Mohammed T. Abou-Saleh

NUTRITIONAL STATE 751can be difficult and may be counterproductive. Changes of thissort may actually reduce the opportunity to provide a nutritiousdiet to elderly hospitalized patients at a time when it is mostneeded. Fresh fruit is often difficult to obtain in institutions andmodern methods of mass food preparation have been criticized. Itmay not be appreciated that less mobile elderly people have a fastprotein flux that requires a higher, not lower, daily requirementfor protein 17,18 and the protein intake of long-stay elderly patientscan be inadequate 31 .Poor dentition is associated with undernutrition 46 and thefitting of dentures to old people in institutional care has beenshown to increase the consumption of raw vegetables 47 ; 78% ofindependent elderly patients examined by MacEntee et al. 48believed their oral health to be good but only 17% had clinicallyhealthy mouths. A study of hospitalized patients aged 61–99 yearsfound that 60% had disease of the oral soft tissue 49 .Medication can impair the absorption and reduce the availabilityof essential nutrients, impair appetite, cause dry mouthsand constipation or directly promote the loss of minerals, as withdiuretics and potassium 50 .For those living in the community, preventive health care withearly recognition and treatment of illness is essential. The elderlypopulation may benefit from greater education and advice abouthealthy and affordable eating, issues normally targeted at youngerage groups. The judicious use of fruit juices, frozen vegetables andsome convenience foods might ease the burden of food preparation.Realizing that visual impairment and arthritic joints canprevent shopping and the opening of packets and tins may pointthe way to practical interventions, such as the provision ofdomestic aides or arranging for someone to collect shopping. Onesurvey found that 22% of elderly people who had difficultyopening screw-top jars had to ask non-household members to doit for them 51 . The teaching of culinary skills is particularly relevantto the older bereaved male who never cooked when his wife wasalive. Men, although age-for-age fitter than women, are twice aslikely to say they are unable to cook a main meal 52 .In the modern era shops themselves are often large, impersonal,confusing places and sited some distance from home, makingeffective shopping difficult for physically and mentally disabledpeople. Low income and disability not only restricts ability toafford a protective diet but also limits access to retailers wherehealthy food can be purchased more cheaply. Local shops are lessprevalent and can be significantly more expensive than moredistantly sited supermarkets 53 .Finally, unless people are aware of the possibility of undernutritionand able to make an assessment, little progress will bemade for the sick and vulnerable. Sadly, doctors and nursesfrequently fail to recognize undernourishment because they arenot trained to look for it 54 and medical students’ knowledge of theissue of nutrition is poor 55 . Improved education is greatly needed.The Royal College of Nursing 56 provides clear guidelines for theassessment of nutritional status in older people.CONCLUSIONA great deal needs to be known about the fundamentals of diet,nutrition and mental health in old age. The evidence connectingnutrition and morbidity suggests this is an area of importance toall professionals working with elderly people and a strong casecould be made for the regular involvement of a dietician in thepsychogeriatric team.Establishing roles for nutritional intervention offers prospectsof simple and economic measures that may improve the treatmentand prognosis of mental disorders in old age, enhance clinicalrecovery and reduce morbidity.At the present time, it cannot be claimed that vigorous dietaryintervention offers curative treatment for mental illness butattention to diet may, at least, reduce the physical complicationsof mental disorder, hospitalization and ageing. However, there isaccumulating interest in the role of antioxidants in the treatmentof dementia [see Nutritional Factors in Dementia] and thepossible significance of omega polyunsaturated fatty acids formaintaining the development and integrity of neuronal functionhas obvious relevance to severe mental illness 57 . Schizophrenicpatients taking additional omega 3 polyunsaturated fatty acidsmay experience milder symptoms 58 and a recent study ofcommunity residing schizophrenic patients aged 20–79 yearsdemonstrated nutritional deficiency, despite most being overweight,with a high intake of saturated fat and low intake ofantioxidant 59 .Further exploration of the relationship between dietary constituentsand the course of mental illness may yet yield informationsignificant to the management of mental illness in old age.REFERENCES1. Department of Health and Social Security. A Nutrition Survey of theElderly. London: HMSO, 1979.2. Stuckey SJ, Darnton-Hill I, Ash S et al. 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