A person is considered frail if he or she has three or more of the following “S”:

• Shrinkage (weight loss)
• Strength loss (weakness)
• Slowness
• Sedentariness (inactive)
• Sleepiness (exhaustion)

1. Avoid common diet misconceptions

 Myth 1: Beans and legumes should be avoided

Seniors often think beans and legumes give them problems from bloating to joint pain.

“Actually, studies have shown that beans are associated with longevity, maintenance of physical and cognitive function, and reduced rates of death from all causes,” shared Dr Ng.

“The trick is to start eating them in small amounts so that your intestinal bacteria and body can get used to your introducing such healthy food into your system.

There are many good local examples of beans and legumes that you can easily incorporate into your daily diet including:

• Lentils (dhal),
• Red and green beans,
• Split peas,
• Soy products such as tofu and tempeh and bean curd skin,
• French beans,
• Long beans

 Myth 2: As you age, you should eat less meat and protein

Some seniors think that consuming 1 egg per day (which contains about 6g of protein) is enough protein.

“In fact, older adults should aim for 20g to 25g or even 30g of protein per meal. This equates to about a palm-sized piece of meat or fish or ¾ cup of beans or lentils,” advised Dr Ng.

“We lose muscle as we grow older, so we need to continually replace the muscle we lose through taking in adequate ingredients that build muscles, the main one being protein, as well as vItamin D and other micronutrients, and doing resistance exercises,” she added.

Thus, it is recommended that older adults should eat more protein than younger adults – about 1.2g of protein per kg of your weight, which works out to about 65g to 75g per day. That divides to roughly about 20g to 25g of protein per meal.

So, eat 3 balanced main meals and make up for any inadequate amount of protein in the 3 meals by adding in high protein snacks between the meals.

Easy ways to increase protein consumption

When eating at home

o   To complement main meals, consider adding a palm-sized piece of low-fat meat like chicken, or fish or tofu or tau kwa or ¾ cup of beans or lentils.

o   When hungry in between meals, consider high-protein snacks such as a handful of mixed nuts or a bowl of red or green bean soup, barley or peanut soup.

o   Drinking low-fat cow or soya milk fortified with calcium and protein are also good items for a mid-morning or mid-afternoon boost.

When eating out

o  When having a plate of nasi lemak, instead of having just ikan bilis and sambal, add a handful of roast peanuts and an egg, or a piece of chicken.

o  Consider choosing hawker food with more protein content such as yong tau foo.

o  Add a piece of tau kwa and egg to plain fried bee hoon.

o  Adding a glass of soya milk to accompany the meal will also increase the protein content.

2. Do the right exercises regularly

Studies have shown that cognitive decline can not only be prevented but even reversed with adequate aerobic and high intensity resistance exercises.

“According to some studies, resistance exercises have been shown to be even more effective than cognitive therapy and brain supplements to treat mild cognitive decline. So, I would suggest start exercising and to do it regularly!” Dr Ng said.

“For those new to exercise, start low and go slow. Start by brisk walking, slowly increasing in duration and frequency till you achieve at least 150 minutes a week (approximately 30mins for 5 days a week) to build up your fitness and stamina. Thereafter please add on resistance exercises of adequate progressive loading, for at least 2 sessions a week,” she advised.

Conquer the fear of falling

A common reason for seniors avoiding exercise is a fear of falling due to already weak muscles. However, this fear leads to a downward spiral – once a person stops exercising, he/she loses more muscle mass, resulting in him/her becoming even weaker and more prone to falls.

On this Dr Ng says, “The trick is to have a regular multi-component exercise regime that comprises:

a) Aerobic exercise: To improve cardiovascular fitness and physical stamina

b) Resistance exercises: Use your own body weight, exercise bands, free weights or the machines at a gym to subject your major muscle groups to adequate progressive loading to grow muscle and harden bone.  

c) Flexibility exercises: To keep our joints nimble for daily tasks such as putting on clothes and getting in and out of a vehicle, and the body more ready to respond to any need for position adjustment.

d) Balance exercises: To train our sense of balance (such as training ourselves to stand on one foot for 30 seconds daily)

“Taichi, which consists of many moves involving shifting of body weight as we stand on one foot, and squatting position (which strengthens thigh muscles), has been shown to improve balance and reduce the number of falls in older adults.

So, a weekly class with perhaps another 1 to 2 sessions of practice along the week at home will be beneficial!” Dr Ng added.

3. Stay connected and have hobbies/interests

Continue to keep up social relationships with your friends and family. Also, try joining the activities at the nearby community club or active ageing centres.

Keep up with what you enjoy doing, be it cooking meals, gardening, singing in a choir, playing board games, playing mahjong, rummy O etc, – they’re all good for keeping your mind active!

4. Get sufficient sleep

Lastly, do have adequate sleep of 7 to 9 hours daily of quality sleep.

If you have problem falling asleep, try to:

1. Avoid caffeine drinks from lunchtime or 3 p.m.
   
   
2. Maintain the same sleep and wake time throughout the week. Plan Satrurday morning activities rather thasn sleep in!
   
   
3. have a pre bedtimne routine to wind down, e.g. readingor listeing to calming music in the hour before you sleep.
   
   
4. Reduce exposure to bright overhead lights after dinner and importantly, avoid blue light (either from the phone or tablet or television screen) 30 to 60 minutes before your bedtime.
   
   So try to stop checking phone messages, or watching YouTube/Tiktok videos or television movies late into the night!

To help yourself sleep through the night, hydrate yourself well in the daytime hours but reduce fluid intake from dinner time. If you should wake up for toilet brakes, try not to switch on bright lights which may reduce your body’s melatonin production and keep you awake.

If you tend to have an active mind keeping you awake, try journaling your thoughts. Write down the lists of things you wish to do the next day rather than have them create anxiety in your mind.

Ensure that the bedroom temperature is cool. Use ear plugs or a fan to create both a cool environment and a noise barrier.

Practise slow abdominal breathing to help your body relax when you are in bed.

Dr Ng, if you had to sum up your advice for seniors, what would it be? 

For seniors who have not started to exercise: 
I urge, “Please increase your physical activities along the day. “Break up” your relationship with your chair! Get up to drink water, check out the noise in the distance, stand up when you answer phone messages, etc.

Thereafter add in 10 minutes of exercises say before each meal (try these 7 Easy Exercises). Every little bit you do will help! And the more you do, the healthier and stronger you will be!

For those who do light exercises regularly such as stretching: 
I suggest that they add in brisk walking or marching on the spot.

For those already walking regularly: 
I suggest to add in strength training at least 2 times a week. 

More nuggets of health advice:

• “Keep on going!” – Make exercise a regular habit because when you stop you may  lose all the muscles you gained!
  
  
• Drink 2 glasses of fortified soya milk a day, for the protein and calcium!
  
  
• “Eat intentionally, don’t anyhow eat!” – Even when you are eating alone, or if there are only 2 of you at home, ensure that you are taking adequate proteins, vitamins and minerals to keep your bones and muscles strong!

Success story 1
A classmate decided to join a gym after she was diagnosed of osteoporosis, to strengthen her muscle and bone. After 3 months of regular exercise, she said: “I have regained my strength of 10 years ago!”
 

Success story 2
A relative was slowing down, getting forgetful and also having problem controlling his high blood pressure. After 6 months of regular brisk walking and strengthening exercises, he was assessed to have increased in his muscle strength, he had lost tummy fat and visibly gained more muscles on his arms and legs and his blood pressure was no longer a health concern!
 

Success story 3
A patient had high cholesterol and prediabetes. After 1 year of a predominat whole food plant based diet and regular exercise, his cholesterol and sugar levels normalised.

Ref: G25

Related articles:
Exercise First, Eat After: Why It's Better and Why Consuming Protein Matters

Health Screening By Age: What to Expect and Why It Is Important