Men's Health Week 2019
This week (10 – 16th June) we are celebrating Men’s Health Week, an initiative which seeks to increase awareness of male health issues whilst encouraging organisations and service providers to meet the specific needs of men.
The focus for 2019 is on men’s health by numbers. In this article, we will look at key figures relating to malnutrition in men, explore some of the contributing factors, and highlight support services available.
Malnutrition in Men:
Research by BAPEN has shown that there is a consistently higher prevalence of malnutrition in women than men1,however, regardless of gender, ageing is associated with reduced energy (calorie) intake and loss of appetite2. Additionally, malnutrition is common amongst people with conditions such as cancer, COPD and liver disease3,4,5.
Men livingwith severe comorbidities or those who are mobility-impaired may experience difficulties accessing and preparing food, as well as being less likely to partake in social food activities such as eating out with family and friends6,7. This can lead to feelings of loneliness and isolation.
Loneliness in Men:
The Jo Cox Commission on Loneliness estimates that nine million men (of all ages) experience loneliness at least once a week, but 10% are afraid to admit it8. Loneliness is a significant predictor of malnutrition and therefore it’s important to address it early on9.
Widows are at increased risk of social isolation and socioeconomic vulnerability, which may affect their food choices and willingness to cook6. Conversely, marriage appears to be beneficial due to benefits of companionship10since social interaction and support are predictors of diet quality11.
It’s important to mention that it’s not just widows or those who live alone that get lonely. There are lots of reasons why someone may feel socially isolated, including retiring from work, not being in a relationship, moving to a new area, caring for someone and dealing with loss of hearing or the development of sight, mobility or continence problems.
Companionship through group activities may seem like an obvious answer. However, the Older Men in the Margins project by the University of Bristol (in collaboration with Age UK) found that men are often reluctant to access social support groups and clubs as they felt they were more suited to women or they didn’t want to be a burden12.
There are plenty of organisations who are tackling loneliness in men, all of which provide supportive environments and offer activities which enable men to share skills and achieve a sense of purpose. The Men’s Shed Organisation have almost 500 men’s sheds throughout the UK. They offer a community space for men to connect, converse and create within a garden shed, whilst reducing feelings of loneliness and having fun. The University of the Third Age (U3A) is open to men (and women) who are retired and they welcome people from all backgrounds. Members share knowledge, skills and passion through regular talks, events and trips.
For those who are unable to leave the house, Call in Time offers a free telephone befriending service which matches volunteers with older people. Users receive a weekly, 30-minute chat on the phone with a befriender who has similar interests and hobbies. The British Red Cross offer a similar initiative through their Connecting Communities Scheme, whereby volunteers visit residents at their homes on a weekly basis for a cup of tea and a friendly chat.
Mental Health in Men:
It’s estimated that 40% of older people (65+) have a mental health problem, rising to 50% in general hospital settings and 60% in care homes. Depression is the most common mental health problem in this age group, and it’s estimated to affect 22% of men over 6513.
Depression is known to be a powerful risk factor for developing malnutrition in community-dwelling older people14. It’s also a major cause of suicide in men, and over 1,000 men aged 50 and over commit suicide every year in England and Wales15.
Whilst mental health has become a hot topic in recent years, government policy has tended to overlook older people’s mental health. There are some good mental health support services available to older people, but men are less likely to use them16.
Organisations such as the Royal College of Psychiatrists are raising awareness of these inequalities, however it’s clear that specific services which are suited to older men are required. Encouragingly, the Mental Health Foundation launched their Grouchy Old Men service improvement project in 2010. It seeks to promote and support good mental health in men (50+) living in the community who are isolated and at risk of suicide and depression.
Nutrition Knowledge in Men:
On average, older men have poorer dietary intakes than women, and living alone further diminishes food consumption and diet quality17. A study of over 1,000 adults in England found that men also had poorer nutrition knowledge than women, and knowledge declined with lower educational level and socio-economic status18.
Interestingly, men with good cooking skills reported better physical health and higher intakes of vegetables in a small study of 39 older men17. Age UK sponsor and run regular cookery classes for men who want to improve their skills later in life. Kitchen Kings teaches men to prepare and cook wholesome food and they share a communal lunch at the end of each session. Age UK say that the most common motivation for participants is a desire to avoid dependence on ready meals. Similarly, Man with a Pan is a healthy eating cookery programme for men aged over 50 in Surrey, and to date, it has over 300 participants.
The good news is that a small preliminary evaluation study in Canada found that community cooking education programmes which are led by dietitians are an effective way of increasing cooking confidence, developing healthy eating habits and improving the variety of foods consumed amongst older men19.
Loneliness, mental health problems and poor nutritional knowledge are several factors which could affect dietary intake in older men. These topics should form an integral part of the nutrition and dietetic care process, and appropriate advice and signposting to relevant services (see below for useful resources) should be offered where indicated.
- Age UK leaflet on Ideas for older men on how to beat loneliness and isolation
- Age UK Kitchen Kings Cookery Classes for Men
- Age UK Man with a Pan Cookery School in Surrey
- Group activity for men: Men’s Shed Organisation
- Group activity: University of the Third Age (U3A)
- Age UK Befriending Service: Call in Time
- British Red Cross Connecting Communities Scheme
- Mental Health Foundation leaflet on promoting mental health in older men: Grouchy Old Men?
- BAPEN (2018). BAPEN Publishes Results of Biggest Malnutrition Survey Ever Undertaken (Wales). Available at: https://www.bapen.org.uk/media-centre/press-releases/378-bapen-publishes-results-of-biggest-malnutrition-survey-ever-undertaken-wales
- Hickson, M. (2006) Malnutrition and ageing. Postgraduate Medical Journal
- Argilés, J. M. (2005) Cancer-associated malnutrition. European Journal of Oncology Nursing.
- Mete, B. et al. (2018) Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity. International Journal of COPD.
- Saunders, J. et al. (2010) Malnutrition and nutrition support in patients with liver disease. Frontline Gastroenterology.
- Winter Falk, L. et al. (1996) Food Choice Processes of Older Adults: A Qualitative Investigation. Journal of Nutrition Education. [Online] 28257–265.
- Sahyoun, N. R. et al. (2005) Barriers to the consumption of fruits and vegetables among older adults.Journal of nutrition for the elderly. [Online] 24 (4), 5–21.
- Jo Cox Commission on Loneliness. A Call to Action. Available at: https://www.redcross.org.uk/-/media/documents/about-us/combatting-loneliness-one-conversation-at-a-time.pdf
- Ramic, E. et al. (2011) The effect of loneliness on malnutrition in elderly population. Medicinski arhiv.
- Payette, H. & Shatenstein, B. (2005) Determinants of Healthy Eating in Community-dwelling Elderly People. Canadian Journal of Public Health / Revue Canadienne de Sante’e Publique. [Online] 96S27–S31.
- Nicklett, E. J. & Kadell, A. R. (2013) Fruit and vegetable intake among older adults: A scoping review. Maturitas 75 (4) p.305–312.
- Age UK (2019). Older Men at the Margins. [Online]. Available at: https://www.ageuk.org.uk/discover/2019/april/older-men-at-the-margins/?utm_source=twitter&utm_medium=Social&utm_campaign=omam
- Royal College of Psychiatrists (2018). Suffering in silence: age inequality in older people’s mental health care. College Report CR211.
- Vafaei, Z. et al. (2013) Malnutrition is associated with depression in rural elderly population. Journal of Research in Medical Sciences.
- Mental Health Foundation (2010). Grouchy Old Men. [Leaflet]. Available at: https://www.mentalhealth.org.uk/publications/grouchy-old-men
- Mental Health Foundation. Men and Mental Health. [Online]. Available at: https://www.mentalhealth.org.uk/a-to-z/m/men-and-mental-health
- Hughes, G. et al. (2004) Old and alone: Barriers to healthy eating in older men living on their own. Appetite. [Online]
- Parmenter, K. et al. (2000) Demographic variation in nutrition knowledge in England. Health Education Research. [Online]
- Keller, H. H. et al. (2004) Men can cook! Development, implementation, and evaluation of a senior men’s cooking group. Journal of Nutrition for the Elderly.