barba, Food and Nutrition Research Institute, the Philippines, reported that both the IUNS and the CRONOS Studies revealed protein and energy deficiencies among older Filipinos.
Dr Alex Malaspina, President of ILSI pointed out that the challenges for research on older persons in Asia are diverse, and called for more research to identify quality of life indicators and the social, cultural, environmental and psychological barriers towards healthy ageing. He also proposed that ILSI-SEA collaborates with other agencies to act as a catalyst to produce a manual for optimum nutrition and physical exercise for older persons for the health professional community in Asia. The workshop identified the following priority research areas:
à develop dietary recommendations and food guides that are culturally appropriate for Asian older personsPriorities for Action in the Area of Education and Training:
à validate suitability of current anthropometric indices, biochemical indicators, dietary standards and functional indicators for Asian older subjects
à assess physical activity levels, energy expenditure, energy and nutrient requirements of older Asians
à collaborate research on lifestyles, health and nutrition of older persons in Asian countries, using a common protocol such as the CRONOS Study
à establish a regional network for research on healthy ageing
à organize a follow-up workshop to identify and harmonize research and intervention efforts.
à undertake training and update knowledge on healthy ageing for professionals and community caregiversConcerns of older persons should be brought to the attention of governments in order to establish stronger measures and policies towards improving their health and well being. Partnerships among the governments, NGOs, academia and the community are essential for successful implementation of the recommendations.
à develop culturally appropriate communication materials
à include input from older persons in planning and management of community programs and organize educational activities in easily accessible places such as community centers and senior citizens clubs
à create a regional directory of organizations and activities involved with care for older persons
Contact Prof Khor Geok Lin, Professor of Community Nutrition, Universiti Putra Malaysia; email: firstname.lastname@example.org or Mrs Yeong Boon Yee, Executive Director, ILSI Southeast Asia, email: email@example.com