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Breakout Session V—Nutrition
and Physical Activity Issues for an Aging Population
Moderator: Irwin H.
Rosenberg
Speakers: John LaRosa,
Cheryl L. Rock, Robert A. Marcus, Robert M. Russell, and Edward
McAuley
Recorders: Pam Van Sly
York, Richetta Webb
Purpose: The growing
number of Americans over age 65 is contributing to an increase in
the average age of the population. The number of older Americans
tripled from the beginning to the end of the 20th century; by the
year 2030, one in five Americans will be over the age of 65. As
a result, we face the potential for crushing increases in healthcare
expenditures for disabilities associated with old age. Prevention
of degenerative and disabling illnesses must become a high priority.
Lifestyle factors that include proper nutrition and diet must play
a greater part in our national efforts. It is well established that
diet and nutritional factors can influence the risk for illnesses
that disable and kill the largest number of older Americans. These
illnesses include heart disease, cancer, diabetes, and osteoporosis.
Advancing age is contributory to a decline in muscle mass and strength.
As such it is a very important factor in determining who will remain
independent and who will require institutional care. Recent studies
have emphasized that muscle degeneration can be reversed with proper
exercise and nutrition at any age, even into one's ninth decade.
Topics—Summary and Recommendations
Nutrition and Physical Activity
in the Prevention of Cardiovascular Disease
John LaRosa, State University of New York,
Downstate Medical Center
As the increasingly urbanized population ages, nutritionally
related chronic degenerative diseases increase. Mortality from cardiovascular
disease has fallen; conversely, the prevalence of cardiovascular
disease is rising. Atherosclerosis, the most common pathological
condition, expresses itself in the middle age and elderly populations,
and may cause considerable disability or mortality. Lowering of
cholesterol levels has been proven to prevent coronary and cerebral
atherosclerotic morbidity and mortality through an increase in activity
level combined with diet. Continued research is needed to understand
more fully the requirements for optimal function and health
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Nutrition and Physical Activity
in the Prevention of Cancer
Cheryl L. Rock, University of California
at San Diego
Cancer is the second leading cause of death in the
United States. Recent studies suggest that one-third of cancer deaths
are due to dietary factors. Much of this evidence is based on results
from observational studies and interpretation of these data has
considerable limitations. To date, the overwhelming majority of
clinical trials testing the effect of nutritional factors on cancer
risk have involved single nutrients or combinations of vitamin and
mineral supplements. Results from these studies, with a few exceptions,
do not support a single-nutrient or reductionist focus. Diet intervention
studies that involve whole foods and overall dietary patterns are
currently under way, although reliance on self-report dietary data
in these studies is problematic.
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Nutrition and Physical Activity
in the Prevention and Treatment of Osteoporosis
Robert A. Marcus, Stanford University School
of Medicine
To deliver long-term skeletal benefits, exercise must
be sustained lifelong. Childhood represents a unique period for
achieving skeletal benefits from exercise. At that time, vigorous
exercise not only promotes BMD but also may initiate permanent beneficial
changes in skeletal geometry. One must consider these issues within
the larger context of preventing fragility fractures. Improving
BMD remains a laudable goal. However, as exercise-induced gains
in BMD are modest, exercise cannot be a panacea for bone fragility.
For frail elders, falls prevention gains paramount importance. Muscle
weakness is an important modifiable determinant of falls, so programs
aimed simply at improving leg strength gain importance even without
improving BMD. Muscle strength and neuromuscular performance improve
remarkably with training, even during the ninth decade.
Although considerable effort is now devoted to understanding
the skeletal effects of physical activity at a molecular level,
it remains imperative to invest similar efforts into strategies
for motivating a sedentary population to adopt exercise as a regular
component of daily life.
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Malnutrition in Aging Populations
Robert M. Russell, Tufts University
Caloric intakes decline with age, as has been shown
in many cross-sectional and longitudinal studies. At some point,
food intakes drop sufficiently so that certain micronutrients are
not ingested in sufficient amount to meet needs. Maintaining nutrition
intakes in the elderly is not only important for prevention of deficiency
states, but also because inadequate intakes of many nutrients have
been linked to higher prevalence of the chronic diseases that plague
the elderly population. For example, adequate B vitamin intake has
been linked to a lower prevalence of blood vessel disease as well
as diminished cognitive function. Higher vitamin C intakes have
been linked to a reduced prevalence of cataracts, and adequate vitamin
D and calcium intakes have been shown in intervention trials to
mitigate the bone demineralization that accompanies aging.
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Physical Activity in Aging
Populations: Problems and Issues
Edward McAuley, University of Illinois
at Urbana-Champaign
Recent research suggests exercise may play a role
in the promotion of health and quality of life in older adults;
however, non-compliance and provision of incentives for participation
continue to be major challenges. Behavior research is needed to
better understand what motivates consumers' food choices and physical
activity levels. Behavioral change models should be developed that
translate sound nutrition advice into actions that result in the
attainment and maintenance of long-term health goals. Public-public
and public-private partnerships for action, including funding support
from all levels of government, industry, and other private organizations
are needed to help build cultures whose members are fit and physically
active. Efforts should be made to encourage environmental modifications
that promote physical activity in the community.
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Final Overall Issues and Questions
As the population ages, the number of Americans over
65 is growing at an extraordinary rate. Consistent with the Healthy
People 2010 goal to increase both the quality and years of healthy
life, prevention of degenerative and disabling illnesses must become
a high priority, with diet and physical activity becoming increasingly
relevant.
- Promote/support dietary targets:
- increase fruit and vegetable consumption
- increase consumption of calcium-containing foods
- increase consumption of whole grains
- increase consumption of fiber-containing foods
- low fat, low sodium
- emphasize nutrient density, especially foods
providing nutrients not currently being consumed sufficiently
- barriers to implementation of current recommendations
to increase fruit and vegetable consumption—cost, spoilage
- public health interventions with vitamin B-12,
calcium, vitamin D through supplements, fortification, and whole
foods
- emphasize intake of fruits and vegetables for
cardiovascular health, cancer prevention, cataract prevention,
and macular degeneration
- Promote/support balanced physical activity programs
and recommendations to achieve broad needed health and functional
status outcomes:
- increase awareness of benefits of strength training
- increase awareness of the relationship between
physical activity and fall prevention
- environmental factors related to physical activity—safe
streets, use of school facilities
- realistic exercise programs based on prevention
outcomes
- identify keys to physical activity initiation
and persistence
- encourage exercise for older adults—emphasize
type
- Promote/support behavioral research to elucidate
effective behavior change and maintenance strategies:
- longitudinal studies as part of National Nutrition
Monitoring
- subpopulations
- cohort study
- outcome of nutrition measures
- research on taste, olfaction relationship to
intake/status
- increase outcomes research related to health
and function
- applied research with community agencies emphasize
early life improvements in nutrition and physical activity for
the effects in later life
- emphasize persistence of positive life habits
- Elucidate effective communication strategies for
complex nutrition and physical activity messages and effective
strategies for targeted subpopulations:
- culturally competent interventions
- use social marketing research to appropriately
tailor strategies
- use healthcare providers to reach target populations
with communication strategies from prevention and promotion
messages
- interventions tailored to subpopulations—social
marketing needed
- age-specific/tested educational materials and
strategies
- tested food guide for older adults
- Broaden understanding of nutrition—physical
activity—aging issues, and interactions among public health,
health professionals, the general and aging public, and policymakers
to improve decisionmaking on these issues at all levels:
- increase salience of aging issues in the public
health agenda at Federal, State, and local levels
- increase awareness of the importance of nutrition
in older populations and ability to assist in maintaining quality
of life and self-sufficiency
- accurate communication by scientists, media,
industry, healthcare providers
- explore population's values around physical activity
and enjoyment of physical activities and relationship to perception
and adherence
- Fund research, services, and communication campaigns
adequately:
Develop infrastructure to meet the needs to address
nutrition and physical activity services through the Aging Services
network and the public health system:
- infrastructure for service delivery for nutrition
and physical activity through aging services and public health
- infrastructure for long-term care
Build on existing programs to fill needs, fill gaps,
and identify changes needed in programs to meet customer needs:
- link additional interventions in nutrition and
physical activity to current services
- access to nutrition and physical activity services,
status assessment counseling across the lifecycle
- need for program data/evaluation data to be balanced
against its effect on program participation
Re-authorize the Older Americans Act, increase participation
of eligible persons in the Food Stamp Program, increase access
to the Commodities Supplemental Food Program, and give attention
to education for nutrition and physical activity in all programs:
- expand Older American's Act nutrition programs
- increase participation of eligibles in Food Stamp
Program
- realistic reimbursement for senior meal programs
Need training, education, and staffing requirements
to provide a competent workforce to deliver services related to
nutrition and physical activity across the continuum of health,
medical care, and community programs.
Other policy issues:
- food labels not legible—elderly friendly
label
- Medicare funding for drugs to increase dollars
available for food
- change State regulations on long-term care reimbursement—4
hours is poor quality care
- dental health and nutrition—medical care
reimbursement relationships identified appropriate reimbursement
for services needed
Other communication/program issues:
- supplements—conventional and unconventional
- more information on food-drug interactions
- aging continuum
- susceptibility of elderly to food-borne disease
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Final Thoughts
There is a growing body of knowledge linking diet
to health and disease. A continued commitment to basic biomedical
research in cellular and molecular nutrition is needed to understand
more fully the requirements for optimal function and health, which
will establish a greater understanding of the nutrient requirements
throughout the lifecycle.
The public and private sectors need to strengthen
the links between basic research in human nutrition and the application
of this knowledge to promote behavior change and deliver cost savings
from disease prevention. This message must be conveyed in a culturally
sensitive manner.
The goal of improving the quality of life and preventing
costly disabling conditions must be addressed by focusing on research
into prevention of chronic diseases, such as heart disease, cognitive
decline, cataracts, loss of immune function, loss of muscle strength
and mobility, bone loss and hip fracture, diet-related incidence
of cancer, and type 2 diabetes.
The morbidity associated with major chronic diseases—cardiovascular
disease, cancer, and diabetes—could be substantially lessened
through behavior modification, including improved diet habits and
increased physical activity.
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