1. Project Summary

This project’s primary aim is to contribute to the improvement of the quality of life of the elderly.  Its benefits are likely to be felt most keenly by the frail elderly, those that require constant care by others, but its activities are not confined to this sub-group.  It is aimed at T6 of Priority 5 and aims to improve understanding of how diet can promote healthy ageing.  The global objectives are to co-ordinate research into the nutrition of the elderly; to improve their quality of life; to reduce public health costs through the prevention of nutrition related diseases; and to encourage the development of nutritionally-balanced food products specially designed for the elderly.

The specific objectives of this co-ordination action are to:

• Co-ordinate European research activities in nutrition for the elderly.
• Document the state of the art in age-related research and technology, to highlight the most promising areas for development.
• Map current research activities within the ERA.
• Identify suitable technologies and policies that can improve the diet of the elderly, through studies and expert group meetings.
• Survey legislation relating to care for and nutrition of the elderly, highlighting loopholes and best practice.
• Improve the understanding of healthy food options available to care providers for the elderly.
• Develop a set of guidelines and recommendations of best practice for use in the health and care industry.
• To assist the implementation of these guidelines through two implementation workshops in the first and second years of the project.
• Disseminate the project’s results through an enhanced website, technology transfer workshops and a staff training programme.
• Promote good communication between the partners and forge permanent research links.

The main outputs will lead to:

• Better co-ordinated European research: less duplication of effort, more rapid commercialisation.
• Increased awareness of the problems faced by the elderly.
• Improved guidelines and recommendations for healthcare professionals and policymakers.
• Improved quality of life for the elderly, through an improvement in the range and quality of food products aimed at this sector of society.  The success of this goal will be measured by analysing developments in the WP5 database throughout the project.

2. Objectives of the project and state of the art

Scientific and technological objectives

The primary aim of this co-ordination action is contribute to the improvement of the quality of life of a very vulnerable group in society, the elderly.  These citizens are those of advanced (i.e. pensionable) years, often with specific care needs, perhaps as a result of infirmity, stroke, cancer, etc.  This project particularly, but not exclusively, aims to cater for the frail elderly; a group which has been defined as "those in whom the assets maintaining health and the deficits threatening it are in precarious balance".  In more practical terms, this definition takes in those who depend on others for the activities of daily living or who are at high risk of becoming dependent.

The global objectives of this project are to co-ordinate research into the nutrition of the elderly; to improve their quality of life; to reduce public health costs through the prevention of nutrition-related diseases; and to encourage the development of nutritionally-balanced food products which are specially designed for the elderly.

The project aims to increase understanding of the dietary requirements of this vulnerable group, and how their nutrition can assist or hinder their healthy ageing.  This should encourage the development and bringing to market of food products that are specifically designed to cater for the altered sensory perception of the ageing population, principally the institutionalised elderly for whom food is selected by professional carers.

The specific technological objectives of this co-ordination action are:

To co-ordinate European research activities in the area of nutrition for the elderly.

To survey the world scientific literature in this field and document the state of the art in age-related sensory research and technology, in order to highlight the most promising areas for future development (by Month 6, with regular updates).

To map current national and international research activities in the topic of nutrition for the elderly within the European Research Area (ERA) (by Month 12).

To identify Centres of Excellence to enhance and expand the consortium, in order to make it the leading European forum for research into this topic (by Month 24).  (A Centre of Excellence will be judged by its number of research publications, number of patents, number of citations, number of Ph.D. theses, number of breakthroughs and academic awards, etc. (for universities and research organisations); or number of patents, license agreements, etc. (for companies)).

To identify suitable technologies and policies that can improve the diet of the elderly, through studies and expert group meetings (by Month 30).

To survey national and European legislation pertaining to care for and nutrition of the elderly, highlighting loopholes and best practice (by Month 12, with annual updates).

To improve the knowledge of healthy food options open to care providers for the elderly (by Month 12).

To develop a set of guidelines and recommendations of best practice specifically for use in food preparation procedures in the health and care industry. To assist the implementation of this best practice through implementation workshops (by Month 36).

To disseminate the project’s results through a specialised website (created at the start of the project), technology transfer workshops (Months 18 and 30) and a staff training programme (between Months 19 and 30).

To create and enhance good communication between the partners and permanent research links, through the immediate development of flexible electronic communication tools, staff exchanges and a consortium expansion.

The focus of the project is on the taste and smell losses that occur with ageing, and how these changes decrease the enjoyment of food, and may subsequently reduce food consumption and negatively influence the nutritional status of the elderly.  Many clinical and laboratory studies have been carried out to examine the cause of these taste and smell dysfunctions.  Despite this, the elderly population is largely ignored commercially, as food companies mainly target younger consumers: there are very few products specially designed for purchasers for the frail elderly.

The project will bring together research institutes, food manufacturers, universities, care organisations and specialists to elucidate the state of the art, encourage the development of new food products, and raise awareness and the level of know-how throughout Europe.  This will be achieved by identifying and transferring the ideas currently at academic level to industrial and commercial levels, and will make a significant contribution towards the development of the European Research Area.

The principal outputs (in order of delivery) of this co-ordination action will be:

Annual co-ordination seminars, to discuss research work in Europe and to ensure that maximum benefit is achieved from public money and to help shape the ERA.

An advanced web site for dissemination of results from this and related projects.

An in-depth literature survey, to elucidate the state of the art.  This will be updated during the project

Annual expert group meetings, to stimulate discussion on ‘hot topics’ in the field and to encourage cross-fertilisation of ideas.

A legislation workshop and report, to disseminate the status of current national and international legislation, to identify bottlenecks or loopholes, and to promote best practice for statutory compliance.

Two strategy workshops, to encourage implementation of the CA’s recommendations for the development of healthy food for the frail elderly.

Identification, mapping and ranking of centres of excellence, to help shape the ERA and to prepare for an expansion of the consortium.

Two technology transfer workshops, to encourage the uptake of innovative new technologies by industry.

A guidance booklet, to be circulated to policymakers, to promote the project’s findings and to encourage the adoption of the best practices identified.

These outputs will lead to the following benefits:

Better co-ordinated European research, leading to less duplication of effort and more rapid commercialisation.  For example, the co-ordination seminars will disseminate Nutri-Senex’s results to other projects, and vice versa.  This will improve the general level of knowledge of European researchers, and their awareness of ongoing research.

Increased awareness of the problems faced by the frail elderly amongst manufacturers, healthcare organisations, nutritionists, dieticians, and policymakers, through newsletter advertising, the project web site, and by direct dissemination.  By carefully targeting this information towards key stakeholders, European policies affecting the elderly can be improved.

Improved guidelines and recommendations for healthcare professionals and policymakers.  If successful, new legislation will be framed to benefit elderly citizens.

Improved quality of life for the elderly, in particular the frail and vulnerable, through an improvement in the range and quality of food products aimed at this sector of society.  The success of this goal will be measured by analysing developments in the WP5 database throughout the project.

State of the art

The ageing of the world’s population is the result of the continued decline in birth rates and increased life expectancy.  The more developed regions of the world have been most affected by population ageing since the beginning of the 20th Century; however, it is an increasing problem in other areas of the world.  These changes are now occurring at an unprecedented rate, according to the United Nations 2002 "State of World Population" report.  Societies are now faced with meeting the needs of the elderly in order to provide for more equality between generations.  This report also highlights important gender issues, such as the increasing number of widows living in poverty, as a result of their higher life expectancy.  This is a particular problem in developing countries, where widows without male offspring often live well below the poverty line.

Older adults, often the frail elderly referred to in this proposal, comprise the fastest growing portion of the world’s population.  It has been estimated that, by the year 2025, individuals over the age of 70 will comprise well over 18% of the US population; however, Europe is projected to remain the major area of the world most affected by ageing.  The proportion of older people will increase from 20% in 1998 to 35% in 2050 and, by then, one in every three people will be over 60.  By 2050, the ‘oldest’ country in the world will be Spain, closely followed by Italy, with 3.6 and 3.4 people aged 60 or above for each person below 15 years of age, respectively.  The United Nations estimated in 1999 that the number of people over 60 globally will exceed one billion by the year 2020: more than 30% of the population of the developed world.  Population ageing is poised to emerge as a prominent worldwide phenomenon.

However, with the ageing of the population, there are many logistic factors for consideration.  Along with the new demands on the food supply and commercial potential for new products come questions concerning the specific nutrition of ageing systems, changes in food preferences and perceptions with ageing, and changes in the overall quality of life.  The perception of ageing as a depressing downward spiral of growing wrinkled, senile, and ill persists.  Indeed, for many of today’s elderly, growing old is synonymous with illness.  About half of all people over 65 are taking multiple medications for a wide variety of ailments and, for many older people, life is punctuated by visits to the doctor and the hospital.

With this increasingly visible ‘greying’ of the population, there are signs of changing trends in the attitudes of health professionals towards geriatric medicine; nevertheless, as gerontology evolves and advances into the new millennium, widely propagated, though unfounded, stereotypes regarding age-related issues must be challenged.  Many clinical and laboratory studies have found a progressive decline in the senses of taste and smell, which tends to begin around 60 years of age and becomes more severe in people older than 70 years.  Taste and smell dysfunction in the elderly is caused by normal ageing, as well as certain diseases, such as cancer and Alzheimer’s, pharmacological and surgical interventions, radiation and environmental exposure.  These chemosensory deficiencies can lead to changes in food choices and reduced food intake, which can subsequently exacerbate medical conditions, impair nutritional status and immunity, and produce weight loss.

Adequate nutrition is vital to maintaining health and enhancing quality of life and this becomes increasingly more importance we grow older.  Food preferences are influenced by culture, family customs and traditions, religious beliefs and income.  In addition to lifelong eating habits, other factors that affect food intake are income, living arrangements, food availability, mental and emotional state, and physical limitations.  The elderly are unlikely to break food choices formed in childhood, but may reduce their intake.  They are proud and dignified, and certainly unlikely to buy food specifically marked as ‘old food’: they tend to prefer the foods they have always eaten, but perhaps in different quantities.  Those most at risk from malnutrition are the institutionalised elderly, i.e. those who do not select their own food, and it is these people who could potentially benefit from the development of specific foods for their altered nutritional needs.

A published study addresses the many issues regarding the satiety in the elderly population.  In this study, repeated consumption of flavour enhanced meals by nursing home residents over a sixteen-week period led to an increase in the intensity of their daily perception of hunger.  Although the documented daily dietary intake of the test subjects remained unchanged, they demonstrated significant weight gain over the course of the study.  In contrast, subjects in the control group did not gain weight and demonstrated a progressive decrease in daily energy intake during the study.  These findings warrant a reappraisal of the roles of sensory-specific satiety and allisthesia on food consumption in elderly persons.  Sensory specific satiety describes the reduction in the positive hedonic response to the sensory qualities of a food item that occurs with consumption.  This is believed to be the mechanism that prompts a person to switch from one food item to another during the course of a meal.

There is evidence that good nutrition promotes vitality and independence whereas poor nutrition can prolong recovery from illness, increase the costs and incidence of institutionalisation, and lead to a poorer quality of life. Good nutrition is ageless and the message to older people must be that the quality of their nutrition is essential to their quality of life. Whilst the evidence of the value of balanced nutrition is clear, the nutritional status of many older individuals lacks that balance, and the problem is often complicated by a fear of foods and over-emphasis on single nutrient issues. This project will look at the relative benefits of cardiovascular risk reduction with dietary restrictions versus the potential risks to the nutritional well-being of the elderly when these interventions often result in reductions in many nutrient dense foods. The real question that must be addressed is whether the "one diet fits all" approach readily fits both the nutritional needs and health concerns of the elderly.

There is currently much work being carried out at EC level in this area. HealthSense-Choice has been funded in order to determine how changes in sensory physiology, sensory psychology and socio-cognitive factors influence food choice in the elderly.  CrownALife is identifying, Europe-wide, the structural and functional specificities of the elderly intestinal microflora.  With this information, they are researching the functional food based preventive nutrition strategies, aiming to beneficially affect the functional balance of the elderly intestinal microflora.  Vitage is concerned with the functional and nutritional consequences of fat-soluble vitamin status and metabolism during ageing.  The overall objective of the project is to provide clear and sound scientific evidence about the changes in the status, metabolism and functions of fat-soluble vitamins that may occur during non-pathological ageing in humans.  Senior Food intends to provide a detailed examination of attitudes of and beliefs to older consumers and their food preferences for products such as snacks, ready-made convenience foods, functional foods and delivered meals. In addition, it will investigate access to foods and social networks to support food procurement.

However, despite the large area of work being covered by these projects, the objectives are largely research based and the project participants are comprised mostly of academic organisations.  This project will seek to co-ordinate the efforts and results of these projects, and others, and implement strategies to disseminate the key findings.  This will be achieved by not only bringing together institutions active in the area of food research and technology, but also health care professionals, government/national bodies involved with the elderly, food manufacturers, NGOs, and charities representing senior citizens.  The overall objective will be to increase the standard of living for the frail elderly in the medium- to long-term by helping to develop more healthy foods and by spreading best practice.

A Co-ordination Action funded by the European Commission under the Food Quality and Safety Priority Thematic Area Contract no: Food-CT 2003-506382