Nutrition of Older People in Emergencies

1. Nutrition of Older People in Emergencies Mary Manandhar Carmel Dolan Paul Rees-Thomas Pascale Fritsch

2. Background • Ageing world: today, more people aged 60 and above than children under 4 • Lack of awareness and knowledge within the humanitarian sector, including donors and governments, about the demographics of ageing, active roles of older people, the complexity of their vulnerability to undernutrition in emergencies, and their rights. • Inadequate skills to deal with undernutrition in this population group within humanitarian agencies, national government systems and at operational level in emergencies. • Persisting ageism and age discrimination within the humanitarian system, and breaches of the UN Principle of Impartiality. • Underfunding of programmes tackling undernutrition in older people in emergencies. • Address gaps and inconsistencies in existing policies and guidelines on nutrition, ageing and emergencies

3. Nutrition of Older People in Emergencies • Part 1: Fact sheet overview of the nutrition of older people in emergencies • Part 2: Technical notes technical details, challenging areas and clear guidance on accepted current practices • Part 3: Trainer’s Guide guidance on how to design a training course by giving tips and examples of tools that a trainer can use and adapt to meet training needs • Part 4: Training Resource List comprehensive list of reference material relevant to this module including guidelines, training courses and reference manuals

4. Part 1: Fact sheet • Who are “older people”? • Our ageing world • Commitments and policies addressing ageing • Underfunding for older people in the humanitarian response • Rights of a ‘vulnerable’ but missing group • Ageing and nutrition • Nutritional requirements • Risk factors for undernutrition • Undernutrition in older people • Assessing nutritional vulnerability • Clinical and medical concerns • Anthropometry • Undernutrition and functional outcomes • Interventions for older people in emergencies • Preventing undernutrition through food • Non-food interventions to prevent undernutrition • Treating undernutrition • Integration • Monitoring and evaluation • Participation, voice and inclusion • Key messages

5. Part 2: Technical notes • Older people in a changing and challenging world • Vulnerability and rights • Undernutrition in older people • Assessment of nutritional status and vulnerability of older people • Interventions and responses to address undernutrition in older people • Monitoring and evaluation • Existing challenges and areas for research

6. Challenges and areas for research • Advocacy, awareness and capacity • Lack of awareness and knowledge within the humanitarian sector, • Inadequate expertise to deal with older people’s undernutrition • Persisting ageism and age discrimination within the humanitarian system, and breaches of the UN Principle of Impartiality. • Underfunding • The child-focused nutritional conceptual framework and focus on children under five, recently re-invigorated with prioritisation of the ‘1000 days’ period, should not prevent inclusion of older people in nutrition policies and programmes. • Organisational policy development and guidance

7. Challenges and areas for research • Assessment • Continued preference for, and use of BMI • Research is needed on the relationship between various MUAC cut-offs and functional outcomes of importance to older people, such as muscle strength, mobility and ADLs. • Research to agree on the best assessment methodologies for all aspects of nutritional vulnerability of older people in emergencies.

8. Challenges and areas for research • Interventions • Adaptation of RUF for the treatment of acute malnutrition in older adults • How to improve techniques and standardisation for non-food interventions? (eg Cash transfers) • How to link nutrition interventions for older people with interventions for other population groups, and with other sectors? • Limited evidence for what works in the treatment of acute malnutrition in older people. • Participation • Strengthen use of participatory methods with older people on all aspects of planning, assessment, intervention and monitoring programmes aimed at preventing and treating undernutrition in older people in emergencies.

9. Questions • Why are the nutrition needs of older people not very often addressed in emergencies? • What do NCC or implementing partners need to be active in addressing the nutrition needs of older people?

10. Way Forward • What can we do with this module? • Identify areas of research • Use it as an advocacy tool • Include in NiE training modules • How can the GNC support the dissemination of the content? • With the NCCs • Should we have an “age-marker” in project proposals, like the gender marker?