Fighting isolation,poverty, neglect

Wellnessof

Elderly

Manuscript Prepared by VLCC Health Care Ltd.

“They have nurtured us throughout our life, now it is our time to lend a hand. This is the circle of love and compassion.”

Respected Senior Citizens & dear friends,

I have always dreamt of a healthy and fit India and strive everyday to contribute in little ways to sustain this vision. My company, VLCC is a manifestation of this dream and continues this quest to make health and fitness accessible to all segments of society.

I am elated and heartened to launch this book in partnership with Help Age India. The book, 'Healthy Ageing' aims to provide quick and relevant information for dietary and health related concerns.

I believe elderly people are the pillars of society. They have made us who we are and now it is our responsibility to help them live with dignity and comfort by providing support systems that can help them live a healthy and independent life.

I admire the wonderful initiatives that have been taken by Help Age India to help the elderly live with due respect and pride. They have undertaken a noble cause which calls for enormous effort by all.

As they age, seniors face the possibility of rising healthcare concerns. This underscores the need for them to pay heed to the increased demands of the body and consciously sustain a healthy lifestyle. I hope this book can become an able guide for the elderly to stay healthy and happy. I wish them wonderful and fruitful years ahead and advice them share this book with their friends and loved ones.

Best Wishes & Warm Regards

Vandana LuthraFounder & MentorVLCC

Wellness of Elderly

1

2

Dear Reader,

I am happy that VLCC Health Care Ltd. made a sincere attempt to publish a booklet on

Wellness of Elderly, which includes scientific aspects of health and nutrition in old age.

The booklet is succinct, comprehensive and easy to understand for the lay readers. It

carries the message of healthy ageing and emphasises the importance of healthy life

style.

We all know that prevention is better than cure and for healthy ageing; following a healthy

life style from childhood is of crucial significance. We all know it, but not many of us

practice it!

We at HelpAge India believe that we should not add years to life but add life to years. The

best way to ensure this is to eat healthy, remain active and continue to be productive.

With best wishes for healthy ageing,

Mathew Cherian

Chief Executive

HelpAge India

Wellness of Elderly

3

WELLNESS OF THE ELDERLY

CALM, COMPOSED, POISED, MATURE, GIVING, LOVING, FORGIVING,

PATIENT…STREAKS OF GREY, SPECTACLES ON DEEP, SERENE AND SOOTHING

EYES, EVER SMILING COUNTENANCE, EVERYONE’S SHOULDER …

YES THESE ARE THE ELDERLY

The Sun Setting is no less beautiful than the Sun Rising

Your Journey through the years has been full of responsibilities. Now it is your time to

relax and think about yourself. A little care and caution can be of help and enable you to

stay fitter, feel better and live healthy. Answers to the right nutrition and lifestyle patterns

relevant to this age can provide the necessary support system, and it is with this

objective, that this effort has been initiated.

Wellness of Elderly

4

INTRODUCTION

The elderly above the age of 60 are an asset to our society. They are matured people with experience and wisdom acquired over the span of many years.

However during the ageing process, many physiological and biological changes do occur, resulting in functional decline. A proper support system to take care of their wellness can be the backbone to take care of them in their twilight years.

SUCCESSFUL AGEING is an integration of the following three. It provides meaning and zest to life at this vulnerable age.

AVOIDING DISEASE

&DISABILITY

MAINTAININGHIGH COGNITIVE

& PHYSICALFUNCTIONING

ENGAGEMENTWITHLIFE

Wellness of Elderly

5

WELLNESS THE REGIME TO HEALTHY LIVING

Diet, lifestyle, exercise and positive mental attitude play a significant role in determining our state of health. Our aim should be not only to increase our life expectancy but to improve the quality of life.

Food should no longer to be regarded simply as fuel that enables us to survive. On the contrary, it is a major factor that influences the quality of life. The older we become, the more important it is to take interest in what we eat. Nutritious food gives protection from wear and tear of ageing and supplies energy to lead a healthy life while keeping tiredness at bay.

As age advances, a sedentary lifestyle and the loss of Lean Body Mass slows the metabolic rate. Consequently, the body needs fewer calories but more vitamins and minerals as their absorption gets reduced.

A wise selection of foods should be made on the basis of Nutritive requirements of the elderly. Though any specific work is not done for this age group, yet young adult requirements become a partial guideline and adjustments are made in the Recommended Dietary Allowances (RDA).

EnergyEnergy is required to carry out the daily routine of activities and involuntary bodily functions like digestion, circulation, respiration, excretion etc. As explained earlier the energy requirement is reduced. The Indian Council of Medical Research (ICMR) has laid down guidelines as follows:

Energy requirements: Energy requirements of Elderly Males and Females with different Body Weights (Kcal /24 hour)

Equation for predicting BMR (kcal / 24hr) for Males > 60 yrs (Proposed by ICMR Expert Group for Indians)

BMR = 12.8 * Body Weight (kg) + 463

Energy Requirement for Sedentary lifestyle = BMR + 30% of BMR

Energy Requirement for Moderate lifestyle = BMR + 40 % of BMR

Hence, according to your Body Weight, the BMR (Basal Metabolic Rate) and the energy requirements per day can be specifically calculated.

Requirement of Protein:Proteins catalyze biochemical reactions and are vital to metabolism. 50-60 gm of proteins amount to 10-12% of the total caloric intake for the day

Proteins selected should be of good biological value and easy in digestion.

Requirement of Carbohydrates:Carbohydrates help in providing energy for daily needs. Elderly people tend to consume more carbohydrate rich food as it requires minimum chewing, is easily digestible, needs minimum cooking and is also cheaper than protein rich food.

At least 50 % of the total calories should be derived from carbohydrates.

Requirement of Fats and Oils:Fats and Oils are the concentrated source of energy. They make food palatable and help in the absorption of fat soluble vitamins like A, D, E and K. Fat intake remains the same as that of young adults.

Wellness of Elderly

6

Requirement of Fibre: Dietary fiber consists of soluble and insoluble fiber.

Whereas insoluble fiber contributes to the bulk of stool and helps to relieve constipation, soluble fiber lowers blood cholesterol level especially among elderly people.

Requirement of Minerals:CalciumA slightly higher amount of calcium is required by the elderly as compared to adults i.e. 0.8 to 1.0 g/day to keep them healthy and also to compensate for lower absorption. It's deficiency can result in Osteoporosis and sudden fractures.

IronIron is essential for the formation of haemoglobin. It is necessary to have 20-30 mg of iron per day.

Vitamins:Vitamins though required in very small quantities are still very essential to maintain good health. Research indicates that ageing process can be delayed by sufficient intake of antioxidant vitamins such as A,E,C and beta carotene.

They also prevent degeneration of blood vessels and thus help in the upkeep of a healthy body.

Different Vitamins and their roleVitamins A is for eye vision, B for digestion, C for gums and healing, D for muscles & bones, E for nerves

Different Minerals and their roleCalcium is for bones, Iron for blood, Sodium & Potassium for electrolyte balance, Magnesium for muscles and nerves, Zinc for mental agility.

To summarize, each micronutrient is essential to meet specific functions in the body and sufficient care must be taken for planning the intake of food sources providing them.

Excessive amounts of macronutrients can lead to obesity and inadequate consumption can lead to undernourished status accompanied with various health problems. Thus, the knowledge of the requirements of nutrients during various stages of life is a boon to healthy living.

HEALTHY EATING GUIDELINES1. Choose foods that are healthy and delicious from all the food groups to ensure consumption of

the widest range of nutrients.

Major food sources of Nutrients

NUTRIENTS FOODS

Energy Cereals, pulses, roots and tubers, fats and oils, sugar and jaggery

Protein Milk, egg, fish, meat, liver, pulses, nuts and oilseeds

Wellness of Elderly

7

Fat Butter, ghee, vegetable oils, hydrogenated fats, nuts and oilseeds

Carbohydrates Cereals, pulses, sugar and jaggery, roots and tubers

Fibre Green leafy vegetables, fruits, unrefined cereals, pulses and legumes

Calcium Milk and milk products, ragi and green leafy vegetables

Iron Liver, green leafy vegetables, rice flakes, whole wheat flour, ragi and pulses

Vitamin A Fish liver oil ,butter, ghee, milk, carrots and green leafy vegetables

(Retinol and beta vegetables, papaya and mango carotene)

B Complex Milk, egg and liver, handpounded rice, whole wheat, whole grams, pulses, green leafy vegetables, nuts and oilseeds

Vitamin C Amla (Indian gooseberry), lime, orange, guava, tomato, lettuce and sprouted grams

Vitamin D Milk

Other Source : Sunlight

2. Eat complex and unrefined carbohydrates such as whole grains, whole wheat bread, brown rice, beans and pulses which are high in dietary fibre and nutrient contents than refined grain. The phytate in wheat bran hinders the absorption of minerals such as Ca, Fe, zinc and copper. Avoid sprinkling raw bran over the food. Instead, buy good quality high fibre cereals.

3. Eat at least five servings of fresh fruits and vegetables each day as these are rich in dietary fibre, vitamins, and minerals. Select more of deeply colored green, orange or yellow vegetables. Avoid overcooking vegetables to minimize nutrient loss. Yellow, orange or red fruits are preferable and whole fruits are preferable over juice.

4. Protein intake should be moderate. Lean meat, skinless poultry, fish or dried beans are lower in saturated fat and are healthier choices.

5. Eat foods rich in essential fatty acids such as oily fish ( mackeral, sardine, salmon), pumpkin, sesame and cold pressed oils such as flaxseed oil

6. An adequate intake of calcium should be ensured by consuming dairy products, canned fish, pulses, sesame seeds and green leafy vegetables.

7. Avoid eating high-fat foods, which may lead to ingestion of excessive calories and cause weight gain. Foods rich in fats, especially saturated fats such as butter and cream should be avoided and instead a variety of vegetable oils should be used to prevent and control HTN and other cardiovascular diseases. Best combinations of oil for consumption are: Groundnut/ Sesame + Mustard/ Canola/ Soybean, Safflower/ Sunflower + Palmolein /Olive + Mustard

8. Intake of simple sugars should be reduced as these provide empty calories. 9. It is vital to drink enough fluids with age. You need to have at least 8 glasses of water. Fruit and

vegetable juices, water, herbal tea all count. Have your last drink 2-3 hrs before bedtime to avoid getting up at night to go to the bathroom. Avoid too much coffee, strong tea and alcohol as these may cause dehydration. Avoid drinking tea with meal as it inhibits iron absorption. Fruit juices including prune juice, which helps to keep bowel movements regular and milky drinks to provide calcium.

10. Minimize salt intake 11. Use low-fat cooking methods such as steaming, blanching, braising, baking, micro-waving, or

use a non-stick cooking pan to avoid excessive intake of calories to help prevent obesity.

Wellness of Elderly

8

12. The diet should be soft, well cooked and should include foods that that can be easily digested and assimilated by the body and need little or no mastication such as khichri, dals, daliya, soups, idli, upma, poha, milk and milk products, soft cooked vegetables, stewed fruit or soft fruits.

The above written nutritional facts are general guidelines to fulfill the normal health requirements of the elderly. The specific additional/ modified food patterns are always worked according to altered body conditions. All such conditions or any therapeutic conditions need to be specifically dealt in detail to the benefit of the reader

Balanced diet for an elderly person

Counting the calories and macronutrients in gms may look like an academic exercise but it is important to take all nutrients in adequate quantities as this helps in attaining a healthy body and mind.

Sources Quantity ( raw ) gmsMales Females

Cereals 350 225Pulses 50 40Vegetables 200 50Green Leafy Vegetables 50 50Roots and Tubers 100 100Fruits 200 200Milk and Milk Products 300 300Sugar 20 20Fats and Oils 25 20

Approximate Nutrients Supplied

Calories 2200 kcal 1700 kcalProtein 65 gm 50 gmFat 50 gm 40 gmCalcium 1 gm 0.9 gmIron 38 mg 30 mgVitamin A (Retinol) 1030 mcg 930 mcgThiamin 1.96 mg 1.45 mgRiboflavin 1.78 mg 1.51 mg

Common Eating Problems and their Management in the Elderly

Eating problems caused by the decline of physiological functions are common among the elderly. This can result in an imbalanced diet that may subsequently affect nutritional status. With proper dietary modifications, these eating problems can be resolved.

1. Chewing difficulties Causes: Loosened teeth, ill-fitting dentures or decreased saliva secretion can result in chewing discomfort or difficulties like mouth ulcers and sore spots.

Care:• A soft, easy-to-chew diet is advised.• Cut food into smaller pieces by chopping or grinding, modify food texture by pureeing with

blenders before eating, cook food thoroughly until tender, or add sauces.• Well-cooked vegetables and rice, dal, soft-boiled eggs, tender chicken or fish should be eaten.

often. Soft fruits (banana, papaya, grapes, melon), soft-cooked vegetables, soups, breads and porridges are also recommended. Visit dentists regularly and wear well-fitted dentures.

Wellness of Elderly

9

2. Reduced taste Causes: Deterioration of taste buds. Care:

• To add flavour, use herbs or spices such as ginger, spring onion, garlic, coriander, pepper or western herbs like parsley, basil and thyme to season food.

3. Dry mouth

Causes: Reduced saliva production Care:

• Ensure adequate fluid intake.• Drink some water to moisten the mouth before meals or chew on some pickles or fresh lemon

slices to stimulate saliva secretion• Use moist food preparation techniques such as stewing and grind, chop or puree foods• Provide food with sauces, gravies or clear soup, or soften bread or crackers with milk or soup.

4. Poor digestionCauses: Reduced saliva and digestive juices may lead to poor digestion and nutrient absorption.Care:

• Have small, frequent meals and chew slowly.• Foods should be fresh and well cooked.• Select softer foods such as khichri, daliya, soup, fish, tofu, steamed eggs, ground meat and

peeled fruit, etc.• Avoid intake of fried or high fat food and reduce intake of caffeine or alcohol-containing food or

drinks.• Use appropriate cooking methods such as braising or stewing. Avoid lying down right after

meals.· Performing light physical activities such as walking may help digestion.

5. Poor appetite

Causes: • Illness, gastrointestinal discomfort or ill-fitting dentures.• Side effect of drugs.• Poor psychological and emotional well-being.

Care: • Have small, frequent meals supplemented with nutrient dense snacks such as bread with

cheese/ paneer/ egg or soup with egg added for thickening, custard, raitas and fruit curd• Use herbs or spices as seasonings, or garnish food to make the dishes more attractive.• Prepare foods that are nutrient-dense by adding minced meat, fish, tofu, egg, potato or dried

beans into soup, khichdi, daliya, and upma. • Avoid drinking large amounts of fluids during mealtime to help reduce the feeling of fullness.

6. Swallowing difficulty

Causes:• Rapid eating/ swallowing • Ill-fitted denture affecting chewing process • Inappropriate food texture e.g. too hard, too large, slippery or sticky • Poor positioning: eating in the lying position increases the risk of choking

Wellness of Elderly

10

Care: • Avoid eating when not fully conscious e.g. just awakening from sleep • Select nutrient-rich food to improve nutritional status • Select food with appropriate texture e.g. purees, thick (creamed soup) or semi-thick liquids

(pureed fruit juices) • Select appropriate utensils or feeding modules e.g. small straw, small spoon, enlarged-

handle spoon, adapted chopsticks, scoop bowl, etc • Keep proper positioning (i.e. upright sitting, head in upright position and not tilted

backwards).• Oral-motor exercises can strengthen muscles and improve closure during swallowing.

Medical Conditions associated with Old Age

As one grows old, the body undergoes a lot of changes and these may be indicated by decline in appetite, weight loss, lack of sleep and memory loss etc. These symptoms may be due to the normal process of ageing or sometimes they may be indicative of diseases like diabetes. If such diseases are identified at an early stage it is possible to provide suitable treatment. But good nutrition in the later years still can help lessen the effects of diseases such as obesity, high blood pressure, osteoporosis and arthritis. Studies show that a good diet in the later years helps both in reducing the risk of these diseases and in managing the signs and symptoms. This contributes to a higher quality of life, enabling them to maintain their independence by continuing to perform basic daily activities.

Danger Signs- Being overweight increases your risk of serious illness, including Diabetes, Heart Disease and high blood pressure. It also puts extra stress on your joints, making conditions such as Arthritis more painful.

Avoiding Diabetes- One in 10 people over the age of 60 develop Diabetes. NIDDM is more prevalent at this age and changing the diet is often enough to control it. Diabetes can be avoided by keeping the weight in control and exercising regularly.

Tactics for combating Diabetes• Never skip a meal or eat much later than usual. This can cause your blood sugar levels to drop

and cause many unpleasant symptoms, the worst of which is a diabetic coma. Small regular meals are preferable to one large one.

• Enjoy a variety of vegetables, fruits, whole grains, low fat milk products, and meat • A variety of foods will help to keep you healthy. Use alternative options • Choose portion sizes to help you to reach or maintain a healthy weight • Choose foods with low Glycaemic index such as barley or lentils• Cut down on fatty foods such as butter, full fat cheese, fatty meats, pastries to control your

weight and blood cholesterol. Use unsaturated oils from olive, sunflower or safflower rather than butter. These lower blood cholesterol and are a good choice for diabetics who are vulnerable to heart problems. Use the best combination of oils for consumption

• Avoid too much salt to prevent high blood pressure• Eat more fish and have oily fish once a week.

• Low fat cooking methods are best: grill, griddle, boil, dry roast, poach, and steam foods rather than fry

• To correct low blood sugar, you should always carry something sweet with you go. Raisins, fruit juice, soda (not sugar-free) or hard sweets like toffees are good for this purpose. All of these should be taken in small amounts.

Wellness of Elderly

11

GLYCAEMIC INDEX OF FOODS

Low GI Foods (55 or less) Medium GI Foods (56-69) High GI Foods (70 or more) Choose more often Choose more often Choose less often

BreadsMixed Grain Whole-Wheat, Rye, Pita White bread

CerealsAll-bran, Oats, Oat bran, Corn-flakes, Bran flakesCorn, Barley

GrainsParboiled rice, Barley, Basmati rice, Brown rice Short grain ricePastaNoodles

VegetablesCarrot, Peas, Yam Beet, sweet corn, sweet potato Potato, Pumpkin

Fruits Apple, banana, cherries, Papaya, pineapple, raisins Watermelongrapes, kiwis, mango, orange, peach, plum

Beverages Coca cola

Legumes Lentil, chick pea, kidney beans split pea, soyabean, baked beans

Miscellaneous French fries, popcorn

Exercise can improve insulin sensitivity and should be encouraged for those who are deemed able to participate. The level of exercise should be gradually increased and tailored to the capacity of the patient. Patients must wear proper footwear during exercise, and care must be taken to avoid injury and falls that can be disastrous to the elderly. Hypoglycemia must be avoided by adequate snacks before starting the exercise. Make sure that your shoes fit properly and that they are comfortable to walk in. The last thing a diabetic wants is an injury from an ill-fitting shoe. Infections or cuts in your feet can start off a chain reaction that can have serious long-term effects. Invest in well-fitting shoes, even if they are costly. These include regular attention to foot care with routine inspection of patients by physicians. There should also be an annual sensory testing with nylon monofilament to detect the presence of peripheral neuropathy.

Exercise Guidelines for Patients with Diabetes Mellitus

• Exercise only when feeling well. It is advisable to postpone exercise for 2 days after signs and symptoms of a cold or flu (including fever) are over.

• Generally, it is best to exercise with a friend who is aware of your diabetes.• Become familiar with specific blood glucose patterns in connection with different activities.

Exercise should be started after a stable relationship is established between food intake and insulin and/or medications.

• Know the symptoms of too much and too little glucose in your blood.• Low blood glucose lightheadedness, rapid heart beat and sweating• High blood glucose, frequent urination, vision difficulty, increased appetite, thirst and weight loss

Wellness of Elderly

12

• Before Exercise• Estimate intensity, duration, and energy expenditure of exercise.• 30 to 45 minutes of exercise is safe when diabetes is under good control.• Good control is defined when blood sugar is between 90 to 140 mg/dl.• Eat a meal 1 to 3 hours before exercise.• Insulin: -Administer insulin more than one hour before exercise

-Administer insulin in abdomen and avoid an extremity injectionDecrease insulin that has peak activity coinciding with exercise period (may not be required during short workouts)

• Monitor blood glucose:-If blood glucose <100 mg/dl, take supplemental pre-exercise snack-If blood glucose >250 mg/dl or urine ketones is positive, delay exercise

• During Exercise• Supplement calories with carbohydrate feeding (hard candies, candy bars, or juice)

every 30 minutes during extended and strenuous exercise.• Drink plenty of fluid.• Monitor blood glucose intermittently when engaged in prolonged exercise.

• After Exercise• Monitor blood glucose, especially if exercise is not consistent.• Increase caloric intake for 12 to 24 hours after exercise.• Be aware of post-exercise symptoms of too much/little blood glucose.• Reduce insulin, which peaks in the evening or night of exercise (may not be required

during short workouts).

• You are advised to wear shoes and socks at all times to avoid trauma to the feet. Inspect your feet on a regular basis for blisters, corns, bunions or any other abnormalities.

• If you have diabetic retinopathy, avoid activities such as contact sports, heavy weight training or inverted hanging to minimize the risk of eye complications.

• Consult your physician if any symptoms develop during/after exercise. Notify your physician when changing your exercise routine.

Dealing with HypertensionHypertension becomes more prevalent with increasing age, most likely because of reduced arterial compliance. As many as 90 percent of normo-tensive elderly adults develop stage 1 hypertension. Circulatory problems are also more common at this stage of life; high blood pressure or hypertension increases your risk of both stroke and heart attack. Obesity is a known factor in Hypertension

Symptoms• Majority of patients have no symptoms, it is usually discovered during a routine check up. • Some patients may experience headache, dizziness and fatigue.

Consequences of uncontrolled hypertension

Untreated hypertension can lead to complications like heart failure and renal failure. Early diagnosis and proper treatment can effectively prevent or delay the complications.

Diet Modification

1. Lose weight if overweight2. Reduce dietary salt intake3. Reduce dietary saturated fat and cholesterol4. Maintain adequate intakes of potassium, calcium, and magnesium5. Reduce alcohol consumption

Wellness of Elderly

13

Diet high in fruits and vegetables, non-fat dairy products and low in saturated and total fat is used for preventing and controlling hypertension

• Foods high in fruits, vegetables, nuts, whole grains, fish, poultry, and low-fat dairy products are advised.

• Cut down on salty foods such as salted crisps, namkeens, nuts, pickles and papads• Salted, smoked foods such as cheese, bacon, sausages, canned fish and other

processed foods, prepared sauces and salad dressings are often high in salt. Replace these with fresh foods such as fish, lean meat, fresh fruits and vegetables, which contain a small amount

• Experiment with other flavorings such as freshly ground spices, dried and fresh herbs, freshly milled black pepper, lime juice and vinegar. You may even try salt substitutes

• Read labels carefully: salt may be disguised as sodium in sodium chloride, mono sodium glutamate or bicarbonate of soda.

Treatment Anti-hypertensive drug is an effective treatment for hypertension, but the patient's cooperation is essential. Patients must take medication as instructed (which is usually life long), attend regular follow up, and make modifications in life-styles:

1. Quit smoking2. Increase physical activity

Individual Guidelines for Cardiovascular Exercise• Select appropriate exercises. Cardiovascular (aerobic) exercises should be a major

component of activities. For a well-rounded program, flexibility and strengthening exercises should be included.

• Be alert for symptoms. If any symptoms occur during exercise, contact a physician immediately. Specific symptoms are:

• Discomfort in the upper body such as burning, aching, tightness or sensation of fullness.• Faintness accompanying exercise. Brief light-headedness may follow unusually vigorous

exercise. This condition does not usually indicate heart disease and may be managed by exercising at a lower intensity. If “fainting spells” or feelings or faintness develop during exercise, discontinue the activity until it is evaluated by a physician.

• Shortness of breath during exercise. During exercise, the rate and depth of breathing should increase but should not be uncomfortable. Breathing should not be so difficult that an ordinary conversation is an effort, wheezing develops, or more than 5 minutes are required for recovery.

• Discomfort in bones and joints either during or after exercise. Mild muscle soreness may develop when beginning exercise, however, if joint and back pain develop, consult a physician.

• Watch for the following signs of overexertion:• Inability to finish. Training sessions should be completed with reserve.• Inability to converse during exercise.• Faintness or nausea after exercise. A feeling of faintness after exercise may occur if the

activity has been stopped too abruptly. Decrease the intensity of the workout and prolong the cool-down period.

• Chronic fatigue. During the remaining day after exercise, an individual should feel stimulated, not tired. If fatigue persists during the day, intensity and/or duration of the workout should be decreased.

• Sleeplessness. If unable to sleep well despite feelings of fatigue, the amount of activity should be decreased until symptoms subside. A proper training program should make it easier, not more difficult; to have good night's rest.

Wellness of Elderly

14

• Aches and pains in the joints. Mild muscle soreness may accompany exercise; however joint should not hurt or feel stiff. Check exercise procedure, particularly, stretching and warm-up exercises, to ensure correct technique. If symptoms persist, check with a physician before continuing.

Start slowly and progress gradually. Intensity and duration may be increased every 4 to 6 weeks.

ConstipationElderly people are often victims of constipation. When the build up of pressure in the large bowel forces its lining through weak points , small pockets are formed which do not cause symptoms by itself ,however, if they become infected and inflamed they may cause pain in the lower abdomen.A high fiber diet combined with plenty of fluids is the best way to prevent infection and inflammation. Food sources with small seeds such as kiwi fruit, strawberries, tomatoes and jam should be avoided.

Healthy Bones and JointsOsteoarthritis, a degenerative condition that causes inflammation of the joints, affects most people over the age of 60.

Arthritis is the painful swelling of the joints due to ageing and is common after the age of 50. There are various kinds of arthritis of which osteoarthritis, rheumatoid arthritis and gout are the most common.

Dietary management of arthritisThere is no 'special diet' for arthritis, however following aspects should be considered, especially for those suffering with rheumatoid arthritis:

• Where necessary, measures should be taken to reduce weight with a balanced, low fat diet in order to minimize stress on the joint, to reduce pain and maintain or improve mobility.

• Fasting and following some very low calorie diets worsen the symptoms of arthritis• Daily supplementation with omega 3 fatty acids as well as the regular inclusion of oily fish,

olive, canola, linseed, flaxseed and soybean oils in the diet has been of benefit to many patients with rheumatoid arthritis. This is due to the anti-inflammatory effect of the omega 3 fatty acids. Try substituting red meat with salmon, mackerel, trout, sardines and shellfish at least three times a week.

• Eat 5-7 servings of fruit and vegetables daily for the antioxidants, especially those rich in Vitamin C (broccoli, citrus fruits, strawberries, kiwi fruits, raspberry & strawberry) and Beta-carotene (mangoes, peaches, apricots, pumpkin, carrot and spinach).

• Enjoy moderate intakes of avocados, nuts and sunflower seeds for vitamin E and whole grains, cereals and eggs for selenium.

• Cut down on processed foods, saturated fats, sugar and salt.• Drink at least 6-8 glasses of water each day. • Use salt in moderation. • If you drink alcohol, do so in moderation. • Fasting and some calorie-restricted fat diets can worsen the symptoms of arthritis.• If you suspect that a particular food may be causing joint problem, rather than avoiding the

entire food group, consult a dietician who can recommend a supervised exclusion diet.• If you are on some drugs to control arthritis, always eat something before taking them,

otherwise you may develop stomach ulcers.

Caring Tips for Osteoarthritis

• Minimize weight bearing on knee joint. For the obese, reduce weight. • Avoid carrying heavy objects.

Wellness of Elderly

15

• Ensure proper balance between work and rest. Watch out for and be mindful of joint pain.• Do Gentle exercises:

• Simple hand exercise can help to improve circulation and reduce joint swelling and stiffness.

• Appropriate knee exercise and thigh muscle strengthening exercise can protect the knee joint.

• Do massages• For chronic inflammation, gentle massage can improve circulation. For a soothing soak,

pour some comfortably warm water into a bowl or foot bath. • Hand and Foot Soak• Aches and pains in your hands and feet may be a problem, particularly if you have Arthritis.• For a soothing soak, pour some comfortable warm water into a bowl or foot bath. Add a

tablespoon of ground ginger and a few sprigs of rosemary( or three or four drops of essential oil of rosemary. Soak your hands or feet for about 15 minutes and just relax.

Writing The AlphabetSitting in a chair, lift, then rotate one foot to "write" each letter of the alphabet. Switch feet and repeat. This helps keep foot muscles limber.

OSTEOPOROSIS

As ageing occurs, there is gradual loss of calcium, which leads to a reduction in bone density. The affected bones thus become thinner, and fractures may occur which may result in loss of independence or lead to complications. Risk factors

• Smoking, excessive alcohol consumption and lack of exercise all increase the chance of osteoporosis

• Malnutrition and inadequate calcium intake also increases the chance of osteoporosis.

Management

Prevention of a fall is of paramount importance for those who have osteoporosis. This is important to prevent fractures and other complications.

Further bone loss may be slowed down by exercise and adequate calcium intake.

Milk and dairy products such as curd, buttermilk, cheese, canned fish, pulses, sesame seeds, sunflower seeds, almonds and green leafy vegetables are essential sources of calcium. Low fat varieties of dairy products would also help to keep your weight in check.

Vitamin D has a pivotal role in the absorption and utilization of calcium and can be obtained from exposure to sunlight or food sources such as oily fish (mackeral, herring, sardine) butter and margarine.

Very large amounts of natural unprocessed bran contains high levels of phytic acid preventing the absorption of Calcium. This should be avoided. You also need to watch your salt intake and cut down on salt in cooking and seasoning as it is linked with increased calcium loss.

Turn back the ageing ClockThe fact is that many age-associated declines occur not because of the ageing process itself, but as a result of our lifestyle habits, including exercise. In our sedentary society, many muscle and joint problems are the result of weakness and inflexibility. By increasing your strength and flexibility, you can prevent injury and slow the age-associated loss of muscle function. This means that some of those old cliches turn out to be true..."use it or lose it" and "you're as old as you feel".

Wellness of Elderly

16

Exercise itself, can slow and even reverse many components of the ageing process. It is probably the single most effective way to lengthen life. Proper exercise can rejuvenate and take years off your chronological age- it is the closest thing to an anti-ageing pill.

Each person over the age of 55, who continues to exercise consistently, has found that they have a marked increase in their muscle tone, strength and aerobic capacity: and they have become more fit and vigorous then ever before. One of the things that happen when you begin strength training is that the connective tissue, such as ligaments and tendons, get stronger along with your muscles. This helps to protect your joints from injury and makes everyday tasks, such as walking up stairs, carrying groceries and keeping up with grandchildren easier.

Ageing and Exercise: Choose Safe Activities

Before starting any new exercise program, be sure to see your doctor

Start slowly, especially if you have not exercised in a long while. Doing too much, too soon can lead to injury.

Drink plenty of fluids when you are exercising. It is very easy to get dehydrated when sweating.

Be aware of your body when you are exercising. Exercising should not hurt or make you feel really tired. You might feel some soreness, a slight discomfort, or be a bit weary, but you should not feel pain. If you do, stop exercising and see your doctor.The best way to start is to think of an activity that you enjoy. Your goal should be to exercise at least 30 minutes each day (or on most days of the week). If you can't tolerate exercising for 30 minutes all at once, break up your exercises into 10 minutes sessions, 3 times a day.

Whatever form of exercises you choose to do, you should include exercises that employ a mixture of endurance, strength, balance and flexibility exercises.Follow these 3 steps when choosing an exercise activity:

Step 1. Choose an activity that makes you breathe a little harder. This is called endurance exercising. This will help build your stamina and give you energy to do the things you want to do.

Step 2. Do strength training. People lose 20 to 40 percent of their muscle and along with it their strength as they age. Strength training exercises can also keep your bones strong and may help you avoid fractures due to fragile bones. You can incorporate strength exercises into your everyday activities. For example, walk briskly or uphill if possible. Take the stairs when you can. Rake the leaves. Use hand tools instead of power tools. .

Step 3. Do exercises that help your balance. For example, stand on one foot, then the other, without support. Get up from a sitting position without using your hands or arms. Every now and then, walk heel-to-toe (the toes of the foot in back should almost touch the heel of the foot in front when you walk this way).

Step 4. Don't forget to stretch! Stretching won't build your endurance or muscles, but it may help keep you limber and flexible.

General Guidelines before exercise:

1. Do not exercise on an empty stomach or just after a big meal. During exercise, the demand for blood may exceed the ability of the circulation to supply to the muscles.

2. Wear comfortable clothing, Dress in loose-fitting, comfortable clothes made of porous material appropriate for the weather. In direct sunlight, wear a cap and light-colored clothing.

Wellness of Elderly

17

3. Wear correct size and non-slippery, sweat absorbing shoes. Wear shoes specifically designed for the type of activity being performed.

4. Carry some water with you.5. Avoid exercise in extreme weather. Exercise is best tolerated in low humidity weather and a

breeze present. Be alert for heat injuries and drink adequate fluid to maintain hydration.6. Remember to do 5 to 10 minutes warm up and stretching exercise before starting.7. Do not forget to repeat the cool down and stretching after exercise.8. Slow down for hills. When ascending hills, decrease speed to avoid overexertion.9. Choose appropriate exercise according to your ability and interest. Never exceed your limit.

Remember that it is NOT the harder the better.10. If you have acute medical problem (such as fever, or pain), stop exercising.11. If you have chronic medical condition (such as hypertension, diabetes mellitus, ischemic heart

disease and arthritis), it is better to seek advice from your doctor or physiotherapist beforehand.

12. If there is dizziness, fainting, shortness of breath, chest pain, vomiting, nausea and severe pain during exercise, stop exercising and seek medical advice as soon as possible.

13. For prolonged exercise like hiking, drink water from time to time to supplement the loss of body fluid due to sweating. Do not wait until you are thirsty.

14. Take appropriate breaks during exercise. Do not over-exert yourself.15. Keep up with the exercise! At least 3 times per week, 20-30 minutes or more each time so as to

derive the maximum benefit.16. Exercise with friends. Company provides enjoyment, mutual encouragement and support.17. Start your workouts with a 5- to 10-minute warm-up followed by 20 to 40 minutes of endurance

training. Then allow yourself a 10-minute cool-down period. 18. A reasonable workload is one that invites you to sweat mildly; you should be able to carry on a

conversation with your partner during your workout.19. A sufficient cool-down period can be gauged by tracking your pulse: it should drop below 100

beats per minute during this phase

In general, walking, cycling, and swimming are preferable to running because the latter may place abnormal stress pressures on your muscles, bones, and joints and further subject you to strains or other injuries.

Resistance training of the large muscle groups (for example, those of your legs, stomach, arms, and trunk) has the greatest impact on minimizing or reversing the overall functional decline that may be seen with age.

Resistance training includes both light weightlifting and stretching exercises. These help preserve muscle mass.

Full-range-of-motion exercises ensure good form, optimized resistance training, and enhanced flexibility. Because aged muscles fatigue more easily and require longer periods for recovery after a workout, ensure that you do additional stretching before or after workouts. Give yourself ample rest periods between exercise sessions.Finally, anticipate that it will take about six weeks before you start noticing differences in your muscle strength and function.

WalkingEvery physical activity is performed with specific movements that maximize your performance. When you exercise with proper form, you will have a lower risk of injury. You will also benefit the greatest when your body's movements are as natural as possible. Walking is not any different from other fitness activities. When you pay attention to your form and follow the guidelines below, you will engage the proper muscles and cause less strain on your back and neck. Walking is a great way to get fit, as long as you do it correctly.

Wellness of Elderly

18

Posture• Stand up straight. • Think of being tall and straight, do not arch your back. • Do not lean forward or lean back. Leaning puts strain on the back muscles. • You should look forward, not down. Look 20 feet ahead. • Chin up (parallel to the ground). This reduces strain on neck and back. • Shrug once and let your shoulders fall and relax; your shoulders should be slightly back. • Suck in your stomach (good abdominal strengthener!)• Tuck in your back - rotate your hip forward slightly. This will keep you from arching your back.

Arms• Bend your elbow 90 degrees. • Hands should be loose in a partially closed curl, never clenched. • Clenching your fists can raise your blood pressure and should be avoided!! • With each step, the arm opposite your forward foot comes straight forward, not diagonal. • As the foot goes back, the opposite arm comes straight back. • Keep your elbows close to your body - don't "chicken wing." • Your forward hand should not cross the center point of your body. • Your hand, when coming forward, should be kept low, no higher than your breastbone. • Many poor examples of arm motion are seen with walkers pumping their arms up high in the air,

which does not help propel you. • If, at first, you find adding arm motion tiring, do it for 5 to 10 minutes at a time and then let your

arms rest.

Taking a Step• Strike the ground first with your heel. • Roll through the step from heel to toe. • Push off with your toe. • Bring the back leg forward to strike again with the heel. • Flexible shoes will ensure you are able to roll through the step. • If your feet are slapping down rather than rolling through, your shoes are likely to be too stiff. • At first, your shin muscles may tire and be sore until they are strengthened.

Your Stride• Take more, but smaller steps rather than lengthening your stride. • Your stride should be longer behind your body, where your toe is pushing off, rather than out in

front of your body. • Your forward leg has no power, while your back leg is what is driving you forward. • Getting the full power out of the push from the back leg as it rolls from heel to toe is the key to

powerful, efficient walking. • Fast walkers train themselves to increase the number of steps they take per second and to get

full use out of the back part of the stride. Warm Up• Start out at a slow, easy pace for each walking session. • Allow your muscles to warm up before you stretch, add speed or hills. • Warm up for 5 minutes at this easy pace.

Stretching• Stretching will add flexibility and can make your walking more comfortable. • Warm up for 5 minutes at an easy walking pace, and then take a couple of minutes to do some

brief stretching.• Never stretch cold muscles or you risk tearing them. • After stretching, you are ready to walk at your desired speed.

Wellness of Elderly

19

Cool Down• For the final 5-10 minutes of your walk, finish with an easy walking pace. • At the end of your walk you must repeat the stretches you did after your warm-up, but hold each

stretch for a longer amount of time.

Common Mistake: Over stridingWhen walkers try to walk faster, a natural inclination is to lengthen your stride in front, reaching out further with your forward foot. This leads to a clumsy, ungainly gait, striking hard with the feet. Your shins hurt and you really don't get any faster.

The cure: • All of the power of your walk comes from pushing with the back leg and foot.• If you are trying to walk fast, concentrate on taking shorter, quicker steps.• Then think of really rolling through your step with your back foot and leg, getting a good push off.• The result will be faster feet and lengthening your stride where it does you some good - in back.

Mental and Social Well Being -Last but not the least

A sound mind can exist only in a sound body however; mental health is dependent on social harmony, family relations and sound financial status.

As age advances the cells in the brain start declining gradually. This results in memory loss and other mental disorders which can be avoided or reduced by active involvement either in work or in recreation e.g. reading books, listening to radio or mixing with friends and relatives.

Elders can play an important role in ensuring harmony in their relationship with family and society. They should understand the domestic situation, occupation and economic problem of the youngsters and adjust their attitude accordingly to ensure peace in the family. They can involve themselves in small chores, like taking grand children to school, shopping, paying electric and phone bills etc. Such assistance will be appreciated by the youngsters and ensure due respect and affection for the elders. The spare time can be devoted in social activities. Social work can be created; if outdoor activities are not possible one can do indoor activities that provide value.

Develop a hobby like gardening or chess or anything else, which relaxes you. This would give a positive new direction to life.

To slow down the ageing process, remember:

Inculcate a goal in life, a sense of purpose. Do not succumb to sheer boredom.

Continue learning and expanding wisdom. Motivate yourself - age is no bar.

Look forward to each morning with positive, pleasant thoughts. A stoic resignation and acceptance of faith should not be over stressed. Living in the past will never give a better present. Thank the Lord for his grace and mercy. Live in a stimulating environment. Establish rapport with varied age groups, even the very young. Share their views and news, understand their problems lend a helping hand, a warm smile and counsel when required.

Practise simple Yogasanas and Pranayama with caution, bearing in mind your own body capacity and limits. Stretching asanas, practised in moderation, help improve flexibility. How can one evolve when the body is stiff and rigid with a failing memory? You have to enhance mental stability to avoid brain cell degeneration, sometimes leading to senility.

Wellness of Elderly

20

Pursue a soothing and satisfying hobby - gardening, music, reading, writing, teaching underprivileged children, doing environmental or animal welfare work, visiting senior friends in homes and institutions and much more. Be proud of your achievements. Exert reasonably, even for your own household chores, to remain in a near peak condition.

Ease out day- to-day tensions by practicing meditation in the morning, always under experienced guidance.

Maintain an efficient cardiovascular system without resorting to excessive medication. Walking increases cardiovascular endurance if swimming, cycling, skipping etc. are not possible or advisable.

Relax - Realise the dangerous effects of accumulation of unnecessary anxiety day after day.

Live now - Try to avoid withdrawing from the world due to failing senses and health, try not to make normal interaction difficult. You must bear in mind that your nerve cells have an amazing potential in terms of the ageing process. Therefore, folks don't lose faith.

Think positive - Finally, convince yourself to believe that grey hair actually becomes a silver crown, a symbol of increasing wisdom, service, fulfillment, tolerance and acceptance.

Accept life as it comes - There are many negative aspects in life. Accept amicably instead of causing a mental crisis.

So count your blessings, old and new! Life is a challenge, a constant uphill walk! Live it, love it, and pamper it!

THE UNDERLYING NOTE

The elderly can enjoy a “grand old age”. A little care about themselves and following the above details for their “Wellness” can help us in achieving our mutual objective.

This body of work is a result of extensive research undertaken by the R & D wing at VLCC. It is a sincere effort to help the elderly discover new ways of extending their activities as well as life span, and also enjoy the foods that boost their health and strength.

ANNEXURE

A Sample Diet Plan for an Elderly Man

Mr. Yadav, aged 70 years and weighing 60 kgs, is a retired Air Force Officer. Besides being engaged in light household activities, he is a prominent social worker of his area. He has turned vegetarian under the influence of his work and religion discourses. A day's sample diet plan for him is planned here

PERSONAL DATA

Age 70 yearsSex Male

Body Weight 60 kgsPhysical Activity Sedentary

Socio-economic Status MIGFood Habits Vegetarian

Wellness of Elderly

21

Recommended Dietary Allowances

Energy 1600 kcalProtein 60 gCalcium 400 mgThiamine 1.2 mg

Sample Menu Plan

Meal MenuEarly Morning Tea

Breakfast Broken wheat porridgePoached egg

Toast with butter Apple

Mid-Morning Coffee Biscuits

Lunch Lentil Dal Palak Saag Salad Chapattis Fruit Custard

Evening Tea Vegetable Upma Tea

Dinner Lauki Kofta Curry Potato & cauliflower (dry) Grated Carrot Salad Boondi Raita Chapattis/Rice

Bed time Milk

Keeping all the aspects in mind, providing a proper diet to the old will keep them free from most of the diseases and they would be able to lead an active and happy life. A proper diet, exercise and a pleasant environment are important for adding healthy and happy years to the life of our elderly. Also to be borne in mind is the fact that "Everyone of us has to reach old age one day or the other, provided we are lucky enough."

Some Easy to prepare recipes Moong Dal Payasam

Ingredients: 1 cup moong dal (split green gram) 1/2 cup jaggery 2 tsp sugar 3 cup milk 2 cups water 2 cardamomA small pinch of edible camphor (paccha kalpooram) 2-3 tsp cashews 2 tsp ghee

Method:

1. Roast moong dal (split green gram) with ghee. Boil this with water, till the moong dal gets cooked.

2. Add jaggery and sugar to the above and let it cook till the jaggery melts. Now add milk and let it cook until everything mixes well.

Wellness of Elderly

22

3. Fry cashews in little ghee and add this to the boiling payasam.4. Grind cardamom, and edible camphor, and add this to the payasam.

Thuvar Dal Ni Khichdi - The most loved Gujarati delicacy!!!!!Ingredients:

1 cup thuvar dal (red gram) 1 cup rice 1/2 tspn. turmeric powder salt to taste

Spinach can be added

For the tempering:2 cloves 5 peppercorns 1 stick cinnamon 1/2 tbspn of jeera (cumin seeds) 1 tbspn. ghee

(Serves - 4)

Method:1. Wash and soak the rice and dal together for at least 30 minutes. 2. Drain and keep aside. Bring to a boil 3 1/2 cups of water and keep aside. 3. To make the tempering, heat the ghee; add the cloves, peppercorns, cinnamon and cumin

seeds and fry for 30 seconds. 4. Add hot water, rice, dal, turmeric powder and salt. Transfer to a pressure cooker and cook

for at least three whistles. 5. Serve hot.

MANGO CURRY

Ingredients: 1/2 kg Green Mangoes (sliced) 6 Red Chilies1 dessert spoon of Coriander 1/2 tsp. of Cumin1/2 tsp. of Turmeric 6 flakes of Garlic1/2" piece of Ginger 2 Onions (sliced)1 tbsp. of Jaggery Salt to taste

Instructions: Grind the chilies, coriander, cumin, turmeric, garlic and ginger.Fry the onions till brown then add the ground masala and fry wellAdd the mangoes and jaggery and cover with water.Add salt to taste. Cook till a little thick

MANGO KOOTU

Ingredients: 1 mango - not too ripe, with a hint of sweetness2 tsps of fenugreek seeds (vendhayam)6-7 dry red chillies (veththamolagai)1 tsp of mustard seeds (kadugu)

Wellness of Elderly

23

1 stem curry leaves (karugapilai)1 tsp of red gram dal (kadalai paruppu)1 cup of grated coconut1-2 tsp of salt3 cups of fresh curd1 tsp of turmeric powder

Instructions: In one tsp oil, fry the fenugreek seeds, curry leaves and red chilies.Turn off the flame and add the coconut to the above (don't fry the coconut)Set the above for cooling (about 5 minutes) and then grind them to a fine paste.In a kadai, sputter mustard in 1 tsp. oil, add some curry leaves, and red gram dalCut the mango into finger size pieces, and add to the oilFry nicely for 5-10 mins and close the lidAdd the ground paste to the mango and mix wellAdd 1-2 tsp. salt and the turmeric powderAdd curd to the above, and wait for it to simmer onceDon't let it simmer too much. 5 minutes should be good

BREAD BHEL PURI

IngredientsServes 4

8 Bread Oil to deep fry 1 Apple (peeled, 1 cm cubes) 1 tsp Lemon juice 1 big sized Onion (finely chopped) 1 big sized Tomato (finely chopped) 1 small sized Cucumber (peeled, 1 cm cubes) 2-3 small sized Potato (boiled, 1 cm cubes) 1/2 medium bunch Fresh coriander leaves (finely chopped) 1 tbsp Peanut (crushed) 1/4 cup Tamarind chutney 1/2 cup Sev For tamarind chutney 100 gms Tamarind 50 gms Jaggery Salt to taste Black salt to taste 1/4 tsp Cumin seeds MethodTake the bread slices, remove crust and cut into small squares (croutons). Heat oil in a kadai and deep-fry the bread pieces. Drain onto an absorbent paper and keep aside. Apply lemon juice to the apple cubes to prevent them from discoloring. For tamarind chutney, soak tamarind in half a cup of water for fifteen minutes. Grind it along with all the remaining ingredients. Pass it through a sieve to get a smooth consistency. Place the bread pieces in a bowl. Add chopped onion, tomatoes, cucumber, potatoes, apple, half the coriander leaves and mix. Add crushed peanuts, salt, tamarind chutney and mix well. Put sev on top, garnish with the remaining coriander leaves and serve immediately.

COCONUT RICE

Method

Heat ghee in a deep pan. Add cloves, peppercorns and sliced onion. Sauté till onion starts turning brown. Add sugar and sauté till it caramelizes. Add drained rice and stir gently so that the rice grains do not break. Add coconut milk and one cup of water and stir. When the mixture comes to a boil, add salt and boil for five minutes. Cover and cook on medium heat till done. Remove from heat and rest for five minutes. Serve hot.

Wellness of Elderly

24

IngredientsServes 42 cups Coconut milk 1½ cups Rice (soaked) 2 tbsps of desi ghee 4-5 cloves 4-5 black peppercorns 1 medium sized Onion (sliced) 2 tbsps of sugar Salt to taste

Potato Cheese NuggetsIngredients:-Potato - 4 (medium) -Onion - 1 sliced-Black peeper - according to taste. -Grated cheese

Steps:Peel the skin of potatoes and grate. Keep the grated potatoes inside salted water for some time. Mix well with cheese, grated onions, black peeper and salt. Make small balls out of the mixture and flatten them into small circles; dip in cream and deep fry in oil. For making a less oil variety, nuggets can be shallow fried in a non-stick.

Paneer Sandwich

Ingredients:Sandwich Bread - 3 pieces, Brown bread - 6 pieces, Spinach - a few leaves, Cheese cube - 1, Ginger & peppercorn paste 2tbsp, Turmeric powder 1tsp, Chili powder 1tsp, Tomato 1, Sugar 1 ½ tsp, Salt according to taste., Water as required, Garam masala 2tsp.

For pasteCucumber -1(small), Carrot - 1, Tomato - 1, Salt - ½ tsp, Peppercorn

For yogurt mix Sour curd - 1 cup (drained), Paneer - 100 gm, Salt - 1 tsp Peppercorn - ½ tsp, Cumin powder - ½ tsp, Mustard powder - ½ tsp Red chili sauce - 1 tsp

Steps:Make a paste of all the ingredients of yogurt mix. Finely chop all the vegetables and marinate with salt and pepper. Butter the bread slices. Apply the yogurt paste over the brown bread and cover with spinach leaves. Spread the vegetables over it and cover with sandwich bread. Spread the yogurt mix over the bread along with grated cheese. Cover with brown bread. Make other sandwiches in the same way and cover with silver foil. Slice the sandwiches diagonally before serving.

Wellness of Elderly

This booklet is not intended to substitute for professional medical advice.

If in doubt, please consult your doctor and follow his/her instructions.

All the statements have been made by the contributor in individual capacity.

Disclaimer

Fighting isolation,poverty, neglect

C-14, Qutab Institutional Area, New Delhi - 110 016Tel.: 41688955-56; 42030400, Fax : 91-11-26852916

e-mail : info@helpageindia.org website : www.helpageindia.orgNational Helpline No. : 1800 180 1253

VLCC HEALTH CARE LTD.S 22/6, DLF Phase-3, Gurgaon - 122 002

Tel.: +91-124-2562026-29website : www.vlcc.co.in