Nutrition
26 July 2022 by

Falls are a common occurrence for older New Zealand adults and can lead to considerable morbidity. More than 65,000 adults aged 50 years or older fell in the first three months of 2022. Of these, nearly 9,000 were considered serious harm falls and more than a quarter (27%) had fallen in the previous 12 months [1].

Eating well is a key strategy to help prevent falls. A nutrient rich diet, that is high in protein helps to maintain optimal physical and cognitive health – which in turn reduces the risk of falls.

Being both underweight or obese increases the risk of falls. However, for adults over 65 years, a BMI in the overweight range (25.0 – 29.9 kg/m2) carries a lower risk of both falling and of being injured in a fall, compared to those with a low BMI (<23 kg/m2) [2]. This protective effect is lost in the presence of malnutrition or frailty, regardless of BMI [2].  Malnutrition and frailty are conditions that often co-exist, and which negatively impact on muscle mass and strength predisposing to falls [3].

New Zealand data shows that half of older Māori and one third of non-Māori living independently in the community are at risk of malnutrition [4] and the prevalence is even higher for those over the age of 80 years (56% and 46% respectively [5].  (Macdonell under review). Prefrailty and frailty is also common (75% of Māori and 76% of non-Māori [6].

Nutrition-related fall indicators

  • Weight loss or low BMI
  • Malnutrition regardless of BMI
  • Frailty – ↓ muscle mass & strength
  • Low vitamin D status
  • Dehydration
  • Hypoglycaemia

Red flags of poor nutrition status

  • Unintentional weight loss
  • Low BMI                    
  • Difficulty accessing food
  • Reports of poor appetite
  • Social isolation/Depression

These nutrition-related conditions occur due to a reduced ability to efficiently metabolise nutrients and are also negatively affected by living alone, low socioeconomic status and depression [7]. Screening for malnutrition can identify those who may benefit from nutrition intervention. Correcting inadequate energy, protein and micronutrient intakes supports optimal recovery of muscle mass and strength and can contribute to improved cognitive and mental health, thereby reducing falls risk.

Malnutrition screening identifies those who are at risk of progressing to malnutrition, allowing the implementation of simple food-first strategies so that further nutrition decline can be prevented. These strategies, which maximise nutrient density, include:

  • Eating little and often – appetites decrease with ageing so having three small meals with high energy high protein snacks between meals can increase overall food intake
  • Add high protein extras – grated cheese, skim milk powder, ground nuts or nut butters can all be added to foods to increase the overall protein intake.
  • Include protein rich foods at each meal – aim for 25-30g of protein/meal from eggs, dairy products, meat, fish, chicken, nuts, and legumes.
  • Add high energy extras – the addition of 1-2Tbspn of oil, margarine, cream, or butter provides an additional 100 – 250 kcal/per serve, helping to prevent further weight loss while sparing protein for anabolism.

Where food-first strategies do not improve nutrition status, specialised nutrition support from skilled nutritional professionals is warranted.  Short-term use of multi-nutrient oral nutrition support strategies when combined with dietary advice, have been shown to significantly decrease falls in malnourished older adults [8].

In summary, a nutrient-dense diet with adequate energy and protein contributes to safe mobility and enhanced strength, balance, and cognition. Together with a stable healthy body weight, these nutritional factors can greatly reduce falls risk.

Sue MacDonell,PhDNew Zealand Registered Dietitian

References

  1. Health Quality & Safety Commission New Zealand. Live Stronger for Longer Dashboard. Accessed: 9th July 2022. www.livestronger.org.nz.
  2. Trevisan C. et al. Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. JAMDA. 2019;20(5):569 – 582.e7.
  3. Fried LP. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
  4. Tkatch MT. et al. Nutrition risk prevalence and associated health and social risk factors in Māori and non-Māori: Results from the New Zealand Health, Work and Retirement study. Australas J Ageing. Apr 19 2021; doi: 10.111/ajag.12952.
  5. MacDonell SO. et al. Is the Utility of the GLIM criteria used to diagnose malnutrition suitable for bicultural populations? Findings from Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ). JNHA. 2022 (Under review).
  6. Teh R. et al. Dietary protein intake and transition between frailty states in octogenarians living in New Zealand. Nutrients. 2021;13(8):2843. doi:10.3390/nu13082843.
  7. Wham CA. et al. Health and social factors associated with nutrition risk: Results from Life and Living in Advanced Age: A cohort study in New Zealand (LiLACS NZ). JNHA. 2015;19(6):637-645.
  8. Neelemaat F. et al. Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults. J Am Ger Soc. 2012; https://doi.org/10.1111/j.1532-5415.2011.03888.x