Citizens identify solutions to address nutritional risk among older adults

Today, the McMaster Health Forum released a citizen panel summary, which identifies some potential solutions to addressing nutritional risk among older adults. Among the options identified, the most promising focused on enhancing the coordination, integration and monitoring of services for older adults at nutritional risk.

Participants generally considered family doctors as their first point of contact with the health system and felt they should be the practitioners with the overall responsibility for directing and coordinating the care and management of older adults at nutritional risk. It was suggested that efforts should be made to better train and support family physicians to provide nutritional advice and to recognize the need for a referral to registered dietitians.

Participants also generally agreed about the need to redirect efforts of the public and health-system stakeholders to reach out to older adults, particularly those most vulnerable. As one participant said, to successfully address nutritional risk among older adults, it was essential to invest in outreach activities. “Go to the vulnerable people rather than having them come to you.”

“Given the rapidly aging population, a growing number of older adults can be expected to face nutrition-related problems and malnutrition,” said Andrea Miller, Registered Dietitian and spokesperson for Dietitians of Canada. “Being at nutritional risk poses serious health concerns, especially for vulnerable older adults living in the community and admitted to healthcare facilities.”

• 34% of Canadians aged 65 or older who live in private households are considered to be at high nutritional risk.
• 38% of older women are at nutritional risk in comparison to 29% of older men.
• 62% of older adults with depression are at nutritional risk, compared with 33% of people without depression.

"The expanding older population in Ontario is in dire need of nutritional guidance, support, and assistance,” said Stuart Phillips, a professor of kinesiology at McMaster University. “This report highlights the nutritional risks of older Ontarians and shows a clear need for something to be done.”

Participants generally agreed that older adults at high nutritional risk are often socially isolated and vulnerable. It can be particularly difficult to actively seek out these older adults since they are often reluctant to acknowledge that they are at risk, do not want to be perceived as a burden, are concerned that their personal freedom may be compromised if they received formal support, or are unable to express their needs.

Participants emphasized that current health-system arrangements make it difficult to address nutritional risk among older adults. While current health-system arrangements may be sufficient for acute illnesses, they do not appear to be effective in meeting the complex care needs of older adults.

There was a general perception among participants that many healthcare providers (with the exception of registered dietitians) have poor training in nutrition. Some participants were also under the impression that physicians were more inclined to lean towards prescription drugs to address a health problem, instead of trying to address the problem from a nutritional perspective (e.g., treating high blood pressure with a pill, rather than addressing the high salt content in the food consumed by a patient).

Despite the availability of such resources, older adults may still face challenges in searching for, and using, information to make healthier nutritional choices. In addition, many resources available online are not ‘older adult-friendly’, and fail to account for factors such as age-related physical barriers (e.g. declining eyesight) in their design, layout and general presentation of content.

Even when an appropriate resource is available, 60% of Canadians and 88% of older adults have difficulty reading, understanding and acting on health information (known as ‘health literacy’). As one participant said: “I don’t think most of us, regardless of age group, know what the best nutrition is.” This was seen as particularly challenging since many older adults are suffering from multiple chronic health conditions, which may be caused or worsened by poor nutritional choices.

“Since the Forum’s launch over five years ago, we have supported health system leaders to make difficult decisions based on the best available research evidence and the views and experiences of health-system stakeholders,” said Francois-Pierre Gauvin, the Scientific Lead for Evidence Synthesis and Francophone Outreach at the McMaster Health Forum. “Now we’re gaining momentum in giving diverse groups of citizens a voice in the future direction of the health system.”

Early in 2015, The McMaster Health Forum hosted a citizen panel on how to address nutritional risk among older adults in Ontario. The purpose of the panel was to support the efforts of policymakers, managers and professional leaders who make decisions about our health system. The citizen panel summary and citizen brief are now publicly available.

A citizen panel is an innovative way to seek public input on high-priority issues. Each panel brings together 10-14 citizens from all walks of life. Panel members share their ideas and experiences on an issue, and learn from research evidence and from the views of others. The discussions of a citizen panel can reveal new understandings about an issue and spark insights about how it should be addressed. On January 24, 2015, the McMaster Health Forum convened a citizen panel on how to address nutritional risk among older adults in Ontario. The citizen panel did not aim for consensus. However, the summary describes areas of common ground and differences of opinions among participants and (where possible) identifies the values underlying different positions.

The citizen brief and the citizen panel it was prepared to inform were funded by McMaster University’s Labarge Optimal Aging Initiative and by the Government of Ontario (through a Ministry of Health and Long-Term Care Health System Research Fund grant entitled Harnessing Evidence and Values for Health System Excellence).