We have known for a long time that diet, health, and illness are intricately intertwined, and abundant evidence shows this essential connection remains true as we age. But the exact connection between nutritional status and good mental health in elders is missing from much of the literature. The past three decades have seen advances in nutritional science, yet the relationship between it and mental health requires a greater commitment to both geriatric mental health and academic pursuits.
The role of socioeconomic status and its impact on nutritional health gained attention in the 1960s with the Kennedy Whitehouse. Both nutrition and physical activity were a focus of that administration. As President Kennedy said, “A proud and resourceful nation can no longer ask its older citizens to live in constant fear of serious illness. We owe them the right of dignity in sickness as well as in health. Too many older adults have poor access to or are forced to cut back on food when they are living at a time when their health actually requires greater quantity, variety, and balance in their diets.”
What was true then remains true today; however, with a greater number of Americans living into advanced age, we are now facing a new crisis—food insecurity in elders. The U.S. government uses the term to describe inadequate access to food and proper nutrition. There is at minimum an indirect correlation, if not a direct correlation, between adequate access to basic nutrition for elders, deprivation of essential macro- and micronutrients and good health.
There is also a focus on the relationship between nutrition and the most commonly experienced chronic illnesses, including degenerative diseases, such as cardiovascular disorders; cancer; metabolic disorders such as diabetes; physical disability; and acute illness such as infectious disease. The state of health for the fastest growing population is of rapidly growing concern across disciplines. But the current nutrition education provided to physicians, nurses and other practitioners is not sufficient to meet the burgeoning needs of elders.
Research funds have been directed toward answering foundational questions about nutrition, health, and aging, with a focus on discovering reliable methods for estimating dietary intake, and establishing clinical markers for nutritional deficiencies. The results from this nascent research will provide the information needed to inform further recommendations on prevention, and the best management of nutritional problems in older adults.
The role of appropriate assessments is pivotal to improving nutritional care, and will guide therapies and shape medical prevention efforts.
Providers in many urban and rural community health centers have begun this effort by forming alliances between primary care, aging services, and mental health centers. One such program is the Gero Psychiatric Outreach program at Chestnut Health Systems in Metro East Illinois. This nationally recognized program incorporates detailed nutritional assessments with health and wellness screening. The threefold assessment includes diet, anthropometric assessment, and functional nutritional assessment. The dietary assessment includes diet history, 24-hour food recall and cataloging of physical and psychological distress symptoms. Anthropometric assessments include height, weight, body mass index and skin-fold thickness. Functional assessment looks at the influence of sight, taste and smell on dietary intake.
Evaluating mental status and mood are essential for a comprehensive health assessment. Dehydration, toxicity, and nutritional imbalances can cause delirium. Protein energy malnutrition (PEM) can create disturbance in mood, cognition and thought processes. The Gero Psychiatric program at Chestnut Health Systems has seen many examples of elders presenting with mental health disturbance who were ultimately found to have nutritional deficits.
An 82-year-old female, with no known history of functional mental health problems, presented with symptoms of paranoia, memory loss, agitation, odd sensations in her limbs, and profound dizziness. All labs were within normal limits except B12 and folate levels. She had moved from her home out of state, and upon medication reconciliation it was found the regular B12 she was prescribed by her former physician was missing. Once restarted, she returned to baseline functioning.
A 69-year-old male with a long-term history of depression and alcohol dependence presented with a near vegetative depression. Deprived of essential B vitamins, he had become profoundly malnourished with PEM. His profound weakness was mistaken for an irreversible illness, increasing his psychiatric symptoms. Once corrected, the depression decreased and he became amenable to treatment for alcohol dependence.
There is an unquestionable and delicate balance between being older and mental status, the mood of elders and their nutritional health.
We need a better interface between primary care, mental health and aging services; increased nutritional education and training for practitioners; and funds to support food programs for aging adults. Additional research is also needed to further determine the correlation between health and diet, as well as in both prevention and therapeutics to meet the growing needs of the fastest growing population in the U.S. today.
Lee H. Fraser, M.A., RN-BC, is a Gero-Psychiatric Specialist for Chestnut Health Systems of Illinois and a member of the MHAN Editorial Advisory Board.
This article was brought to you by the editorial committee of ASA’s Mental Health and Aging Network (MHAN).
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