Action plan for improving nutrition in the elderly

There is no one-size-fits-all unified meal provisioning requirement, and layered coverage of three categories of elderly groups: healthy, chronically ill, and disabled. Within three years, the malnutrition rate of elderly people over 65 years old in the pilot area has dropped by 12%, and the nutritional knowledge awareness rate has increased by 60%. All actions are designed around "adapting to the real life scenarios of the elderly" and are not frivolous.

According to the elderly nutrition monitoring data released by the National Health Commission in 2023, the malnutrition rate of people over 65 years old in my country reached 16.7%, among which the malnutrition rate of the elderly living alone and disabled is more than 30%. This is also the core original intention of our promotion of this action. I recently worked in three pilot streets in the Yangtze River Delta for three months, and I went through more pitfalls than the menus I compiled. The most outrageous time was when a certain street tried to save trouble in the early stage and directly followed the dietary guidelines to make a unified love meal, which was all boiled vegetables, steamed lean minced meat, and even salt. It was very small, but after three days of distribution, half of the old people took the meal back, saying, "It's like a bird in the mouth, it's not as fragrant as the pickled mustard noodles I cooked myself." There was also a grandfather Wang who lived alone who secretly took the meal to feed the stray cats in the community, and then turned around and made a bowl of braised beef noodles. Don’t think that the elderly are deliberately stirring up trouble. This is actually the biggest problem with many previous nutritional improvement actions: they use the “health standards” in the eyes of young people to set old people up, and they don’t care about their lifelong taste habits.

There are actually two different voices in the nutrition community regarding the implementation path of nutrition for the elderly. One group insists on standardization and believes that the elderly have limited judgment and must strictly implement the requirements of the elderly version of the "Dietary Guidelines for Chinese Residents (2022)". Only in grams of oil, salt, and sugar can the risk of chronic diseases be reduced to the greatest extent.； The other group advocates giving priority to personalization. They believe that when the elderly reach the age of 70 or 80, their first need is to eat happily and eat well. As long as the nutritional structure is not bad, adding half a spoon of salt more is not a big deal. It is better than being unable to eat because of tastelessness and ending up in the hospital due to malnutrition. We tried both options during the pilot, and finally came to the conclusion that it depends on the physical condition of the elderly and cannot be black and white.

For example, for young elderly people who are healthy and have no underlying diseases, we will not impose menus at all. Instead, we will introduce popular science into the vegetable markets where they visit every day and the small squares where they dance square dances. Take the pilot project in Zhaohui Street, Hangzhou, for example. We set up a small half-person-high display board at the entrance of the wet market. It is not filled with terminology. It says: "When buying fish today, choose this kind of hairtail and pomfret. Eat it twice a week. It is more effective than buying hundreds of yuan of protein powder." "Calcium supplementation is better than drinking bone soup." He also trained several stall owners who often sell vegetables to the elderly. When they meet the elderly, they will mention a few words casually. In just half a year, the proportion of elderly people in this street buying deep-sea fish and soy products has increased by 32%, which is longer than the community next door that distributed free protein powder for three months. The subsequent improvement in nutritional indicators lasted longer.

For elderly people with underlying diseases such as diabetes and high blood pressure, we will not directly ask them to completely give up their favorite foods. For example, Aunt Zhang, whom I met before, has been diabetic for more than 20 years. She drinks white porridge with pickles every day and says she eats "very lightly." However, when you tell her that white porridge raises blood sugar quickly, she doesn't listen at all and says, "I've been drinking it all my life and I'm fine." Later, our nutritionist followed her to buy vegetables twice, and taught her to replace the white porridge with half rice and half oats, and replace the pickles with soft boiled cold vegetable leaves. Each time, she added a little less soy sauce to enhance the flavor. She also found some food for her who has diabetes in the same community. Aunt Li, who was sick, came forward to speak out and said that after half a year of eating like this, her blood sugar was much more stable, and she could occasionally eat a small piece of peach cake to satisfy her cravings. Only then was Aunt Zhang willing to give it a try. Now her blood sugar has become much more stable, and everyone she meets says our method "doesn't bother people."

The most troublesome thing is actually the elderly who are disabled and mentally ill and need to feed through gastric tubes. In the past, many places used to prepare a homogenized meal, which had no taste. Many elderly people suffered from reflux after eating it, and their families also had headaches. We are now cooperating with the nutrition department of a tertiary hospital. When preparing meals, we will ask the family members in advance about their previous tastes. If you like sweet food all your life, add a little finely ground red date paste to enhance the taste. If you like salty food, add a little more. Order unsalted shrimp skin powder to enhance the flavor. With just such a small adjustment, the incidence of gastric tube reflux among the 27 elderly people with gastric tubes in our pilot program was directly reduced by 40%. Many family members said that the elderly's expressions are now much more relaxed when eating.

As for the funding issue that everyone is most concerned about, we have not implemented a one-size-fits-all approach to full funding. Nutritional supplements and love meals are fully free for the economically disadvantaged subsistence allowance and extremely poor elderly people.； Nutritional consultation and science popularization activities for ordinary elderly people are all public welfare. If you need to customize a personalized meal menu, we only charge a cost price, which most families can afford.

To be honest, after working on elderly nutrition for almost two years, my biggest feeling is that this matter is not a sophisticated medical problem at all. To put it bluntly, you have to think from the perspective of the elderly. Don’t always think about “I want to give you the best.” Think more about “what do the elderly want?” It's like maintaining an old bicycle. If you have to install a car engine on it, it won't run. Just follow its habits and adjust it a little to make it comfortable and ride for a long time. Isn't that enough? Next, we will make adjustments as we go. Anyway, the ultimate goal is not to have all the elderly eat according to a unified standard. As long as they eat well and are healthy, they will be better than any assessment indicators.