Dietary Intake

There are several difficulties in selecting a sample of elderly people for a nutritional study. Some authors [29] suggest the selection of'healthy' elderly. Even if it is possible to obtain an almost homogeneous group, this is not a 'real' sample of an elderly population, which is, on the contrary, characterised by a high heterogeneity of subjects:

Table 1. Clinical signs in malnutrition

Hair

Thinness, sparseness, easy pluckability

Face

Diffuse depigmentation, nasolabial seborrhea

Eyes

Conjunctival xerosis, corneal

xerosis, keratomalacia, blepharitis

Lips

Angular stomatitis, angular, scars, cheilosis

Tongue

Magenta tongue, glossitis

Gums

Spongy, bleeding

Glands

Thyroid enlarged, parotid enlarged

Skin

Xerosis, follicular hyperkeratosis, petechiae, ecchymoses, dermatosis

Nails

Koilonychia

Subcutaneous tissue Oedema

Muscular and skeletral systems Muscle wasting, osteomalacia

Internal systems Hepatomegaly, listless, apathetic, mental confusion, irritability, sensory loss, motor weakness, loss of balance Cardiovascular Cardiac enlargement, tachicardia

Subcutaneous tissue Oedema

Muscular and skeletral systems Muscle wasting, osteomalacia

Internal systems Hepatomegaly, listless, apathetic, mental confusion, irritability, sensory loss, motor weakness, loss of balance Cardiovascular Cardiac enlargement, tachicardia self-sufficient, not self-sufficient and institutionalised [30]. Besides, nutritional examination in a selected healthy elderly population would not show variations in dietary patterns; in fact, they try to maintain the food habits because of a reduction of the adaptation capacity with age [31]. Elderly people's associations with food are more emotional than those of younger adults; for some, food intake is the main event in the course of the day, often providing the only possibility of social contact [31]. The elderly have repeatedly been told that good food means good health [31]. So, the elderly may eat simply because they know they have to, even if they do not feel like eating, or they may eat because the food is delivered and throwing it away would be wasteful [32].

Another question is the continuing debate about the use of reference parameters in nutritional studies in the elderly. In fact, the value of dietary intake data as an indicator of health status in an elderly population is debatable [32]. In a population with an increased number of physical and mental disabilities like the elderly, dietary assessment methods might be adapted or different methodologies might be developed [19]. An independent measure of the reliability of reported energy can be obtained by calculating the ratio of energy intake to the resting metabolic rate (RMR) [33].

In spite of their limitations, dietary surveys are the main tool for assessing nutritional habits, establishing food policies, and creating awareness of nutritional needs [31]. Although biochemical tests have been widely accepted as an objective assessment of nutritional status, especially of marginal states, malnutrition and suboptimal nutrition can be adequately understood only in the light of dietary data on food consumption, meal patterns and methods of preparation [31]. Any method used for dietary surveys in the adult population can, theoretically, be used for surveys in the elderly [31].

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