Functional ability and nutritional status of free-living elderly people.

In 1990 almost half a billion people in the world were over 60 years old (World Bank, 1994). In only 40 years time this number will nearly triple. By the end of those same 40 years three-quarters of the world’s elderly population will be living in developing countries (Kinsella & Suzman, 1992). The challenge for the next century is to alter focus accordingly. Living longer comes at a price. Extra years will not necessarily be years of good health. In the complicated context of ageing biology, transitions from disease to disability rather than disease to death take on prime importance for older people. For many chronic diseases that can never be completely cured, delaying the onset of functional decline, or minimizing the impact of lost independent function on daily life, in effect approximates a ‘cure’ of the condition for those concerned (Besdine, 1990). Moreover, the presence of illness as measured by objective clinical data does not necessarily determine the presence or severity of dependency. And of course for many elderly people in developing countries the luxury of access to such knowledge is often unavailable. With risk of death increasingly likely, and both the longand short-term effects of disease, diet and life style hard to disentangle, the traditional health measures of life expectancy and morbidity begin to appear inadequate outcomes against which to measure any health or nutritional indicator in older people, or evaluate preventive strategies. To what then should we turn? The present paper addresses the following questions: Is functional ability an appropriate outcome indicator of health and nutritional status in free-living people in developing countries? What is functional ability and how can it be assessed? Is there any evidence of a relationship between functional ability and nutritional status in free-living elderly people? I will focus on the community as the site in which functional impairment first appears most often and my bias is towards malnutrition in developing countries. At times, I will refer to our own recent fieldwork experience amongst elderly slum dwellers in Bombay, but no data will be presented. The present paper aims to serve as an introduction to a new issue of growing practical importance in both nutritional gerontology and nutrition in the Third World.