Unanswered questions in the nutrition of elderly people.

I n recent times much interest has been aroused in the nutrition of elderly people and the question of malnutrition has been raised. Surveys are being conducted in the United Kingdom to try and find at least some of the answers. Present knowledge indicates that many older people eat less as they grow older, and McGandy, Burrows, Spanias, Meredith, Stone & Norris (1966), in a study of nutrient intakes and energy expenditure in men of different ages, found the total calorie requirements diminished with age in human subjects and that there is a disproportionate drop in fat intake with age: this may explain a decrease of 15 mg/Ioo ml in serum cholesterol between the ages of 50 and 70 years. This decrease in total calorie intake was accounted for by decrements in basal metabolism and in energy expended in physical activity. The next relevant fact was that lower levels of essential food substances have been found in certain groups of elderly individuals. Kataria, Rao & Curtis (1965) found vitamin C levels of elderly people living at home to be superior to that of those living in a hospital and a large welfare home. Andrews, Brook & Allen (1966) suggested that vitamin C-rich fruit and fruit juices be given routinely in institutional diets as they showed that the vitamin C status of elderly people resident in two hospitals and a large welfare home was significantly inferior to that of elderly people living at home or in a small welfare home. Griffiths, Brocklehurst, Scott & Marks (1967) estimated levels of ascorbic acid and thiamine in normal young volunteers, in geriatric patients on hospital admission, and in elderly people in their own homes. No clinical studies were made and these levels cannot be correlated with clinical signs. On admission to hospital, 58% of the patients were deficient in ascorbic acid, 40% in thiamine, and of these 24% were deficient in both, as judged by the levels in younger volunteers. The levels in the elderly could be raised to those of younger volunteers with 3 weeks of vitamin supplementation, but on a normal hospital diet no such improvement was seen. Griffiths et al. found that the preparation of institutional diets requires to be closely supervised, but there appears to be no suggestion that these groups of people with low vitamin C levels were actually ill. Read, Gough, Pardoe & Nicholas (1965),