Australia Aging Nutrition Report Regarding

Australia Aging Nutrition

Report regarding the public health/nutrition issues of the growing older adult population of Australia

Discussion to prioritize the public health/nutrition issues of the older adult (60+years) population in Australia

Review of current public health initiatives and policies and an analysis of effectiveness of they have had at targeting older Australians

Discussion of if addressing this group as a homogenous group effective and appropriate

Recommendations of additional strategies or improvements to current health initiatives to better target older Australians over the next ten years

The Australian population is aging at a significant rate, creating a scenario where a large portion of the adult population in Australia is over the age of 60. With this segment of population growth is an inherent set of health concerns, as with age often come increases in health needs and expenditures. Health and wellness is often fundamentally affected by nutrition and other prevention strategies that help improve health and avoid or treat chronic illnesses that often plague older adults. Public health is an integral aspect of the development of programs and initiatives that can improve the health of this segment of the population. This work will discuss the particular health issues of this segment, review current initiatives and propose new or improved programs to target this growing segment of the population.

Introduction

The development of comprehensive solutions, with regard to the public health of individuals has long been the responsibility of national health institutions. To support such a plan the institutions must first recognize and detail those public health concerns which are the most important. Coming into an era where the population is aging at an ever expanding rate one issue that is at the forefront of public health concern is the nutritional health of older Australians, i.e. those 65+, it is estimated that this population segment will increase from about 2.5 million to around 7.2 million by 2051. (ALGA, August 18, 2005) The reasons for this are many but logically this homogenous group is at risk for nutritional deficiencies and the many health related problems they can cause or exacerbate. Two main biological/social phenomena associated with aging are at play in the situation of increased risk. First, as the body ages it actually requires fewer calories per day to function, therefore excess calories, such as those associated with highly accessible convenience foods can create an excess in caloric intake or the empty calories can replace those which might have been obtained from better foods. Second, as one ages the susceptibility or probability that he or she might experience disease increases as well, and as is known many diseases both chronic and acute that are associated with greater longevity are negatively or positively affected by nutritional choices. (Wykle, Whitehouse, & Morris, 2005, p. 88) Therefore, the fact that the population segment is growing and the fact that their nutritional health is at greater risk than other adult populations makes this issue a public health issue that deserves significant address and appropriate public health planning, policy and programs. Many years ago, it was recognized that public health risk, as the population ages is much more focused on chronic long-term disease rather than acute infectious disease and yet the connectivity between nutrition and such diseases has only recently been recognized as an essential aspect of public health intervention strategies. (Lewis, 2003, p. 2)

Discussion to prioritize the public health/nutrition issues of the older adult (60+years) population in Australia

The growth of the 60+ population in Australia makes them one of the biggest population segments in the nation. They therefore deserve to have public health policy, planning and programs expanded to better meet their needs. As nutrition is one of the most important health/wellness issue of this population, for many reasons, the expansion should proportionately include an expansion of nutritional needs and risk avoidance programs. This prioritization is essential if this segment of the population is to continue to contribute to society at the highest degree possible. Nutritional well being is an important factor in both longevity and quality of life of older people as nutritional health can create situations where individuals either become dependant or maintain independence for longer periods of time. (NHMRC, 1999)

Challenges to this ideology are limited as health related expenditures associated with the segment will grow proportionately to the population growth and the younger/working segments of the population will have a limited ability to support the burden of public health. This is due almost exclusively to the fact that the younger/working segment will be fewer in number to the older segment and will be too small to economically support a growing need for public health which will coincide with the growth of the non-working or limited working aspect of the population. (Lewis, 2003, p. 43) It is therefore essential that the whole of the community focus on prevention and education with regard to the nutritional health of older Australians, as nutritional health can reduce dependence and therefore social expenditures on health related care and dependence related care. This population is also at greater risk than others for nutritional deficiency, as they are also challenged socioeconomicly, which creates limited choice for sustainable lifestyle choices, which support health and wellness. (Osmani, 1992)

So, not only are they more likely to be unwell, as a result of longevity health risk issues they are more likely to live on limited means and be challenged in their ability to make sound nutritional choices. These limitations leave them susceptible to an even greater number of diseases, of which they already have a higher susceptibility to. In short older people are limited in lifestyle choices, have a difficult time finding work when it is needed, must often rely on limited fixed incomes and make nutritional choices accordingly. These facts give a direct outcome of making them even more susceptible to obesity, cardiovascular disease, diabetes, osteoporosis, oral health problems, renal disease, cancer and ultimately malnutrition, (along with their natural susceptibility to chronic disease). Greater levels of disability, limited accessibility to transportation, good rather than convenient food choices, adequate housing and health care simply exacerbate a greater susceptibility to chronic disease occurrence and management. Lifestyle choices, often forced upon this population are a major contributor to public health expenditures. According to The Australian Institute of Health and Welfare's report, The Burden of Disease and Injury in Australia 2003 poor lifestyle choice accounted for 32% of the total burden of disease and injury, see figure 1.

Figure 1 The Australian Institute of Health and Welfare's report, The Burden of Disease and Injury in Australia 2003 (Abbot, 2000)

The reality of all of these risk factors in concurrence with the increasing number of older Australians clearly makes their nutritional health and the support systems needed to maintain and improve it a paramount issue for public health. To make this issue one of social change then several areas of priority need to be addressed, including improvement of access to health care, prevention and nutrition education as well as social justice issues of import, such as fair and adequate housing and transportation for this population segment.

Review of current public health initiatives and policies and an analysis of effectiveness of they have had at targeting older Australians

The public health of this segment has been addressed through the development of The National Strategy for an Ageing Australia (Australian Commonwealth Ministry on Aging, 2001). This plan addresses the complexity of Australia's aging population and identifies a wide range of issues that must be addressed and prioritized to support change and development in this area. Many of which have been addressed in the introductory material on the issue above. The Ministry on Aging as a public entity has also detailed public health issues that are more responsive to social justice, as in improving the opportunity and environment that older Australians face to help by default address nutritional health and public community health. The focus on nutrition is only marginal as it is noted as a leading cause of preventable chronic disease, and a lifestyle choice issue that plagues the aged population. The plan does not directly focus on nutrition but simply mentions it as a part of the multi-causal problem associated with this segment and really the whole of the Australian population. The plan does focus on the complexity of the issue and especially focuses on the need to assist the aging population with issues of access, career, income, housing, transportation and improvement of lifestyle choice making given both opportunity and complexity of it. Though the work, and its support system provide a general introduction to the issues, it does not provide a framework, of anything but goals, as they should be addressed for the health of this segment of the population and it says little about the nutritional change issues, supporting lifestyle choice as the overriding principle of nutritional choice making. (Australian Commonwealth Ministry on Aging, 2001)

The AIHA also supported the development of The National Health Priority Areas Initiative which is a response to the demand by international organizations, but mainly the World Health Organization to prioritize and improve public health nationally. It is a collaborative program that discusses several priority issues and then subsequently uses those disease issues as markers for improvement. The work does not specifically address nutrition, nor does it specifically address the ageing population, in any way other than the fact that this segment is more susceptible than others to the sic of the seven disease/marker areas of focus; arthritis/musculoskeletal disease, cancer control, cardiovascular health, Diabetes mellitus, injury prevention and control and mental health. The last issue addressed is asthma, but this leaves out the longevity health issues associated with lung health like COPD and emphysema. (AIHW, 2000) Secondarily the plan addresses nutrition only in the manner in which it contributes to the development and alleviation of health, as it associates with the particular health priority disease or health issue. TI also does not specifically address the aging of the population or the fact that this growing segment is at greater risk for many of the health issues it focuses on.

Two much more specific initiatives that support the issue in a more specific way are the National Health & Medical Research Council (NHMRC, 1999), Dietary Guidelines for Older Australians. (NHMRC; 2005) and the National Public Health Partnership Eat Well Australia (NPHP, 2001) campaign which addresses the issues of nutrition as a public health concern in a more general sense. Both documents offer essential information and public health policy change plans for the future of the nutritional health of the whole and aging population of Australia. Dietary guidelines for Older Australians, offers the most specific information supporting prevention issues with regard to nutrition such as increased variety and healthy choice eating, eating three times per day, caring for food safely, increasing fruit and vegetable intake, high fiber carbohydrates, low saturated fat choices, drink plenty of healthy fluids, drink less alcohol, low sodium choices, decrease sugar intake, increase high calcium food consumption as well as improvement of physical activity level to reduce the incidence of obesity and therefore prevent disease among the elderly. The work is comprehensive but demonstrative of relatively low level address issues for healthy eating and lifestyle choices and does not address socioeconomic or other risk factors specific to the elderly. The Eat Well Australia campaign also does not offer specific high risk nutritional information for the elderly. The document itself is more an agenda/strategy plan for the management of health organizations with regard to nutrition. (NPHP, 2001) For the most part health initiatives in general discuss nutrition as an important factor to health, but do not address the specifics of the aging population with regard to nutrition as a public health agenda for the aging population. Those nutritional specific agendas also only rarely address the aging population specifically and much work must be done to create a better agenda and provide greater opportunity for education of this segment of the population with regard to nutritional health and support. This non-specific agenda information, though a good start is challenging as a source of real change and address of this issue for older Australians.

Discussion of if addressing this group as a homogenous group effective and appropriate

Some argue that addressing the issue as if the group was an homogenous group is essentially inappropriate as such address does not support the diversity of the population. (Read, 2004) Yet, it is clear that the data and reality support that nutrition is an essential issue of concern for this population and therefore the whole of the Australian population, especially considering its exponential growth. (Manuck, Jennings, Rabin, & Baum, 2000)

Recommendations of additional strategies or improvements to current health initiatives to better target older Australians over the next ten years

The generalized language of the nutrition and health initiatives is likely the diplomatic answer to keeping the issue one that does not directly assault older Australians with an over generalized assessment of poor lifestyle choice, as apposed to real opportunity and diversity. This addresses the question poorly and this researcher would advocate for improved direct address of causal as well as choice issues that are specific to the risk factors for the 60+ population. Over the next ten years Australia, along with many other nations must address this issue as a public health concern that is specific and diverse and provide greater opportunity for health and nutrition teaching in the population. Additionally, supporting system wide change will also have to address the functional reasons why aging Australians are at greater risk for becoming increased health burdens. This will involve improvement of programs, not just strategies for improvement that address access and economic issues associated with this growing segment of the population. This emphasis should include everything from economic reformation, transportation, housing and access issues for improved healthy eating choices and security, as well as educational venue improvement for the elderly and their support systems. (Olson, 1982) This extensive plan will include both public and private change issues and the development of better options for all, but should be focused specifically on the issues associated with risk in the aging populations. (Bullard, 2004) (Siemering, 2004)