Tasteful Solutions to Elderly Malnutrition Reprinted from Food Insight May/June 1993 Good nutritional habits never get old. Yet malnutrition is serious health problem among the nation's elderly, according to a recent survey of health professionals specializing in elder care. The survey of 750 physicians, nurses and administrators of health care institutions, found that one in four elderly patients is malnourished. One-half of all elderly hospital patients and 40 percent of nursing home residents are believed to suffer from malnutrition. Elderly people are not getting proper nutrients because of deficiencies, excesses, or imbalances in food or diet, according to the survey sponsored by the Nutrition Screening Initiative (NSI), a coalition of more than 30 national medical, health and aging organizations. To help educate dietitians and other health care professionals about the importance of elderly nutrition, the American Dietetic Association Foundation and the International Food Information Council Foundation have been sponsoring a seminar series, "Better Eating for Better Aging," in conjunction with various state dietetic associations. Nutrition and Aging "Nutrition plays a significant role in the prevention of illness, as well as in treatment and recovery, " Barbara Posner, Dr.P.H., M.P.H., told participants at a recent "Better Eating" seminar cosponsored by the Minnesota Dietetic Association. Posner, Assistant Director of Research at Boston University and NSI spokesperson, said that many elderly have unmet health needs, which affect their nutritional status. "Many older people living alone have declining motor skills, making it difficult to shop for or cook food, " Posner explained. Depression also can affect their nutritional status. To identify those at risk of malnutrition, Posner said nutrition screening should be routinely incorporated into medical examinations. A nutrition screen can range from a simple review of weight, height, skin tone, diet, living conditions and behavior, to blood tests and sophisticated assessment techniques. A self-administered checklist is available from NSI to spot eating problems, economic hardship and other conditions affecting nutritional status. Among the primary reasons many elderly become malnourished are losses in their senses of taste and smell, according to Susan Schiffman, Ph.D., professor of medical psychology at Duke University Medical Center. "Without the simple pleasures of taste and smell, the overall quality of life is greatly reduced, especially for the elderly whose senses decline due to aging, " Schiffman said. Declines in taste and smell usually begin around 60 years of age and become more pronounced in subsequent decades of life. Certain diseases and/or medications prescribed for such conditions also can contribute to chemsensory losses. Thresholds, or the levels at which flavors are detected, are about 2.5 times higher in the elderly than in young college students, said Schiffman. But the threshold for detecting fat in food is four times higher in the elderly, which can be problematic for many seniors following low-fat diets. "People with higher thresholds for taste may have difficulty following a low-fat diet because they miss the mouthful contributed by fat and certain odor molecules, which are primarily fat soluble," said Schiffman. Improving Taste To increase consumption of lower-fat nutrient dense foods, Schiffman offered a simple solution: Improve the taste by adding herbs, spices or flavor enhancers such as monosodium glutamate (MSG). Although scientists once believed there were only four taste sensations - sweet, salt, sour and bitter - new data suggest that there are many more tastes such as glutamate. This taste, known as"umami" to the Japanese, has been described by Westerners as brothy or meat-like. "Elderly people may be unknowingly consuming large amounts of fat without being able to really perceive it," said Schiffman. "Yet MSG can be used in foods to help replace some of the mouthfeel normally contributed by fat, allowing older persons to enjoy their food while maintaining a nutritionally adequate, low-fat diet." Studies have shown that adding glutamate to blended or table food improves appetite and reverses the effects of anorexia among the elderly in long-term care settings. MSG has been added to foods since the turn of the century and is classified by the Food and Drug Administration (FDA) as a Generally Recognized as Safe (GRAS) food ingredient. FDA is currently updating its review of MSG safety as part of its ongoing review of all GRAS ingredients, and is expected to issue a report next year. Reprinted from the International Food Information Council Foundation, 1993

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