02.Protein for elderly people
In recent years it’s been acknowledged that nutrient needs in adults change with age, and it’s increasingly recognised that elderly people need more protein than younger adults. As we age, we metabolise amino acids differently, and need higher doses to stimulate muscle protein synthesis. Inadequate protein causes bone (osteopaenia and osteoporosis) and muscle (sarcopaenia) wastage, and also affects immunity and wound healing.
The most recent Nutrient Reference Values for Australia and New Zealand (2006) recommend an increase in the daily protein intake from the age of 70. For men, this is an increase from 0.84 to 1.07 grams of protein per kilogram body weight, and for women from 0.75 to 0.94g/kg. The most recent National Nutrition Survey (albeit from 1995) found adults aged 65+ consumed an average of 73g of protein per day, which is likely to be in line with the NRV recommendations (81g and 57g for the average-weight male and female in this age group respectively). But it’s likely the optimal protein intake for adults over 50 may be higher than this, with recent research suggesting that the recommended intake may not be adequate to preserve muscle, and that levels of 1 to 1.3 g/kg would meet the protein needs of older adults while avoiding issues of too much protein.
So while the protein needs of older adults increase, decreased physical activity and a change in perceptions of taste and smell may mean their appetite, and therefore food intake, is decreased. Food preferences and cooking habits may also change, and unless a conscious effort is made to ensure there is adequate protein, people may not get enough to meet their needs. Marketers have cottoned on to this, and are promoting protein powders as a way for older people to ensure they meet their needs.
But does all this mean you need to take a protein supplement when you hit 50? Probably not, says Milena Katz, spokesperson for the Dietitians Association of Australia, as most people get plenty of protein in their diet. However, she recommends people review their diet, with the help of a dietitian, when they retire. “People change their eating habits as they get older, and particularly when they retire and radically change their lifestyle.”
Katz points out that taking supplements isn’t as good as eating whole foods, because there are other nutritional benefits in whole foods. The supplements are also quite expensive. However, for some people – especially frail elderly people who have little interest in eating – - they are the best option.. Your doctor can give you a referral to a dietitian, and you may be eligible for a Medicare rebate.
While most people can get enough protein from a balanced diet, consulting a dietitian when you retire can help provide advice or at least peace of mind.
Healthy ageing and sarcopaenia
Sarcopaenia (Greek, from sarco flesh + penia loss) is the loss of skeletal muscle mass and strength that occurs with advancing age. It affects five to 50% of people aged 60 and older, varying according to age and how sarcopaenia is defined. Loss of muscle strength can impact heavily upon quality of life, affecting mobility, increasing the risk of falls and fractures, making it difficult to perform activities of daily living, ultimately resulting in a loss of independence and increased risk of death.
Sarcopaenia isn’t inevitable and is also reversible, and a program of strength training combined with protein consumption can be used to successfully maintain and rebuild muscle mass.
The Centre for Strong Medicine provides exercise-based medicine programs for older adults at Balmain Hospital in inner Sydney. The exercise programs, which are done either at home or at the centre, are targeted at people with various conditions, including arthritis, diabetes, heart disease and osteoporosis, as well as frailty, functional impairment and gait difficulties which are often related to sarcopaenia.
The centre’s dietitians advocate eating a high protein meal or snack containing 20 grams of protein within 30 minutes of finishing training to maximise the benefits of training on muscle growth. This can be achieved with conventional foods, such as lean meats, poultry and fish, dairy products or eggs. However, people who exercise at the centre are offered protein supplements for a quick and convenient protein hit.
The Australian Institute of Sport (AIS) fact sheet on the protein needs of athletes at varying levels and how to meet these needs.
While aimed at health practitioners, this summary of recent research in sarcopaenia with links to full articles provides a good grounding on the issue.