Dietary Assessment Tools For Older Adults

Over the past decade, the importance of nutritional status has been increasingly recognized in a variety of morbid conditions including cancer, heart disease, and dementia in people over the age of 65 (Wells and Dumbrell, 2006).

Unfortunately malnutrition in older adults is regularly underdiagnosed (Gariballa, 2000). Although there is no widely accepted definition of malnutrition in older adults, some common indicators include involuntary weight loss, abnormal body mass index (BMI), specific vitamin deficiencies, and decreased dietary intake.

The Malnutrition Universal Screening Tool (pdf) (MUST) and the Mini Nutritional Assessment (pdf) (MNA) are commonly used tools to assess the nutritional status of older adults in community and institutional settings (Elia and Russell, 2012). However, these tools come with limitations. Careful nutritional assessment is necessary for both the successful diagnosis and development of comprehensive treatment plans for malnutrition in this population.

A group of researchers based in the UK have developed a novel technology to assess dietary intake in the elderly. The NANA (Novel Assessment of Nutrition and Ageing) project is a multidisciplinary project consisting of nutritionists, hardware engineers, software engineers and psychologists. The team has developed the NANA system using touchscreen technology to assess diet, cognition, mental health and physical activity for an older adult population.

The dietary component of the NANA system has been successfully validated against traditional measures of dietary intake such as 4 day estimated food diaries and 24 multiple pass recalls and biological markers of nutrient intake. Certain nutrient intakes recorded by NANA and the 4 day estimated diary were measured against the biological markers for these nutrients in blood and 24 hr. urine sample. The results highlighted that intakes recorded by NANA correlated well with intakes recorded by the 4 day estimated food diary, which is considered the gold standard for assessing food intake in older adults. This research suggests that the NANA system is a suitable alternative for the assessment of diet for an older adult population.

The development and validation of the system paves the way towards obtaining more accurate information about what older adults are eating so that those that are at risk of malnutrition can be identified. Further development of the system may facilitate the automation of nutritional analysis and allow for the longitudinal capture of dietary intake.

For more information, see the videos on the following page: ITV News Videos: Malnutrition – What are the warning signs? and Thousands of Elderly People are Malnourished.


  • Elia M., Russel CA., 2012. Nutrtional Screening Survey in the UK and Republic of Ireland in 2011. A Report by the British Association for Parental and Enteral Nutrition (BAPEN).
  • Gariballa SE., 2000. Nutritional Support in Elderly Patients. J Nutr Health Aging. 2000;4:25–7.
  • Wells, LJ., Dumbrell, CA., 2006. Nutrition and Ageing: Assessment and Treatment of Compromised Nutritional Status in Frail Elderly Patients. Clin Interv Aging. 2006 March; 1(1): 67–79.

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