WEBINAR SERIES

Promotinghealth throughout

the life-course

during the

COVID-19

pandemic

Dr Angela de Silva

Regional Adviser Nutrition and Health for

Development

WHO Regional Office for South-East Asia,

New Delhi

Ensuring nutritional adequacy

for health and wellbeing

during the period of

restricted availability

Webinar-2: Promoting Healthy Ageing in the COVID-19 era

Healthy ageing

“the process of developing and maintaining the functional ability that enables well-being in older age.” (WHO World report on ageing and health 2015)

Key factors for healthy ageing

Functional ability: determined by the individual’s intrinsic capacity and their interaction with their environment

Intrinsic capacity: the combination of all the individual’s physical and mental—including psychosocial—capacities

Healthy aging and nutrition

• The healthy ageing process spans the entire life course.

• Dysregulated immune and inflammatory responses influenced by diet-- contribute to age-related diseases (cancer, CVDs, diabetes, osteoporosis).

• Healthy ageing includes optimal diet quality and healthy eating habits as essential components.

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Good nutrition and physical activity across the lifecycle and during can have significant benefits for health and wellbeing in older persons.

Source: Lancet GBD 2017

Target 2.2 By 2030, end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons

Aging and nutrition

Ageing’s physiological processes can negatively impact nutritional status

• Sensory impairments: decreased sense of taste or smell reduce appetite.

• Poor oral health: monotonous, poor quality diet - increase the risk of malnutrition

• Impairment of gastric acid secretion: reduced absorption of iron, vitamin B12.

• Progressive loss of vision and hearing, osteoarthritis-- limits mobility and affects ability to access food, prepare meals.

• Medications: loss of appetite

• Dietary restrictions due to chronic disease/comorbid conditions

Psychosocial and environmental changesthat impact diet (isolation, loneliness)

Nutritional issues in older adults- affects intrinsic capacity

Body composition; decreased lean body mass, increased fat mass.

Sarcopenia, osteoporosis and impaired immune response: inadequate protein, micronutrients,

Energy needs decrease, but micronutrient need is unchanged.

Undernutrition is common but overweight and obesity may also exist. Concurrent micronutrient deficiencies: B vitamins, vitamin C, E, D, and Se, Zn, Ca, and Fe are likely.

Essential Nutrition Actions 2019, WHO 2019Primary health care: Nutritional care for at risk older persons

Ensuring nutritional adequacy for health and wellbeing – including the period of restricted availability

While no foods or dietary supplements can prevent or cure COVID-19 infection, healthy diets are important for supporting immune systems.

Supplements of food and micronutrients will be of use only in cases of deficiency

Consuming a healthy diet should be the goal at all times.

❑ Energy intake should balanceenergy expenditure

❑ Keep total fat intake to < 30% of total energy intake. Reduce saturated fats, increase unsaturated fats, and eliminate industrial trans fats

❑ Limit intake of free sugars to < 10% (further reduce to < 5%) of total energy intake

❑ Keep salt intake to < 5 g/day.❑ Eat at least 400g of fruit and vegetable a day

Healthy diet during the CoVID -19 pandemic, misconceptions and key messages

Eat a variety of foodsWholegrains, tubers/roots, legumes, vegetables, fruit and foods from animal sources. A diversified diet is a good source of micronutrients -- critical for a well-functioning immune system and disease prevention. Thus far, there is no evidence that micronutrient supplementation for healthy populations can prevent or cure COVID-19.

Eat less salt and sugarsDiets high in salt increase the risk of high blood pressure, and CVDs. Diets high in sugars - increase risk of overweight or obesity, diabetes, heart disease. People with pre-existing medical conditions (e.g. heart disease, diabetes) maybe more vulnerable to severe illness with COVID-19. Preventing/controlling conditions can help reducing severity of illness from COVID-19.

Eat plenty of vegetables and fruit There is currently no evidence suggesting that food (incl. fresh vegetables and fruit) is associated with transmission of COVID-19. Vegetables and fruit should be washed thoroughly with safe and clean water.

Eat moderate amounts of fats and oils Excessive unhealthy fats (i.e. saturated fats and trans fats), can increase the risk of CVDs. People with pre-existing heart disease appear to be more vulnerable to severe illness with the COVID-19

Drink adequate waterApproximately 6 – 8 glasses/day can meet hydration needs of adults although it will vary according to climate, activity level and diets. The COVID-19 virus has not been detected in drinking-water and existing WHO guidance on the safe management of drinking-water applies during the COVID-19 pandemic.

Avoid drinking excess alcohol during the COVID-19 pandemic The use of alcoholic beverages is associated with health risks. There is no evidence that drinking alcohol protects from viral or other infections. Rather, the harmful use of alcohol is associated with an increased risk of infectious diseases and/or worse treatment outcomes.

CoVID-19 is expected to affect food security andolder people maybe vulnerable

The pandemic may add between 83 - 132 million people to the total number of undernourished in the world in 2020 depending on the economic growth scenario (Losses in global GDP growth – 4.9 -10 percentage points).

Many older adults in the region are likely to be vulnerable.Discontinuation or suspension of community-levelactivities increases vulnerability

Supporting healthy diets in older persons during the pandemic and beyond

• Increase awareness of caregivers on nutrition needs of older persons

• Advocacy to stakeholders regarding importance of diet in healthy ageing

• Capacity building of health providers and provision of preventive and promotive primary care services to support nutritional needs of elderly

• Improvement of the food environment through regulatory and legislative actions to reduce dietary risk factors for NCDs

• Nutrition sensitive social protection for elderly

• Regular monitoring and data on nutrition and food security status of older persons

• Promote and support research regarding healthy ageing and nutrition, specially in LMICs.

Protect against: all forms of malnutrition – undernutrition, vitamins and mineral deficiencies, overweight and obesity across the lifecycle

Thank you

Opportunity to focus on nutritionof older persons

WEBINAR SERIES

Promotinghealth throughout

the life-course

during the

COVID-19

pandemic

Dr Prasun Chatterjee

Associate Professor

Department of Geriatric Medicine,

AIIMS, New Delhi

Meaningful engagement

for older people during

restricted living situation

Webinar-2: Promoting Healthy Ageing in the COVID-19 era

Impact of the

Pandemic on older people

• Inactivity,

• Boredom,

• Isolation,

• Anxiety,

• Depression,

• Worthlessness,

• Increase in mortality

• Elder Abuse

• Cognitive impairment

Self-determined activity pursuits with appropriate supports even during lockdown

“Meaningfulness” of activities of older people can amplify the health- related benefits when it is Self-determined (Hutchinson & Kleiber, 2005).

In particular, when it allows for affirming or expressing one’s personal values or valued self-attributes

Successful Ageing

How to Plan

Outline practical ways to support older people with or without functional decline to remain engaged in ways that optimize their remaining interests and resources

Activities and interactions must be enjoyable and doable

Planning for relatively self-determined activity engagement (its do-ability)

Weigh Therapeutic value vs therapeutic potential

• The Nature and diversity of possible leisure and recreation activities,

How to select activities that help clients to achieve their

goals and match their interests

and needs,

Leisure-based activities can be a resource for preventing declines in health

Online baking,

Playing music,

Doing puzzles,

Brain games,

Gardening,

Following an at-home exercise DVD

Leisure-based activities can be a coping resource

Cooking

Cooking a favorite recipe

Listening

Listening to music while preparing

food

Playing

Playing cards

Talking

Talking on the phone with

friends

Pleasurable and meaningful activities help to cope with ongoing challenges (Hutchinson et al, 2008)

Try to reduce how much you watch read and listen

The challenges

Barriers to participation

Fear of falling,

Lack of confidence,

Decline cognitive abilities to problem-

solving

Especially important for people who is not interested

in socializing

Long term care setup

Examples from SEAR member states

THAILAND

• Telemedicine

• Increase communication channels through web application groups and personal LINE.

• Creating a collaborative network with local authorities,

• Group work within LTC

Democratic People's Republic of Korea

• Communication with neighbors,

• Engaging social activities

• Conducting Intergenerational program

• Regular exercises

BANGLADESH

• Peer to peer interaction within Home

• Fun Activities

INDONESIA

• Handicrafts, baking or cooking courses for the elderly at

home.

Elderly women at Kemiren Village take a break from pounding rice to make music with their tools, instead

MAYANMAR And MALDIVES

• Intergenerational learning

• Promoting Life Long Learning

• knowledge sharing;

• Information and communication which to promote independence, autonomy, empathy, understanding, respect and reciprocity (Black, Dobbs & Young, 2015).

INDIA

• E-Intergenerational learning:- Connecting older people with youth in Win-win model leveraging digital platform

• Reinforce intergenerational solidarity

• Promote lifelong learninghttps://doi.org/10.1111/jgs.16563

Information and communications technology (ICT)

https://www.indiatoday.in/india-today-insight/story/eldercare-in-the-times-of-a-pandemic-1676845-2020-05-11

Stay engaged, Stay Happy and Stay independent

• https://www.aginglifecarejournal.org/meaningful-enjoyable-and-doable-optimizing-older-adults-activity-engagement-at-home/

• Intergenerational Digital Engagement: AWay to Prevent Social Isolation During the COVID‐19 Crisis,Prasun Chatterjee MD, Journal of the American Geriatrics SocietyVolume 68, Issue 7First published: 12 May 2020