An ecosystem approach to address 'food & nutrition' challenges in ageing and longevity

A new initiative driven by The Aging2.0 Collective around Food & Nutrition. As the impact of the social determinants of health becomes more recognised, we’re seeing a greater role for food and nutrition in maintaining good health in older age as well as in illness prevention and recovery. We’re also seeing a number of startups and innovative programs address this. Food & Nutrition is one of the new 'Topic Teams' being created in The Collective, and we’re now looking to map the key issues (the 'How Might We's below) and existing organisations on the ‘demand’ and ‘supply’ side of the topic to join us. The Topic Team will articulate a clear mission for this work (this post being part of that process), map promising innovators around the world, develop measures and metrics around best practices and then build new market-facing collaborative approaches to address this important societal topic. We're now in the first phase of that work - looking to develop a common mission - and are keen to showcase ongoing initiatives as well as develop new insights and connections.

Pervasive malnutrition in an out of care settings. The American Geriatrics Society’s Health in Aging site suggests that up to 60% of older people in hospitals become malnourished, and rising to up to 85% of those in long-term care facilities. The situation is similarly shocking in Europe. A recent white paper by the Global Coalition on Aging and Danone’s Nutricia brand refers to the fact that 33 million adults are either malnourished or at risk of malnutrition across the continent, and one in four patients admitted to hospitals is malnourished. There is less data available for those living in their own homes, but it is clear that incidence of malnutrition correlates to those living alone and feeling isolated. 

Exacerbated by post-codes and pandemics. Where you live affects how long you live. The difference of a few train stops in Chicago accounts for a 14-year difference in life expectancy, with affordable and available fresh food being a major factor in health outcomes. 23.5m Americans live more than a mile away from a food store, and these food deserts will be more extreme when people have to shelter in place and / or aspects of the food supply chain become stressed during a pandemic.

Specific changes throughout the life course. The ageing process impacts food and nutrition in a variety of ways.  It is well known that metabolism slows down with age, related to lower muscle mass and less exercise. However, less appreciated is the fact that older adults need 25-50% higher levels of protein, which means up to 100g of protein per day for a 180 pound man. A cursory glance at most hospital and nursing home menus will be enough to see why many are malnourished while in medical care. 

Dental problems in older adults are significant if under appreciated. According to West Health, 19% of older Americans have untreated tooth decay and 60% have gum disease, and nearly 20% have lost all their teeth. This is in part driven by the fact that over 500 commonly dispensed medications cause dry mouth, a factor in tooth decay. Other common issues include: swallowing difficulties, dehydration (often due to UTIs) a lack of dexterity, making using utensils or cooking equipment harder, impaired senses (in particular taste, smell, and vision), and increasing difficulty in absorbing nutrients. The impact of the gut microbiome on overall health is becoming increasingly recognised and new research has drawn important connections to ageing in general and brain function in particular. Outside the body, mobility or transportation difficulties can make going to the shops and food shopping a challenge. 

Implications of poor nutrition: poor health and higher costs. The connection between malnutrition and health is clear. As the Mayo Clinic points out, malnutrition triggers a variety of health issues, including: a weakened immune system, slower wound healing, muscle weakness, decreased bone mass (and greater risk of falls and fractures), and overall higher risk of hospitalisation and death. Moreover, our health systems are paying significantly more because of it. The GCOA-Nutricia white paper mentioned above suggests that those in hospital who are malnourished end up staying 75% longer, contributing to the €170bn annual cost of the condition. West Health estimates that the economic burden of disease-related malnutrition in the US in 2011 was $55bn. Beyond short term financial costs, the toll on society is increasingly heavy. For example, the link between poor nutrition and disease immunity is clear, likely contributing to emerging statistics showing the doubling of the Covid19 death rate in the poorest areas. In an increasingly polarised and unequal society, this brings with it potential for wider social and political unrest.

Harnessing the opportunity - prioritising food as a building block for healthy ageing. Food and nutrition is an enormously important macro topic. Globally around 800m people lack sufficient nutrients yet a third of the world is obese, suggesting an industry in need of major innovation. The industry itself is worth approximately $8tn, accounts for around 1.5bn jobs and around 10% of GDP, according to The Economist. As that article points out, the food supply chain has passed a severe test during Covid19, but the industry will need to deliver an additional 50% of output by 2030, amidst increasingly uncertain geopolitical situation, growing monopoly power and climate change. 

There will be growing pressure on the food system and food companies to deliver game changing innovations, such as personalised meals, DNA and microbiome trackers, social eating services, hydration innovations, alternative proteins and many more. Yet so far innovation has been modest; according to the World Economic Forum, only around $14 billion was invested in 1,000 food-focused startups between 2010 and 2018, compared to over ten times that amount in approximately 18,000 healthcare-focused startups over the same period. 

Amidst all this noise and pressure to act, it is in the interests of those in the Collective to ensure that food innovators focus on the needs of older adults. We need to build common objectives across the diverse stakeholder base, identify best practices and innovators to showcase, agree on metrics of impact and build collaboratives to deliver. This is what we're doing with our new Food & Nutrition Topic Team, and we're now inviting collaborators. The stakeholders that we bring together will form a collaborative, together with our 120+ global Ambassadors and 20+ expert Super Connectors to jointly determine the innovation agenda and priorities. Below is a (too) long list of potential questions based on our initial research, and a few examples of innovators we’ve seen so far. The research questions and focus areas will be determined by Topic Team members in the coming weeks.

A selection of “How Might We?” questions to explore in the Topic Team: 

• How might we deliver personalised diet plans that reflect the needs of the individual’s preferences, behaviours, DNA and microbiome? (E.g. JoinZoe, Foodvisor, PlateJoy, Surely, Lighter, DayTwo, Viome, Vitagene, Surely, Betr Health, Zipongo)
• How might we make food easier to consume for those having trouble eating? (E.g. shaped, blended, 3D printed foods with personalised nutrition, (UK startup hydration) to target dehydration and dysphagia)
• How might we stimulate hunger in those who may need extra help? (E.g. using smell of food for those with dementia)
• What alternative sources of protein could be appealing, affordable and accessible for older adults who don't get enough? (e.g. alternative protein market map).
• How might we determine which supplements should be more widespread? (E.g. spermidine, collagen, NAD etc)
• How might we integrate new socialisation models to make food a shared experience when relevant? (E.g. Casserole Club, GoodGym, Community kitchens, Kalimera)
• How might we build a system- and city-wide model with a joined up approach? (E.g. BlueZones, Way to Wellville, Purpose Built Communities)
• How will this pandemic (and future climate disruption) impact our societies, food chains, eating habits and types of food we have access to? (E.g. this article)
• How might we decide on relevant malnutrition guidelines and standards?  (E.g. Malnutrition Task Force)
• How might we make good food more affordable and accessible? (E.g. reducing food deserts, home meals)
• How might we change the narrative around food and health? (E.g. sports people actors e.g. Lewis Hamilton, Novak Djokovic)
• How might we improve training in medical schools around food?
• How might we build new models towards driving healthy behaviours? (E.g triggers, nudges, enjoy “taking” eating medicine)
• How might we integrate our local communities and the environment? (E.g. home-grown produce, gardens, allotments, biophilic cities, vertical farming)
• How might we scale up and standardise ‘social prescribing’ and food as one of the ‘social determinants of health’ (E.g. Elemental, UniteUs, NowPow, Healthify)
• How might we improve operations and reduce the approximately 30% of food that is wasted? (E.g. Kafoodle, Fair Share - collect food from supermarkets)
• How might we improve the quality of food across different care settings? (E.g. Sustain’s Better Hospital Food)
• How might we make it easier for older people to order food and have personalised, nutritious, affordable meals delivered if they don’t want / can’t leave home? (e.g. Uber Eats, Deliveroo, Meals on Wheels)
• How might we improve the quality and reliability of food made by in-home caregivers and food preparation? (e.g. Birdie, Vida, Cera)
• How might we make it easier for people to prepare their own food, safety? (E.g. EatWell Meal Kits, Fresh Direct)
• How might we ensure that people can maintain their food preferences choices as they move into different homes and care settings?

We're also developing a list of potential 'Topic Champions' to sponsor this work, including:

• Retail: Tesco, Lidl, 711, Sainsbury's, Waitrose, Whole Foods, Krogers, Walmart, Walgreens Boots, Carrefour, CVS.
• Manufacturers: General Mills, Nestle, CP, Pepsico, Danone / Danone Ventures, Unilever, Tyson Foods, Heinz, Kellogg’s, Anheuser-Busch, JBS, ADM, Mars, Cargill, Coca Cola, Heinz, Asahi, Diageo. Kirin, Yili, NH.
• Service providers & delivery: Sodexo, Comfort Keepers, Meals on Wheels, Uber Eats, Deliveroo, Compass, McDonalds, Starbucks, Yum! Brands.
• Health & insurance: Humana, L&G, BCBS, SOMPO, Aetna, Genworth, AIG, Allianz, AXA, ING, Ping An.

This is an ambitious undertaking, but just one of many parallel Topics we'll be launching in the coming weeks (e.g. we'll be sharing more information about the 'Crossing the Digital Divide' Topic Team, sponsored by Nomura Research Institute shortly). This is only possible due to our new digital collaboration platform (built together with our partners Shapeable.ai) combined with our 120 city Chapter network and corporate partners. Next steps will be determined by our members' priorities, and we'll be sharing some of the future learnings here in the months ahead. (I'll also likely update this post in the days ahead, to share any particularly useful edits).

Thanks to Nicholas Bernhardt-Lanier for his input and research on this Topic. For more information, to share your project or to get involved, connect with me here or email [email protected].