Malnutrition is a common problem in elderly population through out the world. Nutritional problems may result from changes associated with the aging process, diseases or other medical conditions.

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Decline in physical and cognitive status often increase with age. Muscle mass is a predictor of strength, mobility, insulin sensitivity and basal metabolic rate thus with decline in body mass, calories need decreases.

1. Changes in ability to absorb and utilize nutrients.

2. Changes in ability to metabolize nutrients.

3. Changes in energy requirements and activity.

4. Effect of medication on appetite nutrient absorption and utilization..

Psychosocial factors play even greater roles than physical, medical and dental issues in determining the health and well being of elders. Elders particularly at risk include those living alone, the physically handicapped with insufficient care, the isolated, bed ridden geriatric patient with chronic diseased and restrictive diets. Poverty is also a major contribution to malnutrition. Depression, anxiety and loneliness all can undermine the desire to prepare and eat food and have been associated with anorexia, weight loss and increased morbidity and mortality in older people.

Functional disabilities such as arthritis, stroke, and vision or hearing impairment can affect nutritional status indirectly. The older person may have difficulty getting to and from grocery stores, carrying groceries and preparing meals. Inability to handle eating utensils, see food clearly may all lead to social isolation, poor eating habits and subsequent malnutrition.

Most elders take several prescribed and over the counter medications daily. These drugs can interact with food and diet, sometimes with serious side effects. Drug can affect the absorption and utilization of some food and nutrients and vice versa. Prescribed drugs are the primary cause of anorexia, nausea, vomiting, gastro intestinal disturbances, xerostomia, taste loss and interference with nutrient absorption and utilization thus leading to malnutrition.

The condition of the oral cavity can affect nutrition and vice versa. Oral health status affects the ability and desire to eat. The conditions like xerostomia, sense and smell of taste, oral infectious conditions, dental status and many other factors that can affect diet and nutrition intake.

As adults age, they tend to use more stokes and chew longer to prepare food for swallowing. Masticatory ability; however seems to be more of function of denture status than of age and the degree of dental impairment which determines chewing performance and food selection.

The effect of dentures on nutritional status varies greatly among individuals. Some people compensate for decline in masticatory ability by choosing processed or cooked foods rather than fresh and by chewing longer before swallowing; others may eliminate entire food groups from their diets. Intake of vitamin A, fibers and calcium also decline as edentulism increases.

Determining the nutrient status of older adults involves an assessment of body composition to identify the presence of obesity and to detect individuals who are significantly underweight. There are method to evaluate every individual and decide their nutritional demand according to their need. This can done by Anthropometric Method. In this method body mass index (BMI) is calculated as weigth in kilograms, divided by square of height in meters.

BMI = Weigth/Heigth²

A BMI of 21--23 kg/m2 or less is normally an indication of energy malnutrition.

For individuals, the recommendation is to maintain a BMI in the range 18.5--24.9 kg/m²

To avoid a weight gain and to achieve better health, people of all ages should include a minimum of 30 minutes of physical activity of moderate intensity (such as brisk walking) on most, if not all, days of the week ⁶.

Questionnaire For Assessing The Nutritional Health Of Older Adults ⁵

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All the nutrients necessary for optimal health in the desirable amounts can be obtained by eating a variety of food in adequate amounts from the following five food groups.

1. Four servings of vegetables and fruits, subdivided in to three categories:

2 servings of good source of vitamin c, such as citrus fruits, salad greens and raw cabbage.

1 serving of a good source of Pro vitamin-A such as deep green and yellow vegetables or fruits.

1 serving of potatoes and other vegetables and fruits. 2. Four servings of enriched breads, cereals and flour products.

2. Four servings of enriched breads, cereals and flour products.

3. Two servings of milk and milk based foods, such as cheese.

4. Two servings of meats, fish, poultry, eggs, dried beans, peas, nuts.

5. Additional miscellaneous foods including fats, oils and sugars, as well as alcohol; the only serving recommendation is for about 2-4 tablespoons of polyunsaturated fats, which supply essential fatty acids.