Many community-dwelling seniors are reported to have inadequate dietary intakes. Factors affecting food intake have been studied mainly from the perspectives of health professionals. As the reasons for adequate food intake are complex, understanding the seniors' perspective could provide further help in understanding their needs. / Three semi-structured interviews were conducted with each of eight community-dwelling women aged 73 to 91 who were at-risk of malnutrition. A qualitative analysis showed the women were reporting three essential aspects: struggling to maintain their independence (i.e., frustration with health care, stereotyping seniors, simplifying cooking); learning new ways of functioning (i.e., adapting to health limitations, simplifying meals etc) and; taking control (i.e., planning own meal and food supplies, monitoring health and keeping physically and mentally active). Finally, this qualitative research paradigm was useful and it demonstrated how careful listening could help to understand the individual needs of free-living seniors at risk of malnutrition.

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Dietary assessment methods are often plagued with inconsistent or inaccurate data. Self-reported intakes are particularly susceptible to error as research has shown that humans habitually report food intake inappropriately. Self-reported intakes have been used to create energy recommendations for populations. In order to assess energy intake, a novel 4 day multimedia dietary assessment method was developed utilizing a tape-recorder and camera in an attempt to more accurately quantify energy intake than traditional methods. The Recommended Nutrient Intakes for Canadians ( RNIC) provide population mean energy estimations. An objective was to determine whether the RNIC provides an accurate index of energy requirements. Current literature suggests that the RNIC is inadequate in some populations to meet energy needs when validated against methods such as doubly-labelled water (DLW). Total energy expenditure (TEE) and body composition were determined through the use of DLW in 76 women (49--93 years) over 13 days. The multimedia diet records did not reflect true intake in these subjects as demonstrated by a mean 24% underreporting rate when compared to TEE. Mean energy expenditure (MJ/day) as determined by doubly-labelled water was significantly higher (p < 0.01) in each stratified age range when compared to reported energy intake by multimedia diet records. The use of tabulated RNIC's underestimated true energy requirements by a mean of 29%. Food and Agriculture Organization/World Health Organization energy predictions closely estimated actual TEE in the study population. This research agrees with current literature questioning the validity of self-reported dietary intake data.

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The nutritional status of forty-five women aged 71 to 89 years, who met defined health criteria, was assessed by an analysis of three-day diet records and anthropometric measurements. Subjects were grouped, according to the average caloric intake at home <75%> of daily intake to reflect the dependency of the subjects. Subjects were also divided into seven groups according to the site from which they were recruited.For the total population, there was no correlation between calorie intake per day and age, and there were negative correlations between age and all of the measures of body composition. In addition, a higher intake of calories per kg was negatively correlated with weight, suggesting that the heavier subjects had proportionately lower levels of caloric intake per kg of body weight.There were no significant differences in the risk for protein-calorie malnutrition (PCM) among the healthy elderly women who were subjects of this study as measured by an analysis of their dietary intake and anthropometric status, and based upon their dependency on others for <_75%> of their average daily caloric intake. It is concluded that for this population, source of food at home or away, as an indication of dependency, did not significantly affect nutritional status.When grouped according to the site from which they were reecruited, subjects in two of the groups were found to have the potential for malnutrition. Subjects in one of the groups had poor intakes of vitamins and minerals, but adequate body fat and somatic protein stores, and were not at risk for PCM. However, subjects in the other group appeared to have good diets and adequate fat mass, but very low muscle protein stores, and were at significant risk for PCM.The role of socioeconomic factors were minimal in this population as the two groups found to be at greatest risk were those observed to be near opposite ends of the socioeconomic spectrum. Therefore, it is concluded that upper income elderly are as much at risk for PCM as those in lower income groups, and that women in upper socioeconomic groups must be assessed for risk for PCM.It is apparent that the nutritional needs of most of the healthy elderly women in the study were being met. For those groups found to be potentially at risk, there was a possibility that they may not have been as healthy as was indicated, suggesting that risk for PCM is more a function of poor health which results in associated dependency. / Department of Home Economics

Hypothesis. We hypothesized that contrary to "normal aging," frail elderly women would have a heightened resting energy expenditure per kg fat free mass (REE/kg FFM) and thermic effect of food (TEF) response. / Methods. 13 healthy (H) [X +/- SEM: 81.4 +/- 1.1 yr] and 9 frail elderly women (F) [84.7 +/- 1.6 yr], free from acute conditions underwent REE and TEF measurements (liquid standard mixed meal: 720 kcal, 58% carbohydrate, 14% protein, 28% fat) using ventilated hood indirect calorimetry. Anthropometric and body composition measurements, thyroid hormones, cortisol, cytokines and catecholamine concentrations, and physical activity (PASE) and mobility ("time up and go" TUG) scores were related to the results obtained. / Results. H had a faster TUG: 10.2 +/- 1.6 vs. 21.0 +/- 9.3 s (p=0.001), greater PASE score: 179.2 +/- 116.1 vs. 47.1 +/- 26.2 (p=0.003), greater triiodothyronine [T3]: 5.1 +/- 0.6 vs. 4.3 +/- 0.4 rhomol/L (p=0.003) and lower cortisol concentrations: 351.1 +/- 19.9 vs. 474.5 +/- 43.6 nmol/L (p=0.011). In H vs. F: REE/kg FFM was 1044 +/- 20.4, 1021 +/- 23.7 kcal/day (NS) and TEF response as expressed as % of REE was 18.4 +/- 5.6, 19.5 +/- 4.2 (NS). The time course of glucose (p=0.043) and insulin from 90 minutes onwards (P=0.013) suggested insulin resistance in F. REE was positively correlated with FFM, percent body fat and [T3] (r>0.499, p<0.021). / Conclusion. REE/kg FFM and TEF response was not different between H and F and thus the greater prevalence of malnutrition in F, cannot be explained by these parameters.

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