Nutritional challenges for an ageing population
In partnership with the Parliamentary and Scientific Committee (an All Party Parliamentary Group), the Nutrition Society were delighted to host a discussion meeting at the Houses of Parliament on 25 March 2019, titled “Nutritional challenges for a growing and ageing population.”
Chaired by Stephen Metcalfe MP, the panel consisted of Professor Ilaria Bellantuono, Department of Oncology & Metabolism, The University of Sheffield, Professor Emma Stevenson, Professor of Sport & Exercise Science, University of Newcastle, and the Society’s President, Professor Philip C. Calder, Professor of Nutritional Immunology, University of Southampton.
With over-65-year-olds now the fastest growing age group globally, global gains in life expectancy have not necessarily translated to an increase in years lived without disability and disease. Rather, the greatest proportion of healthcare expenditure is now concentrated in old age, with ageing a risk factor for a number of diseases including cardiovascular disease, cancer, dementia and respiratory tract infections. Improving health in old age (‘healthy ageing’) and preventing accelerated functional decline is therefore an increasingly critical issue for policymakers globally.
The panel discussion
Professor Bellantuono began proceedings with a short overview of the health and social implications of an ageing population. With every year spent in good health worth 0.3% of GDP, promoting healthy ageing has ramifications for both individuals and the wider public. 50% of over 65-year olds have multimorbidity, suffering from several chronic diseases simultaneously, yet medicines are rarely - if ever - trialled on those with multiple diseases. Clinical testing of drugs would therefore benefit from wider population participation. Moreover, multimorbidity is most common in those with the greatest levels of socio-economic deprivation. As such, Professor Bellantuono recommended a more holistic approach to promoting healthy ageing with integrated interventions required at both a community and individual level.
Professor Stevenson followed, focussing on the importance of maintaining skeletal muscle mass. Although some loss of muscle mass over time is to be expected, accelerated decline in muscle power is associated with frailty, reduced quality-of-life, and increased multimorbidity. With those who are active across the life course losing less muscle more slowly, Professor Stevenson emphasised that it is never too late to gain and maintain muscle mass via exercise and good nutrition. Optimising protein synthesis is also critical, with protein requirements for the elderly likely to be elevated. Discussing recent findings from the ‘Protein4Life’ research project, Professor Stevenson noted that with many elderly people currently failing to meet overall protein intake recommendations, issues of cost, sustainability, and palatability need to be considered when promoting and developing sources of protein.
Professor Calder finished the panel discussion with an overview of age-related immunological decline, observing that although this a less obvious aspect of ageing than frailty, it is similarly important. The immune response governs response to infection, ideally exerting a protective effect through the actions of a number of different cells working together to maintain the body’s exclusion barrier, eliminate pathogens, and maintain immunological memory. With some level of age-related decline to be expected, slowing the speed of decline is important for improving vaccination response among the elderly and maintaining the immune response. Improving intake of several nutrients including iron, zinc and vitamin E can help to improve healthy ageing. Overall, the panel emphasised the importance of prevention as being key to promoting health ageing.
The main messages following audience discussion
Lively debate followed the panel talks and continued into the evening, with a number of questions from an audience that included representatives from scientific learned societies, parliamentarians, research bodies, committee members and subject matter experts.
Questions covered a range of topics, from the potential importance of the microbiome in supporting healthy ageing, to more technical questions around definitions of disease and the role of genetics. Nutrition Society members were encouraged to submit their questions in advance of the event for selection. A question from member Danielle Logan, PhD candidate from Queen’s University Belfast, was asked during the course of the discussion, enquiring as to the panel’s thoughts on the main factor that needs to be changed in order to tackle malnutrition in older adults.
The panel were agreed that with genetics playing only a minor role in determining the rate at which individuals’ age, lifestyle and diet can significantly contribute to healthy ageing. Yet promoting healthier lifestyles at a population level will require structural changes across a wide range of sectors, and sophisticated, simple communication of nutrition science messaging. In response to the audience questions and discussion over the course of the evening, the panel suggested the following strategies to promote healthy ageing:
- Working to emphasise the more positive aspects of nutrition (not simply the negative ones) in order to encourage adequate nutrition
- Working to target those who are hardest to reach within communities and most vulnerable to malnutrition, through GP services, and by using influential people within those communities being targeted
- Broader environmental changes to ensure a healthy diet is affordable and accessible for all
- Improved nutrition education for medical doctors and better follow-on support for the elderly, with improved use of geriatricians and dietitians in clinical and community settings
- A focus on prevention, with long-term studies looking at preventative measures across the life-course and further research into acceptable and sustainable sources of protein required
The Society would like to thank the Parliamentary and Science Committee and the panel speakers for their help supporting the meeting and look forward to hosting further nutrition related discussions in the future.