India signs cooperation agreement with World Food Programme for 2023-27
There is an urgent need for cost-effective nutritional interventions with provisioning of regular health check-ups, health services and health aids, technological innovations including telemedicine, nutritional products for deficiencies on elderly people. Along with the need, the segment is facing the challenge of product development that includes acceptability of the product by the Indian elderly population.
As we all know, ageing is an inevitable, irreversible and progressive phenomenon. There’s no question about the fact that our bodies change as we age. As people age, there tends to be a parallel increase in the presence and number of chronic conditions such as hypertension, cardiovascular disease, osteoporosis, diabetes and dementias among others. These further compromise the quality of life in old age. Nutrition has emerged as a major modifiable determinant of chronic disease and age related decline. Most importantly, nutritional adjustments not only influence present health but also determine whether an individual will develop diseases like cancer, cardiovascular disease and diabetes later in life or not. Some of the common changes in the body when people get older/elderly (individuals of 60 years and above) are as follows:
Metabolic rate slows down:
This happens naturally, but it becomes more pronounced if people don’t get exposed to physical activity or some sort of exercise. When metabolism slows, the body doesn’t burn as many calories, which means people need to eat less to stay fit and healthy. As a result, the food that is consumed should be as nutrient-rich as possible.
Digestive system changes:
The body produces less fluid which is needed to process food in the digestive system. These changes can make it harder for the body to absorb vital nutrients like folic acid and vitamins B6 and B12.
Appetite may change:
Many elderly take one or more medications for health conditions; these can cause side effects such as lack of appetite or stomach upset, which can lead to poor nutrition.
Emotional health may be affected:
Elderly people who feel depressed or lonely often lose interest in eating. On the other hand, emotional issues may cause some people to eat more and gain unwanted pounds.
The nutritional needs are completely different for elderly people when compared to teenagers, children and even middle aged adults. Eating well is vital for everyone at all ages. Whatever is the age, the daily food choices can make an important difference in one’s health. When it comes to elderly nutrition, special attention is required as the body undergoes major changes. According to a report, jointly brought by United Nations Population Fund (UNFPA) and HelpAge International, India’s population is likely to increase by 60% between 2000 and 2050, but the number of elders, who have attained 60 years, will shoot up by 360% and the government should start framing policies as soon as possible, else its consequences are likely to take it by surprise. India has around 10 crore elderly at present and the number is expected to increase to 32.3 crore, constituting 20% of the total population, by 2050.
Longitudinal Aging Study in India (LASI) revealed that economic development and urbanisation have brought lifestyle changes that have led to unhealthy nutrition, physical inactivity, and obesity contributing to the prevalence of diabetes. Almost one-half (47%) of older Indians have at least one chronic disease such as asthma, angina, arthritis, depression, or diabetes. As such the population is emerging as a new and serious challenge for public health problem. It also increases the burden on the society and healthcare system. Rise in chronic diseases is encouraging people to go for preventive treatment and increasing shift towards preventive therapies.
Dr Saradha Ramadas, Professor, Department of Food Service Management & Dietetics, Avinashilingam University, Coimbatore, said, “National Programme for the Healthcare of the Elderly (NPHCE) envisages geriatric clinics (specialty that focuses on healthcare of elderly people) in Out Patient Department (OPD) and physiotherapy units in 640 district hospitals with more than 2,000 geriatric clinics in community and primary health centers.” Some of the leading companies like Abbott Nutrition, Nestle, Danone Nutricia, Glanbia Nutritionals and British Biologicals have range of nutrition products pertaining to elderly people.
Old age is a significant phase in a person’s life. Elders should not just ensure their ‘survival’ rather they must sustain their productivity and enjoy a reasonable standard of life. Good health is the pre-requisite of good ‘quality of life’ and nutrition is the key to good health. Ageing is associated with predictable changes in physiology and function, income, health and psychological well-being with the potential impact on diet and nutritional status of the elderly.
Role of nutrition in ageing
Nutrition is an important element of health in the elderly population and affects the aging process. Emphasising her thoughts on role of nutrition in elderly people, Ranjani Raman, Wellness & Nutrition Consultant, Founder, Nutrilife India, Bangalore, said, “Nutritional management is very different in the elderly when compared to adults. Considering the challenges such as restriction to eat certain foods due to certain disorders such as diabetes, kidney disorders, cancer, results in under nourishment or malnutrition in elderly people. There is great need to ensure that the basic nutrient requirement is met inspite of restrictions advised by the practitioner. Adequate protein supply is required and this has to be managed depending on the disease condition. Emphasis is laid on vitamins and minerals which usually are neglected resulting in anemia, arthritis, low blood pressure, blurred vision. Even intake of fluids has to be monitored in people with kidney disorders. With old age, the digestive system can weaken and certain people cannot eat all foods thereby resulting in deficiencies. Hence, the nutritional management in elderly is crucial and important.”
Talking about opportunity for nutritional segment for elderly people, Rohini Saran, Nutrition Consultant, Ministry of Women & Child Development, New Delhi, said, “As per census 2011, there are more than two crore elderly in India between the ages of 65-69 years. That brings a huge opportunity for the healthcare sector. There are a lifestyle related diseases that affect the elderly and hence nutritional food sector is one of the areas in which the market can gain advantage.”
Supporting Rohini Saran’s thoughts Ranjani Raman said, “Since all essential nutrients may not be available from all food sources, it becomes vital to provide the same through safe, medically approved products. India has a great opportunity to show growth in this particular segment by providing wide range of products in the market and one need to check if the products are genuine, safe and approved.”
“India, a country of unity in much diversity definitely provides the biggest opportunity to companies in both rural and urban settings to market nutritional products, meant for the elderly as they are either totally absent or rarely available at the counters. With increased awareness and health consciousness, the Indian market is flooded with nutritional products in recent years, but not very popular among its end-users. The supply of various nutritional products for healthy ageing is only regularised in urban segments, especially the metro cities. However, the market for rural elderly is still deficient and Indian manufactures are far behind in planning and designing of cost-effective nutritional products for healthy ageing. The growth will depend on successful ventures with adequate research and development inputs in coming years,” said Dr Surendra Kumar Mishra, Senior Advisor, MAMTA-Health Institute for Mother & Child, Bhubaneshwar.
Good nutrition is ageless. Quality of nutrition of elderly people is central to quality of their life. Expressing his views about nutritional products for elderly persons, Dr V D Sattigeri, Former Director, Central Food Lab, Central Food Technological Research Institute (CFTRI) said, “New research implies that potassium is important for regulating pH levels in body fluids, blood pressure, muscle and nerve cells osmotic pressure and water balance. Potassium may be included in diet products and meal replacement bars. Vitamin B12 and omega-3 fatty acids such as Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) are promising components against cognitive decline in elderly. Vitamin B12 deficiency is high among elderly often due to atrophic gastritis.”
“With growing life expectancy, disposable money, rising aspirations and penchant for better quality of living there is scope in major health categories such as cognition, Age Related Macular Degeneration (AMRD), Chronic Obstructive Pulmonary Disease (COPD), Cardio-Vascular, Type 2 Diabetes, Osteoporosis, Osteoarthritis, Urinary health, Digestive health, nerve disorders and immunity related. Hundreds of nutraceuticals entities and nutritional products have been pouring in from all over the world boosting up the growth rates beyond 20% in these chronic segments,” said Suhas Wadwalkar, Nutraceuticals Market Consultant, Mumbai.
Product development and innovation
Considering the opportunity of the elderly nutrition segment in India and importance of nutrition in elderly people, will the government and companies make effort in increasing the market of this segment by providing innovative products? That’s a serious aspect to look upon. Sharing her views on product development, Shikha Shukla, Regional Manager, MAMTA – Health Institute for Mother & Child, Bhubaneswar, said, “Effective health interventions meeting the needs of the elderly is lacking in India. It is only recently the needs and concerns of the elderly have been noticed with launch of National Programme of Health Care for the Elderly (NPHCE). Till date, the focus of research has been restricted to young mothers, children and adolescents; it is only now that a need for intervention for elderly have been recognised and emerged. There is an urgent need for cost effective nutritional interventions with provisioning of regular health checkups, health services and health aids, technological innovations including telemedicine, nutritional products for deficiencies on elderly people. Further, the challenge of product development includes acceptability of the product by the Indian elderly population. As there are diverse nutritional requirements, there is need to plan a complete health package including nutrition to meet the health needs of the elderly and with proper health insurance coverage.”
Sharing her views on product innovation, Rohini Saran suggested some of innovations that nutrition companies can come up with in elderly nutrition space:
- Low calorie nutrient dense drinks
- Fibre rich breakfast bars which are easy to chew
- Low fat and preservative free instant food
- Calcium rich food products – health drinks
- Since malabsorption is always a concern – nutrient rich supplements
- Powders that can be incorporated into regular food
- Nutrient low fat snacking options for the elderly
“Nutritional products may be a convenient, tasteful and good idea to fulfill requirements of nutrients in body. Nutritional products for elderly people may be helpful in decreasing health complications and improving quality of life. According to Frost & Sullivan, the total Indian nutraceutical segment market in 2015 is expected to be $5 billion. It is very difficult to predict market size of nutritional products for elderly people in India as this category is in nascent phase with only few companies. There is lack of awareness about elderly nutritional products in both medical fraternity and consumers. Hence companies face challenge to invest in research and development of elderly nutritional products. Even after development of nutritional products, there is good investment in marketing for creating awareness,” said Himanshu Rai, Head-Nutrition, D2C Products and Services.
Kishore Shintre, Founder & Principal Consultant, NutreShin Solutions, said, “Elderly population is growing in percentage all over the world and of late it is becoming a sizeable proportion, so with their specific needs, markets have been taking serious look at the possibility of Geriatric Foods. The only difference will be as opposed to developed countries, 80% of Indian elders live in villages, and almost 75% of them are illiterate and economically dependent. With such situation nutrition becomes very important to prevent diet-related complications of diseases in the old.” Further he said, “The market growth of nutritional products for ageing population is estimated at 10 to 12% and the market size in 2014 was about Rs 2,400 crore. This includes, antioxidant micronutrients like beta-carotene, Vitamin C, E and B2 and zinc and selenium which also protect skin cells. Calcium, Vitamin D and Vitamin K for bone health as well as folic acid, Vitamin B12, B6 and B2 and Omega 3 and 6 fatty acids to counter risk of cardiovascular diseases.”
“Zydus Cadila Healthcare launched Nutriva, a new company marketing nutraceuticals and nutritional products which has couple of nutritional products for elderly. However, with the drug pipeline drying up, increasing price controls on pharmaceuticals is leading to sluggish growth and poorer margins. Because of growing demand in categories related to geriatrics there is significant focus to cater to the unmet needs of this sizable population which is expected to be around 30 crore by 2020,” said Suhas Wadwalkar. About 15 companies offer 50 brands of nutrition products for elderly in India.
“The growth in the ageing population is likely to affect the market in number of ways. First, companies will have to understand consumption needs of elderly and how the elderly market responds to various marketing activities of the firm. Companies have already begun to respond to needs of the aged population by developing new products or modifying existing ones. The increasing number of elderly population puts more economic power in the hands of consumers, who are likely to demand products and services suitable to their needs and lifestyles,” said Dr Saradha Ramadas.
Shikha Shukla on innovative products said, “There are some nutritional products that contain Essential Amino Acids (EAA) mixture and enhance muscle strength amongst elderly. In addition, nutrition innovations have been designed with tube feedings for the elderly, who are unable to take food. Specialised enteral tube mixtures have been developed that are healthy and easy to absorb and digest.” Dr Surendra Kumar Mishra pointed out that nowadays, nutritional products are developed to addresses disease symptoms, reduce risk of complications and even control the progression of diseases and disorders.
Though there has been a growth in the market size of nutrition segment in India it requires widening of the horizon by including innovative products for elderly. There is lack of data on needs and requirement of Indian elderly population that makes it essential to understand the ground reality through population-based surveys while designing nutritional products. Considering India’s shooting elderly population in the present and coming years, there is a huge demand for nutritional products for elderly in rural and urban areas, provided initiatives are taken by the companies to come up with innovative products by understanding the needs and requirements of Indian elderly population and government supporting them in research challenges and facilities.
Cost-effective nutritional products, without compromising the quality, are the need of the hour, especially for elderly in rural areas. Combined efforts from the government, researchers and corporate may boost the market of nutritional products for elderly in India.