Malaysia is moving towards becoming an ageing nation.

The increasing aged population is likely to pose challenges and put demands on our healthcare services.

Hence, it is crucial to encourage Malaysians to age healthily.

One essential way to do this is via proper nutrition.

The government has been planning and implementing various strategies to improve the nutritional and health status of the elderly, including through the establishment of the Malaysian Dietary Guidelines for Older Persons.

Nutrition during the golden years emphasises on meeting the older adult’s physiological needs based on preferred cultural food practices.

Natural changes

There are a number of physiological changes that take place as we age.

The elderly frequently experience a change in their appetite due to a reduction in their sensitivity to smell and taste.

This most often manifests as reduced appetite.

So, an elderly person may heavily salt a dish – to the extent that other family members find it too salty – but to the elderly individual, it may taste just right, or even still a bit tasteless.

This is due to their declining sensitivity to salt.

In a related matter, dental issues, such as missing teeth, may lead to avoidance of high fibre foods such as vegetables, fruits and tough meat.

As we age, it is common that our skeletal muscle will experience progressive loss in mass, function and strength.

This is why most elderly have reduced mobility and a higher risk of falling.

A slowing down of the body’s metabolism and nutrient absorption frequently starts around the age of 30, and escalates after reaching 60.

Healthy Plate for the elderly

The Health Ministry has advocated for the “Quarter-Quarter Half” concept, which refers to a quarter of the plate being filled with carbohydrates, another quarter with proteins, and half of the plate filled with vegetables and/or fruits.

This “Healthy Plate” can be promoted for the elderly as well, with modifications based on food texture.

An adequate amount of noodles, rice and/or tubers are crucial for the elderly person’s diet.

These should preferably be in the form of whole grains.

However, if you can’t manage all the carbohydrates being whole grains, then just try to mix some in, e.g. serving a mixture of white rice and brown rice.

It is crucial to consume adequate protein to prevent muscle loss and sustain physical function.

An elderly person requires 1g to 1.2g of protein per kg of body weight daily.

Many elderly face challenges meeting their protein requirement due to reduced appetite or chewing difficulty.

Some protein food sources that have softer texture (to help with chewing) are fish, eggs, tofu, tempeh or dhal.

Opt for whole foods, as opposed to processed foods, e.g. fresh meat instead of frozen nuggets or hotdogs.

Opt for fresh vegetables or fruits as opposed to canned vegetables or fruits.

If the elderly person has chewing difficulties, try steaming the vegetables until they are very soft or chop them finely.

You can also offer them fresh fruit juice with pulp if they have difficulties masticating hard- textured fruit.

Fresh fruit can also be used as a naturally-sweet dessert, e.g. pengat pisang.

Additional nutrients

Other key nutritional needs for the elderly include calcium, vitamin D and iron.

Consuming two glasses of milk and/or milk products a day serves as both a source of protein, as well as a way to achieve daily calcium requirements.

You can also Incorporate milk into food while cooking, e.g. when making an omelette or pudding, or by partially substituting coconut milk (santan) with milk.

The elderly should ensure they obtain adequate sunlight exposure for vitamin D to assist in calcium absorption.

They should also include vitamin D-rich food, such as oily fish (e.g. sardines, mackerel) and egg yolks, in their diet.

To ensure adequate iron, iron-rich foods such as poultry, fish, eggs, tofu and green leafy vegetables, should be consumed.

Older women are also encouraged to drink at least 1.6l of fluids per day, while older men should take in 2.5l per day.

Total fluid intake is obtained not only from drinking water, but also from other liquid-based food sources, such as soups and beverages.

Encouraging “wet” food intake, such as porridge, noodle soups and fruits like watermelon, may be helpful in ensuring adequate fluid intake among the elderly.

Dipping biscuits or bread in liquid beverages such as milk, coffee or malted drinks, is another way to help reach that optimum fluid intake.

However, older individuals with health conditions like heart failure, chronic liver disease or kidney disease will need to comply with fluid restrictions according to their doctors’ recommendation.

The elderly are advised to avoid alcoholic beverages due to its ability to impair the immune system and increase susceptibility to infectious diseases.

Myth or fact?

Here are some beliefs when it comes to nutrition and the elderly:

Consuming a variety of food daily according to the Malaysian Food Pyramid 2020 should be sufficient to provide all the nutrients required by the body.

Hence, health supplements may not be required for those who are able to meet their daily nutrient requirements via their diet.

In addition, regular consumption of health supplements in high dosages without the advice of healthcare professionals can be harmful.

Do consult a dietitian, who can evaluate if any add-on nourishing formula with additional nutrients is required after a detailed evaluation.

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While activity levels may decrease, the requirement for nutrient-dense food remains high to combat frailty.

Appetite may decrease, and hence, every bite should be nutritious.

Focus on “nutrient-dense” food, instead of “calorie-dense” food.

Unintentional weight loss – which means losing weight without planning for it – is unhealthy and frequently indicates the possibility of muscle loss.

Proper assessment from healthcare professionals is required when this occurs in an older person.

Other tips

Nutrition during the golden years is not simply about managing diets.

It is a foundational pillar for maintaining independence, living with dignity and ensuring good quality of life as one grows older.

Involving the elderly in the purchasing and preparation of food is crucial to support their physical and emotional well-being.

This enables them to choose food according to their preferences.

If there is an issue of mobility, assistance may be sought from neighbours for transport, or grocery or food delivery services can be utilised.

Family members should ensure that their elderly relatives have enough money to buy food, and help provide financial support if they don’t.

Eating together with others is widely recognised as another crucial factor for the physical and emotional well-being of the elderly.

Sharing meals combats loneliness and encourages better nutrition.

Do include the elderly in family gatherings, outings, holidays and celebrations.

This might be a good opportunity to improve food intake for those with poor appetite or depression.

Assistant Professor Dr Chee Huei Phing is a dietitian at Universiti Tunku Abdul Rahman. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.