With a worldwide ageing population (³60 years), it is important to understand the determinants of elderly health. This review addresses the impact of nutrition on health and the effect social environments have on food intake respectively. Using information collected from journal articles with a relevance of 10 years, it is evident that nutrition is affected by an individual’s age and the resources that allow them to access a social facilitated eating environment. Nutrition for an individual is providing themselves with the food necessary for their health and growth and by doing this, they reduce their risk of morbidity and nutrient deficiencies.
The nutrition of the elderly population relies on many different factors however with the increased risk of malnutrition, the focus is increasing their food intake rather than on a strict diet. It is important to understand the effects of an individual’s eating environment when trying to increase their food intake. For hospitalised elderly, it is crucial to gain feedback from the patients regarding their preferred eating location to reduce their risk of malnutrition and increase their protein and energy intake (Markovski et al. 2017). In this study, elderly patients were observed consuming their midday meal on two consecutive days; day one in the dining room and day two by their bedside. After a total of 34 patients were observed on 54 separate midday meals, it was found that “their intake of energy and protein increased by 20% when patients consumed in the dining room compared to the bedside” (Markovski et al. 2017 p.225). It is suggested that the growth in food intake could lead to weight gain and improvements in their nutritional status (the extent of nutrients in the body and how well they can maintain a normal metabolic integrity). The patient’s malnutrition was reduced and their nutritional status increased by the greater social interactions associated with eating in the dining room as the enjoyment of food intake and the sense of familiarity increased as opposed to the isolation of the bedside where 20% less energy and protein was consumed.
Further explored in Mahadevan et al. (2013), was the concept of mealtime experiences having a positive or negative health impact for the elderly in assisted-living. Studies show that these elderly individuals are eating an insufficient amount of “key macro and micronutrients as a result of a reduced appetite and decreased food intake” (Mahadevan et al. 2013 p.153). Macronutrients are made up of protein, carbohydrates and fat while micronutrients are vitamins and minerals all needed for growth, physical-wellbeing and the metabolism. The study consisted of 38 participants ³65 years of age, males, females and mixed races from four assisted-living facilities (Montclair and New Jersey area, USA). Focus groups lasting 60-90 minutes and audiotaped with participant permission generated information that can be used to improve their experience and therefore reduce further morbidity issues. It arose that many of the facilities used a 5-6-week menu cycle that resulted in the patient not wanting to eat their meals. Mahadevan et al. (2013 p.156) stated that meal times are a “social occasion that had potential to provide comfort and familiarity” however with the strict food plan, bad food presentation and general utensils that opposed their restaurant/buffet-style wants and the lack of friends and family that can join their meal times, the patients feel depressed and eat less macro and micronutrients than what they need.
Similarly, Paquet et al. (2008) argue that the social interactions of hospitalised elderly during meal times influences their food intake. Numerous studies have established that greater food intake is impacted upon by the social environment of the meal. This was supported by the information found from observations of 32 geriatric patients, 3 meals a day per patient every other day until discharge for a 6-week maximum period (Paquet et al. 2008). Analysing their interpersonal exchange and food intake using the interpersonal circumplex model, concluded that an individual’s energy intake rate was positively impacted upon by their own communal behaviours. Energy intake is the basis of the diet, nutrients within a food portion must be of a level that meets the energy requirement for the individual’s energy expenditure in order to maintain a healthy weight. The study infers that social interactions alone may not increase food intake, but that the “behaviour and complementarity” of an individual in a social setting may play a larger role than just providing them with social connections (Paquet et al. 2008 p.609). Energy intake requires specifically portioned meals that meet the nutrient standards for the individual. With lengthened meal times and a social environment that increased food intake, the concept of social facilitation could rise however better health also relies on the number and nature of interactions between participators. When these interactions increased, so did the health and energy levels of those living in hospitalised arrangements.
Ageing has a major impact on nutrition, the pleasure of eating decreases which leads to a multitude of nutrient deficiencies. For the elderly population, “malnutrition is a much greater health risk than overnutrition, studies show that between 15% and 45% may be malnourished or at risk of malnutrition” (Winter, Nowson 2016). Malnutrition is caused by an absence of proper nutrition by either not eating enough, not eating the right foods or the body being unable to use the foods eaten. To reduce this risk, it is important to promote a greater food intake for those ³60 years through non-restrictive diets, eating at least 3 meals a day and encouraging social environments with friends and family surrounding meal times. Although the diet is non-restrictive, it is important to “consume at least 25g of protein in each meal to promote optical muscle synthesis” as found by many longitudinal studies that state the “higher intake of protein by older adults” reduces muscle loss (Winter, Nowson 2016 p.37). The risk of malnutrition is reduced by the enjoyment factor of eating increasing and possibly due to a free-living arrangement.
The concept explored in this article is that “social activities such as eating with others” affects the longevity of elderly individuals respective to their gender (Huang et al. 2017). The Taiwanese study included a “representative sample of 1894 participants from the Elderly Nutrition and Health Survey in Taiwan” who were aged “³65 years and completed eating arrangement questions as well as their confirmed survivorship information” 10 years later (Huang et al. 2017 p.1). It was found that there was a greater risk of mortality when the aged individual ate alone, as eating with others can promote an improved dietary capacity and therefore energy intake due to the social facilitation. Huang et al. (2017 p.1) found that “63.1% of men and 56.4% of women ate with others three times a day” it was also evident that when eating with others, larger quantities of food was consumed “an average of 114 calories more per meal” (Huang et al. 2017 p.3). The study also presented that a higher rate of meals spent with others for the male population resulted in a lower risk of mortality than those who shared fewer meals. This was due to the Taiwanese culture more likely teaching women to prepare meals than males, leading the male demographic to eat out regularly and having a diet filled with “low carbohydrates, protein, dietary fibre and other nutrients intakes but with a higher fat intake rate” and therefore reducing their life expectancy (Huang et al. 2017 p.8) Mortality is the inevitable death, this is caused in this case by an insufficient diet from lacking social connections during meal time. Mortality cannot be avoided, however, to expand their life an individual needs a beneficial, nutritious diet enforced by friends and family who provide a social environment that promotes healthy eating.
These articles all provide reasons why a social environment is key to a healthy nutritious life for the elderly population. They also provide evidence for programmes and policies to be built on that will benefit those who are vulnerable and provide them with a better health and wellbeing. Providing them access to supplements to combine with their diet allows them to reduce food intake if age and chronic illness cause them to have smaller portions without excluding them from social opportunities. With hospitals implementing regular screening tests to identify nutritional risk among elders in assisted and free-living housing arrangements, prevention strategies can be put into action such as promoting social eating and therefore an increased food intake. Allowing aged individuals to eat in a social setting is aimed at supporting food enjoyment and discouraging dietary restrictions which result in a decrease of malnutrition and an increase of their daily energy intake.