The gut microbiota is the assembly of microorganisms living in our intestine and their genomes are known as the microbiome. The correct composition and functionality of this microbiome is essential for maintaining a "healthy status." Aging is related to changes in the gut microbiota which are frequently associated with physiological modifications of the gastrointestinal tract, as well as, to changes in dietary patterns, together with a concomitant decline in cognitive and immune function, all together contributing to frailty. Therefore, nutritional strategies directed at restoring the microbiota in the elderly have to be addressed from a global perspective, considering not only the microbiota but also other extra-intestinal targets of action. The present review aims at summarizing the current knowledge on intestinal microbiota alterations and other functions impaired in the elderly and to analyze tools for implementing nutritional strategies, through the use of probiotics, prebiotics or specific nutrients in order to counterbalance such alterations.

Nutrition and the gut microbiome in the elderly.

Clinical and Experimental Pharmacology and Physiology

Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.

Malnutrition in Older Adults-Recent Advances and Remaining Challenges.

Purpose The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. Methods A literature search was performed on six databases using the terms "malnutrition", "hospitalised elderly", "nutritional assessment", "Mini Nutritional Assessment (MNA)", "Geriatric Nutrition Risk Index (GNRI)", and "Subjective Global Assessment (SGA)". Results According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. Conclusion It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future.

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Assessing the nutritional status of hospitalized elderly.

Polypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients. This cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled multicentre study of polypharmacy in primary care. Patients’ baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily). Three thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22–1.71), > 8 diagnoses (OR 2.64; 95% CI 2.24–3.11), BMI ≥30 (OR 1.18; 95% CI 1.02–1.38), a lower SF-12 physical health composite score (OR 1.47; 95% CI 1.26–1.72), and a lower SF-12 mental health composite score (OR 1.33; 95% CI 1.17–1.59) than the median of the study population (≤36.6 and ≤ 48.7, respectively). Age ≥ 85 years (OR 0.83; 95% CI 0.70–0.99) led to a significantly lower risk for excessive polypharmacy. No association with excessive polypharmacy could be found for female sex, low educational level, and smoking. Regarding the study centres, being recruited in the UK led to a significantly higher risk for excessive polypharmacy compared to being recruited in Germany 1/Rostock (OR 1.71; 95% CI 1.27–2.30). Being recruited in Germany 2/Witten led to a slightly significant lower risk for excessive polypharmacy compared to Germany 1/Rostock (OR 0.74; 95% CI 0.56–0.97). Frailty, multimorbidity, obesity, and decreased physical as well as mental health status are risk factors for excessive polypharmacy. Sex, educational level, and smoking apparently do not seem to be related to excessive polypharmacy. Physicians should especially pay attention to their frail, obese patients who have multiple diagnoses and a decreased health-related quality of life, to check carefully whether all the drugs prescribed are evidence-based, safe, and do not interact in an unfavourable way. This trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).

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Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy.

Changes during aging and their association with malnutrition

Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age. According to World Health Organization, ageing is a course of biological reality which starts at conception and ends with death. It has its own dynamics, much beyond human control. However, this process of ageing is also subject to the constructions by which each society makes sense of old age. In most of the developed countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old age. In this chapter, you understand the details of ageing processes and associated physiological changes.

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Ageing Process and Physiological Changes

Health consequences of obesity in the elderly

Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations.

India is endowed with several indigenous foods (IFs), that hold special cultural significance among local and ethnic caommunities, yet no attempts have been made till date to systematically compile their nutritive values. As per FAO's recent mandate on creation of “Global-Hub on Indigenous Food Systems,” IFs have received renewed global recognition for their potential to contribute to improved food security while enhancing biodiversity across the world. Hence, the useful properties of wild IFs require proper study and documentation in order to bridge the gap between scientific evidence generation and indigenous peoples' ancestral knowledge. For this purpose, we conducted a literature search in two scientific databases: PubMed and Google Scholar, between July 2020 and December 2021, to identify studies reporting nutritive values and/or antinutrient content of IFs (not included in Indian food composition database), consumed by Indian indigenous communities. A total of 52 Indian research articles were included, from which data was selected and extracted, to create a compendium on nutrient (n = 508) and antinutrient (n = 123) content of IFs, followed by computation of antinutrient-to-mineral molar ratios for 98 IFs to predict their mineral bioavailability. Maximum nutritive values were available for green leafy vegetables (n = 154), followed by other vegetables (n = 98), fruits (n = 66), cereals (n = 63), roots & tubers (n = 51) and nuts and legumes (n = 36). Several IFs seen to have better nutritional content than conventional foods and were found to be rich (i.e., >20% Indian recommended dietary allowances per reference food serve) in iron (54%), calcium (35%), protein (30%), vitamin C (27%), vitamin A (18%), zinc (14%) and folate (13%). Some IFs displayed high levels of antinutrients, however, anti-nutrient-to-mineral molar ratios were found to be low (for mainly leafy vegetables, other vegetables, and roots and tubers), thus indicating high mineral bioavailability. Hence, efforts are desirable to encourage the inclusion of these nutritionally superior IFs into the usual diets of indigenous communities. The IF database collated in our review can serve as a resource for researchers and policymakers to better understand the nutritional properties of region-specific IFs and promote them through contextual food-based interventions for improved dietary quality and nutrition outcomes in indigenous population of India.

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Indigenous Foods of India: A Comprehensive Narrative Review of Nutritive Values, Antinutrient Content and Mineral Bioavailability of Traditional Foods Consumed by Indigenous Communities of India

Manisha Sabharwal

Papers

Changes during aging and their association with malnutrition

Ageing Process and Physiological Changes

Health consequences of obesity in the elderly

Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations.

Indigenous Foods of India: A Comprehensive Narrative Review of Nutritive Values, Antinutrient Content and Mineral Bioavailability of Traditional Foods Consumed by Indigenous Communities of India