The majority of poor older people in developing countries enter old age after a lifetime of poverty and deprivation. In many developing countries including Ghana, the ageing of the population is taking place in the absence of adequate economic development, and thus necessary economic resources may not be available. We will define the aged or older individuals here as people who are at least sixty-five years or older.

There are a wide range of reasons why older individuals might not be eating the most nutritious diet which is all the more reason why health professionals and care providers need to be constantly aware of the necessity for maintaining an optimal nutritional health status in the elderly. Many elders have insufficient income and are poor. They also are highly vulnerable because they have low educational levels, few pension benefits, lack adequate housing, suffer from gender inequalities and are poorly integrated socially.

In view of the above, the elderly may be at serious risk for malnutrition. There are also physical and clinical factors that contribute to malnutrition in the aged.
After age fifty there are many metabolic and physiological changes which impact on the nutritional needs of an individual. The metabolic rate slows and can decline as much as thirty percent over a lifetime. This results in decreased caloric needs which can be complicated by changes in an older person’s ability to balance food intake and energy needs. Even with a decreased caloric need, many older people have difficulty getting sufficient calories which can eventually lead to chronic fatigue, depression, and a weakened immune system.

As we age our body composition changes with a decrease in lean tissue mass (as much as 25%) and an increase in body fat. Such changes can be accelerated because older adults utilize dietary protein less efficiently and may actually need a greater than recommended amount of high quality protein in their diet to maintain lean tissue mass. These changes in metabolism and physiology can be exaggerated due to complications from digestive difficulties, oral and dental problems, and medication-related eating and nutrient problems.

When a person does not eat enough of the necessary foods to satisfy both the energy and tissue-building needs of the body, malnutrition occurs. Maintenance of fluid balance is also an area of crucial concern among the elderly. The failure to drink sufficient liquids leads to dehydration and this can have serious consequences. Frequently, dehydration occurs with malnutrition.
Risk factors for malnutrition among the aged include,

• Chronic disease and conditions such as diabetes, AIDS, alcoholism, arthritis, cancer, depression and dementia, digestive disorders, heart or kidney disease, neurological disorders, and sensory losses
• Chronic use of multiple medications: Many elderly people are on medication for chronic ailments and these medications may have side effects such as nausea, loss of appetite and diarrhea which may affect food intake.
• Disability or functional decline: Loss of the ability to move around and function independently may lead to inadequate food intake hence resulting in undernutrition.
• Hospitalization and admission to a nursing home: Malnutrition can occur in hospitalized and institutionalized patients either due to negligence of hospital staff or inability of patient to tolerate food due to his or her primary illness.
• Inadequate income or fear of spending: Poverty is the one important factor which could adversely affect food intake among the aged.
• Mouth and dental problems like loss of teeth and difficulties in swallowing could lead to poor food choices, reduced food intake and hence malnutrition.
• Social isolation and living alone: Increasingly many aged in Ghana are beginning to live in isolation as we gradually make the transition from the extended family system to the nuclear family system.
• Specially prescribed diets used in management of diabetes, heart disease, or kidney disease: Compliance to such diets are not always easy, hence the unmotivated elder may not comply.

The above concerns raised are real and should be taken into consideration when planning for the nutrition needs of an older or aged individual.

By Laurene Boateng

Reviewed by Dr. Edward Owusu Nyarko