Diet and lifestyle monitoring for older adults
Summary NANA is a simple, validated, touch screen system for older adults to record their food and drink. It can be used every day and can also measure their mood, cognitive function and physical activity.
Problem Nutritional status impacts upon the health and physical function of older people, who face a high risk of nutrient deficiencies and malnutrition. Poor nutritional status is particularly related to loss of skeletal muscle mass and strength, i.e. sarcopenia, which increases both the risk of adverse health outcomes in older people, such as frailty and the burden of other diseases. Severe sarcopenia is extremely disabling as it prevents independent living and places an increasing burden on healthcare providers. A number of factors including physical (such as reduced mobility, problems swallowing), cognitive (reduced ability) and mental health (e.g. depressed mood), affect nutritional status in older people although the specific relationships are not well understood. Existing tools for measuring diet, cognition and physical activity provide only snapshots of the situation and cannot identify rate of decline nor readily distinguish cause and effect. Most dietary assessment methods rely upon a pen and paper approach and require participants to recall and record what they have eaten. These are often unsuitable for use with older people, especially those with memory loss or other impairments. Multidimensional assessment covering nutrition; health status; function in activities of daily living; cognition; and mental health would enable effective targeting of interventions.
Solution NANA is a comprehensive assessment system developed in partnership with older adults using advanced technology to collect information on a daily basis on what people eat and drink, their cognitive function, physical activity and mood. NANA was developed and validated for use in the home and comprises a large database of food items that are selected through an intuitive touch screen interface partnered with images of the food items. Nutritional information is derived from a standardised nutrional database to provide a picture of what people are eating on a daily, weekly or monthly basis. This can be viewed alongside the individual’s pattern of cognitive function, daily mood ratings and physical activity. The information collected by NANA can be fed back to the individual, to their family or to health and social care providers to provide ongoing monitoring or prospective early detection of change in status or function. This can then be used to support interventions or form the basis of discussions about food and lifestyle to enable people to maintain their independence and live as well as possible.
Impact on economy NANA has the potential to impact the economy in several ways. The first is through keeping older adults at home and out of hospital and care homes through early detection of changes in their nutritional status or functioning and enabling early responding. This should reduce the direct burden on healthcare services through reducing the total number of hospital stays. Integrated collection of information could also reduce the duration of hospital stays by facilitiating earlier return home and continued support and monitoring. Reliable and current information about older adult’s nutrition and general functioning should also benefit families by reducing stress and potential demands on services for their own health and well-being. It may also enable family members to keep working rather than having to give up work to care for an older relative. Finally, the successful introduction and adoption of a novel technology for older adults could stiumulate purchases of additional services and technologies by creating a new market.
Impact on culture The introduction of NANA has the potential for increasing awareness and use of technology by older people and other groups who are typically later adopters of technology. This could challenge negative perceptions and stereotypes of older people and stimulate new ways of thinking about and planning for later life. Seeing older people comfortably using new technology could stimulate creative new portrayals of older age and facilitate inter-generational engagement and exchange through newly devised activities. It could also open up possibilities of applying technology in other areas of life, for example social activities, such as meeting new people or sharing interests and hobbies, e.g. cooking or gardening. It could also bring the world into the homes of people with mobility problems, for example by enabling them to access cultural experiences such as virtual visits to museums, art galleries, debates or educational opportunities.
Impact on ecology While not directly addressing ecology, NANA has the potential to raise awareness about healthy eating and, by associaition food production. Educating younger generations about the importance of good nutrition and a balanced diet through the life course is one mechanism for encouraging change in eating behaviour. Facilitating discussions about feeding our future, older selves has the potential in the longer term to change consumer demand and expectations, thereby influencing food production.
Impact on politics NANA has the potential to impact on decision making about responding to and planning for our ageing population in the medium- to long-term. Specifically, being able to collect prospective information about people’s diet, health and general functioning makes it possible to detect early signs of change and intervene to maintain people at home while they are as well as possible. This has application not only to those at risk of nutriton-related conditions, such as malnutriton and frailty but also those with early signs of cognitive decline or emerging physical needs. The availability of integrated holistic information and the potential to detect change provides an opportunity for a step change in planning and provision for older adults by directing services towards prevention of decline and maintenance of functioning.