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ADDING LIFE TO YEARS
ANNUAL REPORT 2002-03

CHAPTER 1: PROMOTING HEALTHY AGEING

Healthy Ageing

Getting older does not inevitably mean becoming more dependent on health services. Most older people enjoy good health, and it is simply not true that growing old necessarily means becoming unwell. Health promotion has a great deal to offer in reducing illness and allowing older people to remain independent for as long as possible, the top priority for most of us. There are therefore huge gains to be realised from encouraging older people to be physically and mentally active.

The key message is: it's never too late to adopt a healthier lifestyle.

Health Improvement: Physical Activity

There is never an age at which we become too old to benefit from increased physical activity. In addition to disease prevention, physical activity has a critical role in maintaining functional ability, preventing disability, immobility and social isolation.

The Social Justice Strategy includes a milestone to 'increase the number of older people taking exercise and reduce the rates of mortality from coronary heart disease and the prevalence of respiratory disease'. There is a growing recognition of, and evidence to support, the important role of physical activity in maintaining independence and reducing social isolation among this growing section of the population.

The Report of the Expert Group on the Health Care of Older People Adding Life to Years recommended that older people should be encouraged to be physically active.

The Physical Activity Task Force Strategy Let's Make Scotland More Active was endorsed by Ministers as the Scottish Executive's strategic framework for physical activity and launched by the First Minister in February 2003.

The Scottish Health Survey (1998) indicated that 59% of men and 72% of women are not active enough to benefit their health - this means that they do less than 30 minutes of moderate physical activity on at least five days of the week. However, of those aged between 55 and 64, the level of inactivity rises to 74% for men and 81% for women with the age group 65 to 74 showing further increases to 86% for men and 92% for women.

The outcome from the National Physical Activity Strategy will be the development of four implementation plans in 2003-04. These will look at what can be done on a practical level in homes, schools, communities and workplaces to increase activity levels and improve the health and well-being of all the people of Scotland - from young children to pensioners. Work has started on the development of an 'Active Homes' implementation plan which, as part of its remit, will address the activity needs of frail/elderly people living at home and in residential care. This will be available by April 2004. Progress has already been made, with an assessment of the opportunities for physical activity now being included in the inspection of care homes as recommended by the 2002 Care Home Standards review.

NHS Health Scotland has produced a leaflet Getting Fitter Needn't be a Marathon which complements their TV advert, launched in May 2002, of the same name and was produced to encourage older people to think about being more physically active. The leaflet highlights the health benefits of making simple lifestyle changes such as walking to the shops and activities in and around the home. Getting Fitter Needn't be a Marathon is intended to motivate people to undertake the necessary levels of physical activity that will help keep them healthy. The leaflet concentrates on the increased energy levels, fun and enjoyment associated with being active.

Falls prevention is a key element in any health improvement strategy for older people. NHS Health Scotland, in partnership with RoSPA (Royal Society for the Prevention of Accidents), Age Concern Scotland and NOS (National Osteoporosis Society) held a conference on Falls Prevention at Heriot-Watt University on 26 November 2002. Attracting over 450 health and social care professionals, the event - the biggest of its kind ever held in Scotland - highlighted the important issues of trips and falls involving older people. A follow-up video and booklet pack was distributed to NHS Boards earlier this year.

Diet and Nutrition

It is important that older people have good eating habits. Older people should have enough to eat and their diets must be sufficiently varied. In particular, more fruit and vegetables should be encouraged as part of a balanced diet. The diet should also include starchy foods such as bread, other cereals and potatoes to provide energy, milk and dairy foods to provide calcium, and meat or alternatives to provide iron.

The nutritional needs of older people are different from other groups in society and it is important that nutritional information is clearly labelled on foods. The Food Standards Agency has developed a Food Labelling Action Plan to ensure that much clearer and more meaningful information is carried on food labels so that people can make better informed choices about their diet and the foods they buy.

Smoking

Stopping smoking has health benefits at all ages. Older smokers should be encouraged to try to stop, and extra help must be targeted for high-risk groups such as those with heart disease.

Older People in Care

Surveys of older people at home and in long-term care have shown that many are under-nourished. This impairs health and well-being and diminishes chances of recovery from supervening illness and injury. The new National Care Standards for Care Homes guarantee that older people will receive varied and nutritious meals, taking account of older people's preferences and special dietary needs.

The Nursing and Midwifery Practice Development Unit (NMPDU) [now part of NHS Quality Improvement Scotland] has produced a best practice statement on nutrition for physically frail older people to offer guidance on meeting the nutritional needs of physically frail older people within continuing care facilities such as community hospitals, nursing and care homes. It was developed and demonstrated within a community hospital to inform the care of dependent older people. The statement has been developed collaboratively by the Gerontological Nursing Demonstration Project research team at Glasgow Caledonian University, the Scottish Gerontological Link Nurse Network, staff at the Demonstration site at Bo'ness Community Hospital and NMPDU. The recommended best practice statement is primarily for the use of registered nurses but other members of the professional health care team may find them helpful in understanding the nurse's contribution to overall care, and in particular understanding the contribution which skilled nurses can make to the health of dependent older people. The statements have been written in accessible language so that care staff, older people, and their families or carers can understand them and contribute to evaluations.

Older people constitute the majority of emergency medical admissions and have longer hospital stays than their younger counterparts. Under-nutrition is common in hospital admissions, affecting up to 50% of the elderly. If routine nutritional supplements could be proven to improve energy balance, nutritional state and clinical outcomes, this would have important economic and clinical relevance. A study on Protein Energy Supplements in Unwell Elderly Patients was carried out by Dr Jan Potter and her colleagues to determine whether oral protein supplements, prescribed during hospitalisation to elderly medical admissions, affect nutritional status, mortality, length of hospital stay, functional recovery and institutionalisation. A study sample of 381 elderly patients with a variety of medical problems giving rise to their hospital admission was carried out. The sip-feed supplement used in the study was acceptable to the patients and achieved a high level of compliance achieving a real increase in energy intake. The results of the study showed that routine prescription of protein nutritional supplements can prevent weight loss in this group of emergency admissions. There was also a reduction in mortality in the most undernourished and a reduction in the length of hospital stay even for adequately nourished older people. This is an important result in a patient group who are in hospital more often and for longer than their younger counterparts.

There are some particular public health issues which relate specifically to nutrition and older people: for example bone health and vitamin D and folate status. These issues are considered on a UK basis by the Health Departments, the Food Standards Agency and the Scientific Advisory Committee on Nutrition (SACN). There is also cause for concern about the nutritional status of some groups, in particular those without their own teeth, those living in institutions, older age groups and low socio-economic groups.

Vitamin D

The National Diet and Nutrition Survey: people aged 65 years and over (Finch et al., 1998) revealed that the majority of older people in the UK fail to achieve the recommended intake for vitamin D, which is necessary for the absorption of calcium and for bone health.

The Scottish Executive set up a small working group to examine the literature and discuss this topic, and in particular the use of Vitamin D supplements in care homes. The Chief Medical Officer will be considering the advice of the group shortly.

Folic Acid

The same survey also showed that average intakes of B vitamins were adequate but, in some people, B vitamin status was poor, particularly folate status. The Scottish Executive supports the introduction of the fortification of flour with folic acid. However more research is being conducted into the potential masking effect which folic acid fortification can have on anaemia which allows early detection of vitamin B12 deficiency. A final decision will be made once this research has been completed.

Oral Health and Nutrition

In general, those people over 65 who have their own teeth have better vitamin and mineral intakes and better nutritional status than those who have lost most or all of their teeth. Those with no natural teeth or few natural teeth eat a more restricted range of foods, influenced by their inability to chew. People without their own teeth are less likely to select foods such as apples, raw carrots, toast, nuts and oranges.

The Scottish Community Diet Project

The Scottish Community Diet Project (SCDP) has a broadly-defined operating arena, namely low-income communities (based on geography and common interest). However, informed by the first two phases of the project as well as by its independent evaluations, the SCDP's current Business Plan (October 2001 - March 2004) identifies a number of groups, settings and processes as being priority areas for action. Older people are prioritised under the current phase of the project and this has been reflected on a number of fronts, as the following examples show:

The Health Improvement Challenge

On 17 March 2003, the Scottish Executive published the Health Improvement Challenge which sets out a framework for action in the form of a Challenge. It includes work on all the determinants of health. In its first phase, the focus will be on five of the top 10 key risk factors affecting health, and four specific areas. The risk factors are tobacco, alcohol, low fruit and vegetable intake, physical activity levels and obesity and the four specific areas are early years, teenage transition, workplace and communities.

To improve Scotland's overall health outcomes we must improve the health of everyone in Scotland. The Challenge complements existing strategies, including those relating to older people. It is a framework for action, not a new policy direction. The Challenge is the first in a series of documents and the Scottish Executive is now considering a short consultation/discussion paper to follow-up on some specific populations such as ethnic minorities and those with a physical disability or a mental illness.

The Health Improvement Challenge is about improving the health of all the people in Scotland, narrowing the opportunity gap and improving the health of our most disadvantaged communities at a faster rate, thereby narrowing the health gap.

EXAMPLES OF PROJECTS INVOLVING OLDER PEOPLE

Grants awarded to community food projects in 2002 included some very specific examples of promoting nutrition amongst Scotland's older community. For example, Hanover Housing Association in Kelso were awarded 2,470 for a project called 'Bringing Together the Old and the New'. This initiative aims to contribute to the health of the elderly by piloting a programme addressing the issue of cooking on limited budgets in a quick and healthy way, and indeed sharing the expertise of the older community on food issues with younger generations.

A second example is the grant of 2,580 awarded to Fife Chinese Older People Association in 2002 to establish a network and support unit to promote the benefit and awareness of healthy eating amongst the elderly population within Fife's Chinese Community.

Building on a SCDP small grant to Oakley Fruit and Vegetable Stall in Fife for the initial set up of this service within a GP surgery, the project launched a 'fruit prescription' scheme on 20 March 2003. This initiative will benefit all the local community, but the young and older communities will especially be targeted.

Community-led, purpose-built mobile food initiatives are an important means of bringing affordable healthy food stuffs right to the doorsteps of the older community, particularly in rural areas where access to shopping is often limited. The SCDP recently awarded a grant of 1,000 to the Food Train in Dumfries and Galloway for the expansion of its service into rural areas of Dumfries and Galloway, which will largely, but not only, benefit the outlying communities' older population.

The SCDP is currently working with NHS Health Scotland and two community- based mobile food projects in East Lothian and in Paisley to evaluate in case study form the effectiveness of purpose-built mobile retail initiatives as a means of tackling the barriers to a healthy diet as outlined in Eating for Health, A Diet Action Plan for Scotland. The two case studies have already highlighted the importance of mobile food vans in reaching the elderly communities in the urban town of Paisley (Health on Wheels Van funded by Have a Heart Paisley) as well as in the rural villages of East Lothian (Roots and Fruits Van funded by a cocktail of funders including small grants from the SCDP). Research findings were published in April 2003.

Study tours, training events, conferences, the SCDP newsletter and other activities are open to full participation by older people, who indeed are probably the most active volunteering group within Scotland's community food projects.

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