My nonna was a passionate cook who lived to her 92nd birthday.
She aged well, and was in her own home until her last couple of years, when she moved to an aged care facility in a small North Queensland town.
As soon as she went in, she started to lose weight.
Never a big eater to start with, she lost all interest in food. She weighed around 40 kilograms when she died.
I wonder now what made her lose her appetite, and whether it was a combination of several factors.
She was Italian, so perhaps the food wasn’t familiar. Perhaps she didn’t trust food that she hadn’t cooked herself. Maybe she didn’t like the people she was supposed to dine with. Or perhaps she was done with living.
The number of Australians aged 75 and above is expected to rise by 4 million by 2060, increasing from about 6.4 to 14.4 per cent of the population.
In 2012, there was roughly one person aged 100 years and over to every 100 babies; by 2060, it is projected there will be around 25.
Most of the discussion about the ageing population is about how we will house and provide health care, with a big focus on dementia and age-related diseases.
But not much thought has been given to the critical and complex task of how we feed the ageing population.
What is the future of food as we age?
Our nutritional needs and our appetite change in a myriad of ways as we get older.
It’s not just that older people need to eat fewer calories. They also need more protein, calcium and vitamin D, because as we age, the body becomes less efficient at absorbing key nutrients.
And because our appetite can decline for a range of physical, emotional and social reasons, we have to work harder at making sure we eat well to maintain good health.
Cherie Hugo, a Brisbane-based dietician who works in aged care, says the different nutritional needs of older Australians call for a different approach to cooking and eating.
“It is about looking at ways to increase the appeal of a meal and make it easier to eat,” she explains.
“As we get older, our senses diminish so we have to look for ways to amplify foods to engage the senses.
“We might not be seeing the food as clearly as before or we don’t have the same smell or taste.”
Those senses enhance a meal experience, so “if we aren’t engaging the senses we aren’t enjoying the meal as we used to”, Ms Hugo says.
“So we have to improve the flavours as well as the visual appeal of a meal,” she says.
Ms Hugo says it’s also important to make sure the dining environment is as appetising as possible.
“The lighting has to be brighter and the ambiance of the dining room conducive to really wanting to hang and eat and converse,” she says.
That doesn’t mesh with our perceptions of food and eating in the aged care setting: the dominant image is of mushy institutional food eaten in a drab and quiet dining hall.
Ms Hugo says dieticians have to take into account the social and sensual environment around meal times in aged care.
‘If we get the food right, there will be savings’
Ms Hugo and other scholars in the area of geriatric nutrition published a study in 2017 in the academic journal Nutrition and Dietetics that found that one in two aged care residents are malnourished.
The rate of malnutrition in aged care hasn’t shifted much in the 15 years Ms Hugo has been a dietician.
Ms Hugo heads The Lantern Project, which works to tackle the rates of malnourishment in aged care.
It takes a multidisciplinary approach to geriatric nutrition. It involves over 650 members — both national and international — including aged care organisations, peak industry bodies, allied health researchers and resident advocates.
Malnutrition can exacerbate existing illness and create the conditions for others to develop.
Ms Hugo believes if we get the food right in aged care, there will be cost savings for aged care providers and the health care system at large.
“I’ve been focusing my PhD work on the economic benefits of good nutrition in health care,” she says.
“I’ve been trying to demonstrate that if we get the food right, there will be savings.
“That’s because malnutrition can lead to some costly outcomes on the health care and aged care system.
“When someone is malnourished there is a higher risk of falls and broken hips as well as a significant increase in pressure sores and problems with wounds. Wound care is very expensive in the aged care sector.”
Diet and dementia
It’s not just our bodies that get knocked around by the passing of time, but also our brains.
You might think the best options to keep the ageing brain fighting fit are Sudoku puzzles and fish oil tablets, but nutrition also plays a part.
Dr Genevieve Steiner, a cognitive neuroscientist with the NICM Health Research Institute at Western Sydney University, is researching the brain and diet.
Her focus is dementia, which affects one in 10 Australians over 65 and one in three over 80.
“We have to take an across-the-lifespan approach to dementia prevention,” she says.
“The research shows that if you can combat conditions like obesity and high blood pressure as well as diabetes in mid-life, then that’s going to reduce the possibility of dementia later in life.”
Dr Steiner says obesity and diabetes are common in Australia, and they’re mostly related to lifestyle.
“That means we can actually do something about dementia later in life by tackling unhealthy lifestyle choices in mid-life,” she says.
Dr Steiner acknowledges that eating and brain health is a fast-paced area of research, with a lot of observational studies making up the evidence base.
Some recent Melbourne-based research points towards the Mediterranean diet — rich in fruit, vegetables, cereals, moderate fish and dairy and low amounts of red meat and sugar — as bringing about improvements in memory and thinking.
But more research needs to be done before any specific dietary guidelines can be made.
While the Mediterranean diet may not yet be doctor’s orders for older patients, I wonder whether my nonna’s home-cooked Italian diet — mostly fruit and veggies, meat and some pasta with an occasional strong espresso and biscotti — was one of the reasons she remained as healthy and clear-minded for as long as she did.
It’s a lesson to me that at any age, we should be thinking of eating well.