Introduction

As explained in Chapter One, a major focus of the New Dynamics of Ageing (NDA) Programme was nutrition, and the two connected critical issues concerning older people: malnutrition and obesity. Malnutrition is defined as a state in which there is a deficiency, excess or imbalance of energy and nutrients which leads to adverse effects on body tissues, function and/or clinical outcomes (MAG, 2011). In the UK, it is estimated that at any one time under-nutrition affects over three million older people (The Advisory Group on Malnutrition, 2009). Approximately 10–14 per cent of people living in sheltered housing have been found to be at risk of under-nutrition, as well as 30–42 per cent of residents recently admitted to care homes (BAPEN Quality Group, 2010, p 4). Even older adults living at home are at risk – data from the 2012 Health Survey for England (HSCIC, 2013) indicate that 0.5 per cent of those aged 65–74 and 1.3 per cent of those aged 75 or older are underweight (defined as a body mass index <18.5kg/m2). Concurrently, overweight and obesity are a growing concern in older adults as they increase the risks for, and complications of, chronic diseases such as cardiovascular disease, type 2 diabetes, hypertension and some cancers. The prevalence of obesity in the UK is 34.1 per cent in men and 35.9 per cent in women aged 65–74, and 29.8 per cent in men and 28.7 per cent of women 75 years or older, respectively (HSCIC, 2013).

Various important contributors to under-nutrition, overweight and obesity in older adults have been identified. These include medication use, age-related physiological and psychological changes such as reduced mobility or problems with chewing and swallowing, depression or social isolation, cognitive factors such as dementia or other neurological illnesses, financial limitations, low levels of physical activity and function, limited access to affordable and appetising healthier foods, and difficulties in acquiring, preparing and consuming healthier meals (Brownie, 2006). These factors can result in an inadequate nutritional intake or an imbalance between energy intake and expenditure, both of which increase the risks for malnutrition and related acute and chronic illnesses.

Maintaining independence and autonomy are critical features of healthy and successful ageing. This includes being able to look after oneself, including shopping and preparing meals (McKie, 1999; Rioux, 2005).