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Ensuring the elderly eat enough: The health implications of a better diet

A study aims to develop healthcare solutions and in turn cut down the average length of hospital stay by 15 per cent, and hospital re-admission within three months by 5 per cent.

Ensuring the elderly eat enough: The health implications of a better diet

File photo of an elderly person in Singapore. (Photo: Xabryna Kek)

SINGAPORE: Madam Lim Siew Heng was 38kg at her heaviest, underweight even for her petite 1.55m frame. In recent years, her weight dropped to below 30kg. Now aged 94, Mdm Lim was probably undernourished.

Her granddaughter Candy Quek, 26, told Channel NewsAsia that dietitians would always advise Mdm Lim to eat better, and that her family would try to feed her nutritional drinks. However, Mdm Lim had a small appetite and would reject such offerings.

Things changed two years ago after a fall that resulted in a pelvic fracture. She became bedridden as a result. “There was an urgent need for her pelvis to recover. We didn’t want her to be bed-bound,” Ms Quek said.

At this point, Mdm Lim started actively taking nutritional drinks and eating more. This worked wonders, Ms Quek said. Mdm Lim recovered and is able to walk, although she prefers getting some assistance for fear of falling again. She now has phases where she eats the same food in small portions for a period of time. Some of her favourites have been french fries, beancurd and kaya toast. Her weight has gradually been increasing.

A study aimed at finding healthcare solutions for undernourished elderly like Mdm Lim was launched in August this year. By identifying and fixing the problem early, researchers expect the average length of an elderly person's hospital stay to be cut down by 15 per cent, and hospital re-admission within three months to reduce by 5 per cent.

The three-year study, being conducted by Changi General Hospital and SingHealth Polyclinics in collaboration with healthcare firm Abbott, will investigate the effects of nutrition management on community-dwelling elderly in Singapore. The study will recruit 1,200 people aged 65 and above until May 2019 to investigate the role of nutrition in improving health outcomes, reducing hospital re-admission rate and length of stay among elderly with nutritional deficiencies.


The study will be the first project conducted at the Nutritional Health for the Elderly Reference Centre within CGH's Integrated Building. It aims to establish an Asia-centric reference database on elderly nutrition by using a predictive algorithm to identify elderly at risk of undernutrition in the community. This will help to increase nutrition literacy by 30 per cent and develop an oral nutrition supplement suited for Asians.

Associate Professor Ng Tze Pin, research director in the department of Psychological Medicine at Yong Loo Lin School of Medicine at the National University of Singapore, said the involvement of SingHealth polyclinics in this new interventional study is significant.

“It means elderly nutrition is now being given due attention for the first time in government primary care polyclinics. I see an important role of primary care polyclinic doctors and nurses in screening for malnutrition using simple questionnaire tools,” said Prof Ng, who was among three researchers who published the first study documenting the high prevalence of undernutrition among Singapore's old folk in 2007.

Malnutrition among the elderly has been on the radar of researchers, policy makers and clinical practitioners in North America, Europe and Japan for more than three decades, he said. 

On the timing of the study, Dr Samuel Chew, senior consultant in the Department of Geriatric Medicine at CGH, pointed to the rapidly ageing Singapore population, where one in four will be above 65 by 2030.

Singapore's population is ageing so rapidly that in less than ten years, it would become a "super-aged" nation, where one in five is 65 years of age or older. (File Photo: Xabryna Kek)


Malnutrition, a risk for 30 per cent of community-dwelling people aged 55 years and older, is a serious health issue, said Prof Ng. “Numerous studies show that malnutrition leads to increased severity of disease and disability, length of hospitalisation stay and healthcare costs, poor quality of life and increased mortality,” Prof Ng said.

“It is a paradox of the present time that while we are relentlessly combating obesity and diabetes, undernutrition among the elderly has been under the radar for a long time. It is good that a new study now focuses attention again on this under-recognised and under-managed problem,” Prof Ng added.

Dr Chew said there is a pressing need for a change in paradigm from healthcare to health, and from investigations and treatments to prevention.

“Nutrition plays a key role in improving the quality of life of this particular vulnerable cohort of our population by enabling functional optimisation and independent living for as long as possible,” he said.

A study focusing on Asia is also timely, as current data and evidence on the importance of nutrition in improving the health of elderly people come from Western populations, said Dr Low Yen Ling, director of research and development at Abbott Nutrition Asia-Pacific Centre. It will help develop solutions that are customised to the Asian context, she said.

“By prioritising nutrition care in the hospitals and ensuring that people are well-nourished, we remove a barrier to successfully managing chronic conditions while lowering the financial burden on individuals and the healthcare system at large,” she added.


Undernutrition is not an inevitable side effect of ageing, but many changes associated with the process of ageing can cause poor nutrition, said Dr Chew. For example, ageing is frequently associated with decreases in taste acuity and smell, deteriorating dental health, and decreases in physical activity, which may all affect nutrient intake, he said.

Ms Eleanor Yap, who has been working with the elderly for more than 10 years and manages an e-magazine for seniors, said that the issue is not as straightforward as it might seem. She gave an example of an older adult who may be eating less due to depression, having suffered grief, failing health, lack of mobility and other factors. If an older adult is living alone, he or she may not be able to afford to full meals every day, she said.

Dr Low said that unlike in less developed countries where malnutrition is mainly due to monetary constraints, causes in developed nations are mainly related to underlying disease, hospitalisation, or inability to eat properly due to factors such as poor appetite, swallowing difficulty, depression and social isolation.

“Yet often it is left undiagnosed or untreated. However, we know that with screening, early identification and intervention, it is a largely preventable and treatable condition,” she said.


The experts urged families to look out for unexpected weight loss of 5 to 10 per cent over six months, loose clothing or jewellery and new-found difficulty in getting up from a sitting position, unsteadiness of walking gait, and recurrent falls.

Other common symptoms of undernutrition include tiredness, fatigue, or apathy, longer healing times for wounds, loss of fat, reduced muscle mass and reduced tissue mass.

Good nutrition and a balanced diet, which include adequate calorie and protein to help maintain body weight and a healthy Body Mass Index, therefore reducing risk of muscle loss and strength, are important, said Dr Chew. Suitable foods are carbohydrate foods like brown rice, noodles, bread, potatoes, oats and other wholegrain cereals, protein foods like fish, chicken, meat, eggs, milk, cheese, tofu and beans, he said. 

(File photo: MCI)

However, if there is any problem with eating adequately, a fortified drink or oral nutrition supplement may be necessary, Dr Chew added.

Research shows that eating meals with others enhances dietary variety and nutrient intake. Meals eaten in groups are up to 46 per cent larger than meals eaten alone, and that the more people there are at the meal, the greater the intake, he said.

Dr Low said that most people who are malnourished do not even realise it as it can be invisible to the eye, and it often goes undiagnosed. 

“Routine screening and early identification is critical to identify and implement nutrition interventions in order to prevent or treat malnutrition so people can live healthier lives and carry on doing the things they love,” she said.

Source: CNA/ja


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