During this holy month of Ramadan, a category of elderly people cannot fast because of health problems, while others do so but with difficulty. For Dr Khadija Moussayer, Ramadan is generally safe for practitioners and age is not in itself an obstacle to its respect.
Specialist in internal medicine and in geriatrics, and ex-intern at the Hospitals of Paris (Charles FoyI geriatric hospital), Dr Moussayer indicates that there are absolute contraindications (whatever the age) in case of diabetes treated at the insulin and unbalanced, kidney failure, heart disease and any other pathology that does not support even a short fast (in particular certain autoimmune diseases and certain rare diseases).
It is wise, in any case, believes the specialist, for the elderly to take stock with their attending physician so as not to jeopardize their health, and to show responsibility, especially after 75 years when fasting is rather not recommended. On the other hand, people over the age of 60 (as well as those around them) should know that their ” settings “Physiological, very different from a younger person, require them to be more vigilant and even wise, especially in this difficult period of the coronavirus epidemic, she continues.
Likewise, she says that if healthy people were to be able to fast during this Ramadan, as in previous years, patients with Covid-19 should however consider not doing so. They must follow the derogations provided for by religion, again in consultation with their doctor, as for any other disease.
To this end, Dr Moussayer delivers the main recommendations to remember so that fasting goes smoothly for the elderly. The elderly are strongly advised, according to the specialist, to consult their doctor before any decision to observe Ramadan or not and on taking their medication (no self-medication!), Not to reduce their usual food consumption and ensure to consume a good amount of protein.
She also advises this category of person to drink well (1.7 liters per day minimum on average), maintain a physical activity of 15 to 30 minutes per day to fight against the harmful effects of sedentary lifestyle during confinement, adopt as much as possible new identical and regular hours of sleep from day to day and make a very substantial breakfast before sunrise, have a light meal when it breaks and have another 3 hours after..
Frequent lack of appetite in the elderly: a risk of undernutrition during Ramadan
Older people often tend to reduce their food intake without reducing their energy needs, says Dr Moussayer. This lack of appetite that occurs with age is partly due to altered perceptions of odors and taste (which thus stimulate less). The discriminatory capacity weakens, making it difficult to identify and appreciate foods. The detection threshold of the 4 basic flavors is thus increased on average by 11.6 times for salty, 7 for bitter, 4.3 for acid and 2.7 for sweet compared to a young individual explains. she does.
Contrary to popular belief, Dr Moussayer explains that the energy needs of PA are almost identical to those of young adults, i.e. 2000 kcal / d for men and 1800 kcal / d for women against respectively 2800 and 2200 at 30 years old. . As a result, the conjunction of a decrease in appetite and the observation of long hours young can compromise the nutritional status of BP and lead to a spiral of unfortunate consequences. BP should therefore not restrict its usual food consumption after breaking the fast without, moreover, pouring into equally harmful excess (regardless of age!).
Great vigilance with regard to hydration disorders
The BP naturally tends to lower its water intake, says the specialist, noting that the threshold of perception of thirst also dulls with age. The water losses of the PA are also more important because of the stronger resistance of the kidney to the action of a substance which limits the losses in urine (the antidiuretic hormone). In addition, the regulatory mechanisms are less secure, and the elimination of excess sugar or sodium is accompanied by a greater loss of water. The water balance is also threatened by certain drugs (diuretics, neuroleptics, etc.), she explains.
“For all these reasons, drinking water requirements are always higher in PA than young adults (1.7 l / d against 1.5 l / d), especially since the signs of dehydration, especially during Ramadan, are often late and not always easy to interpret. Thus, manifestations of sudden drowsiness, neuromuscular disorders, constipation … or acceleration of the heart rate must lead to emergency rehydration and this without wasting time in discussing the part of the person and / or his entourage»She emphasizes.
Watch out for the loss of muscle capital
Muscle capital decreases in PA, which worsens the nutritional and hydration state, warns the specialist. She explains that water reserves (73% of the body’s total water is stored in the muscles) indeed decrease correlatively to the decrease in muscle mass (17% of body weight at age 70 against 30% at age 30. ). This phenomenon, sarcopenia, has considerable repercussions through the weaknesses it causes: risks of infection by lowering the protein reserves necessary for immune defenses, falls and possible fractures compromising the autonomy of the PA.
“To avoid worsening muscle wasting, the recommended nutritional intake of animal (meat, fish, etc.) and / or vegetable proteins (almonds, pistachios, cashews, red beans, lentils, chickpeas, split peas, mushrooms, dates and dried figs, cereals …) and in particular during Ramadan, must be higher than that of young adults: 1 to 1.2 against 0.8 to 1g / kg / day, or 12 to 15% of nutrients»Recommends the specialist.
A quality of sleep to preserve
Sleep changes with age both in structure and in quality, says the specialist. According to his analysis, its total time decreases and it becomes less efficient because it is more fragmented by frequent nocturnal awakenings. The observation of Ramadan should not be done in complete rupture with a good hygiene of life and therefore of sleep.
It is therefore necessary, as much as possible, according to Dr. Moussayer, it is to try to keep a regular bedtime and to wake up, to devote an hour of its time in the afternoon, to a restorative nap, to practice a physical activity and exposure (without excess) to natural light during the day. Drinks containing stimulants (coffee, tea) as well as tobacco should be avoided or consumed minimally. No abuse of food all night long which will then disrupt sleep. The good rule of thumb in this area is to eat a very substantial breakfast before sunrise, eat a light meal when it breaks and have another 3 hours after.
Physical activity to be maintained during confinement
To deal with the consequences of a sedentary lifestyle during the confinement required by the coronavirus epidemic, it is recommended by Dr Moussayer to get up at least every 30 minutes to walk for 4 or 5 minutes and to do flexibility and strengthening exercises. muscle, at least for 15 min per day: even in a confined space, it is a good way to maintain muscle mass. This physical activity also has a positive impact on sleep and on morale in general.