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Which are better for seniors: vegetarian, vegan, or high animal protein diets?

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Vegan Buddhist nuns have same bone density as non-vegetarians, says a study done in 2009. On the other hand, a study done in 2005 reports that high-carb, vegan diet causes major weight loss. In the 2009 study, researchers compared the bone health of 105 post-menopausal vegan Buddhist nuns and 105 non-vegetarian women, matched in every other physical respect, has produced a surprising result. Their bone density was identical.

The study was led by Professor Tuan Nguyen from Sydney's Garvan Institute of Medical Research. He collaborated with Dr Ho-Pham Thuc Lan from the Pham Ngoc Thach Medical University in Ho Chi Minh City, Vietnam. Their findings, "Veganism, bone mineral density, and body composition: a study in Buddhist nuns," are published online since December 2009 in Osteoporosis International.

"For the 5% of people in Western countries who choose to be vegetarians, this is very good news," says Professor Nguyen, according to the April 15, 2009 news release, Vegan Buddhist nuns have same bone density as non-vegetarians. "Even vegans, who eat only plant-based foods, appear to have bones as healthy as everyone else."

Lower protein and calcium intake in vegetarians?

"Bone health in vegetarians, particularly vegans, has been a concern for some time, because as a group they tend to have a lower protein and calcium intake than the population at large. In this work we showed that although the vegans studied do indeed have lower protein and calcium intakes, their bone density is virtually identical to that of people who eat a wide variety of foods, including animal protein."

"The nuns' calcium intake was very low, only about 370 mg a day, where the recommended level is 1,000 mg. Their protein intake was also very low at around 35 g a day, compared with the non-vegetarian group, which was 65 g," says Nguyen, according to the news release, Vegan Buddhist nuns have same bone density as non-vegetarians. Professor Nguyen and Dr Thuc Lan chose to study Buddhist nuns because their faith requires them to observe strict vegan diets all their lives.

"We didn't study vegetarians from the West because many are lacto-vegetarians, so could have considerable calcium in their diets. It would have compromised the results," Nguyen explains, according to the news release. "The Buddhist nuns came from 20 temples and monasteries in Ho Chi Minh City. The control group, 105 non-vegetarian women of exactly the same age, were recruited from the same localities."

Although Professor Nguyen and Dr Thuc Lan do not advocate a vegan diet, they note that fruits and vegetables are likely to have positive effects on bone health

They also note that the study did not measure Vitamin D levels (as important to healthy bone as calcium) and factors such as lifestyle and physical activity. These variables may affect the outcomes for vegetarians elsewhere. What wasn't mentioned in the study's abstract was the phenomenon that as people age, their needs for more protein may change. Do older people need more protein in their diets than the young? You also may wish to see the site, Research Australia.

Do protein requirements increase with age?

Or does too much protein cause bone loss and eyesight issues? Diets high in animal protein may help prevent functional decline in elderly individuals, says one study. But elderly vegans are wondering whether their diet also prevent rapid decline.

The new study says that a diet high in protein, particularly animal protein, may help elderly individuals maintain a higher level of physical, psychological, and social function according to a recent study published in the Journal of the American Geriatrics Society.

Due to increasing life expectancies in many countries, increasing numbers of elderly people are living with functional decline, such as declines in cognitive ability and activities of daily living. This can have profound effects on the health and well-being of older adults and their caregivers, as well as on health care resources.

What types of dietary protein requirements increase with age?

Research suggests that as people age, their ability to absorb or process protein may decline. To compensate for this loss, protein requirements may increase with age. Megumi Tsubota-Utsugi, PhD, MPH, RD, of the National Institute of Health and Nutrition in Japan, and her colleagues in Tohoku University and Teikyo University, Japan, wondered whether protein intake might affect the functional capabilities of older adults. Researchers designed a study to investigate the relationship between protein intake and future decline in higher-level functional capacity in older community-dwelling adults in Japan.

Their analysis included 1,007 individuals with an average age of 67.4 years who completed food questionnaires at the start of the study and seven years later. Participants were divided into four groups (quartiles) according to their intake levels of total, animal, and plant protein. Tests of higher-level functional capacity included social and intellectual aspects as well as measures related to activities of daily living.

The relationship between protein intake and future decline in higher-level functional capacity of older adults is researched

Men in the highest quartile of animal protein intake had a 39 percent decreased chance of experiencing higher-level functional decline than those in the lowest quartile. These associations were not seen in women. No consistent association was observed between plant protein intake and future higher-level functional decline in either sex.

"Identifying nutritional factors that contribute to maintaining higher-level functional capacity is important for prevention of future deterioration of activities of daily living,” says Dr. Tsubota-Utsugi, according to the March 10, 2014 news release, "Diets high in animal protein may help prevent functional decline in elderly individuals." “Along with other modifiable health behaviors, a diet rich in protein may help older adults maintain their functional capacity.”

You also may wish to check out the abstracts of these other studies: "Difference in Muscle Quality over the Adult Life Span and Biological Correlates in the Baltimore Longitudinal Study of Aging (pages 230–236)" and "Sarcopenic Obesity and Risk of Cardiovascular Disease and Mortality: A Population-Based Cohort Study of Older Men (pages 253–260)." Another study's abstract you may wish to see is, "Effect of Tai Chi on Cognitive Performance in Older Adults: Systematic Review and Meta-Analysis (pages 25–39)."

Elder care or housework by robot?

Not many people may think mechanically rather than nuturing when it comes to hiring household help with mostly caregiving duties and attention to the needs of the elderly. And few think about hiring a "Stepford Wife" type of robot for in-home care, at least at this time. But change is coming in the form of robot care as compared to caregiving aides in the home.

On the other hand, Care-O-bot® 3 is being promoted by its creators, as the future of in-home care for the elderly. The robot is designed to perform many of the tasks an able-bodied human can, catering for senior citizens who are no longer able to live independently.

Instead of paid caregivers, when seniors need help with cleaning, cooking, dressing, hygiene, and movement or physical therapy, will they be able to afford a care-o-bot, a robot that takes the place of a live caregiver, but never gets stressed out and resorts to hostility or elder abuse?

Will young technical types build caregiving robots for their great grandparents? You can check out the sites "Product sheet Care-O-bot® 3 " and "Care-O-bot 3 in research."

A Care-O-bot® is the product vision of a mobile robot assistant to actively support humans in domestic environments. Maybe it can clean and do the work of a house servant, but can it care for the elderly in ways needed, such as managing the medicine, changing the sheets, doing the wash, and cooking healthy meals?

Will a robot eventually take the place of the home health aide to seniors in various environments from a person's home or apartment to an assisted living environment? The difference between a programmable robot and a human caregiver, is the interchangeable parts for the robot and the fact that when a robot runs out of energy, it turns itself off. When a person runs out of energy, sometimes the person becomes abusive. The question is how calm and collected will the robot remain, and will it be affordable and well, humane?

Maybe the language needs a neutral word for ombudsmen other than ombudswomen, such as ombudsors or ombuds reps. Instead of speaking of micromanaging geriatric patients, the patients usually want to be addressed as in charge of their own destiny, even when they have low mobility. But when it comes to seniors discussing the work of geriatricians, many seniors are just getting tired of how seniors are cared for in affordable long-term residential environments, especially when they're not able to afford the premiums of long-term care insurance.

What seniors are curious about is how the brain processes music, getting dense nutrition, especially when chewing is painful at times, and how kind and affordable will the caregiving be when services are needed. Others are concerned about where to live when individuals outlive their savings or the fixed income doesn't cover food expenses or rent for the entire month.

Frameworks form from lessons learned

Lessons learned managing geriatric patients offer a new framework for improved care, says a recent report, "Regardless of Age: Incorporating Principles from Geriatric Medicine to Improve Care Transitions for Patients with Complex Needs," published online in the Journal of General Internal Medicine on February 21, 2014.

A large team of experts led by a Johns Hopkins Medicine geriatrician reports that efforts to improve the care of older adults and others with complex medical needs will fall short unless public policymakers focus not only on preventing hospital readmission rates, but also on better coordination of community-based "care transitions." Lessons learned from managing such transitions for older patients, they say, may offer a framework for overall improvement.

With its focus on holistic approaches to patient care, caregiver support, and delivery system redesign, geriatrics has advanced our understanding of optimal care during transitions. If you check out the abstract of the report, you'll see how it can provide a framework for incorporating geriatrics principles into care transition activities by discussing the following elements that focus on active verbs such as: identifying, engaging, building, predicting, avoiding, and adopting.

(1) Identifying factors that make transitions more complex

(2) Engaging care "receivers" and tailoring home care to meet patient needs

(3) Building "recovery plans" into transitional care

(4) Predicting and avoiding preventable readmissions

(5) Adopting a palliative approach, when appropriate, that optimizes patient and family goals of care. The article concludes with a discussion of practical aspects of designing, implementing, and evaluating care transitions programs for those with complex care needs, as well as implications for public policy.

Nationwide, some 22 percent of older adults experience so-called care transitions annually, moving from and among hospitals, rehabilitation facilities, nursing homes, long-term care, assisted living and their homes

In the report published online in the Journal of General Internal Medicine last month, the experts say studies have long shown that fragmented care, incomplete information "handoffs" and poor planning among community-based and home caregivers jeopardize health and safety. Similarly, the team says, those with traumatic brain injuries, cancer, end-stage kidney failure, complicated diabetes, heart disease, developmental disabilities and cerebral palsy need better coordination of their care across health care settings.

Using a review of research and clinical experience, the authors built their framework and recommendations for improving care on the foundation of what's been learned about caring for aging Americans. Among their recommendations for health policymakers and caregivers are the need to engage community-based care "receivers" earlier in the transition process, to adopt a palliative care approach with patients and their families that sets realistic care goals, and to focus not only on preventing hospitalization, but also on making out-of-hospital transitions easier.

"In this framework, emphasis is placed on the importance of looking at community, system and regional factors that play into care transitions," says report co-author Alicia I. Arbaje, M.D., M.P.H., according to the March 11, 2014 news release, "Lessons learned managing geriatric patients offer framework for improved care." Arbaje is director of transitional care research for Johns Hopkins Bayview Medical Center and assistant professor of medicine at the Johns Hopkins University School of Medicine.

Many of the group's recommendations focus on communication among providers

For example, Arbaje says, hospital staff should not only make follow-up phone calls to check on discharged patients, but they should also send written care instructions. Family members and caregivers should be a part of patient education during discharge. Small chores, such as alerting a skilled home health care provider well in advance of a patient's discharge, can make coordinating care and recovery plans more effective.

"Our suggested framework is designed to help providers think ahead instead of reacting during a patient's crisis," says Arbaje, according to the news release. Recovery and emergency contingency plans need to be broader than referring a patient back to a primary care physician and instead include other components of an individual patient's health care system and support.

"These findings shed light on what we can do as a health system and community to reduce readmission rates by looking at more than just the patient. The conceptual framework gives structure to understand problems with care transitions and outlines what and who to consider when planning and implementing them. It can be a valuable tool for health care systems and policymakers to guide care coordination efforts as part of health care reform," she says, according to the news release.

Other authors of the report are Devan L. Kansagara, M.D., M.C.R., and Honora L. Englander, M.D., of the Oregon Health & Science University; Amanda H. Salanitro, M.D., M.S., M.S.P.H., and Sunil Kripalani, M.D., M.Sc., of the Vanderbilt University School of Medicine; Stephen F. Jencks, M.D., M.P.H.; and Lee A. Lindquist, M.D., M.B.A., of Northwestern University's Feinberg School of Medicine.

The Association of Specialty Professors provided funding for the conceptualization of priority areas for publication, of which this manuscript is one

Johns Hopkins Bayview Medical Center, located in Baltimore, Maryland, is a full-service, Joint Commission-accredited academic medical center. Among the wide range of services offered are an area-wide trauma center and the state's only regional adult burn center.

Founded in 1773, our 565-bed facility features several centers of excellence including stroke, geriatrics, joint replacement, wound care and bariatrics, to name a few. As part of the Johns Hopkins Health System, our physicians hold full-time faculty positions at The Johns Hopkins University School of Medicine. For more information, you may wish to visit the Johns Hopkins Medicine site.

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