Malnutrition. According to the UNICEF, malnutrition "is a broad term commonly used as an alternative to undernutrition but technically it also refers to overnutrition. People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition). They are also malnourished if they consume too many calories (overnutrition)." We are focusing on the elderly who become, over time, undernourished for a variety of reasons.

Physical causes. It wouldn’t be hard to imagine how physical factors prevent our poor parents or Lolo and Lola from eating right and regularly. Chronic illness has a direct effect on losing appetite but it is also a circumstance where more nutrients are needed by the body (a so-called catabolic state where wasting away is occurring). Senile dementia and stroke are some examples of chronic conditions that make good nutrition difficult. Sometimes, it’s as simple as having no teeth, ill-fitting dentures, cavities or gum disease that make eating painful or impossible. There are also certain medications that suppress appetite, alter taste, or cause nausea and vomiting. The usual culprits are antihypertensives, antidepressants, osteoporosis drugs. Aging digestive organs may also lead to malabsorption where essential nutrients are taken in by the body. Some digestive enzymes and acids do not work the way they used to.

Psychological/Social Causes. Again this would be easy to understand. The Social Weather Station (SWS) just reported that 3.8M Filipinos went hungry last quarter. How many of these are aging people without any source of income? Depression can lead to loss of appetite. Some old people happen to be alcoholics as well. It’s known that alcoholism suppresses appetite and leads to vitamin and nutrient deficiency. Older patients are also placed in restrictive diets (low salt, no salt, low protein, etc.) that eventually make eating boring or unpleasurable.

Signs of senior malnutrition. A little detective work goes a long way to discover sources of suppressed appetite. Ask your loved one to lay out on a table ALL the medications he/she is taking. The side-effects are listed for every drug. Some drugs cause "dry mouth" or "loss of appetite" and these may then be referred to the doctor for adjustments in dosage or outright change in medication. Look for physical problems such as wounds that make walking an ordeal and thus limit trips to the kitchen or dining room. Check if there appears to be dental problems that make eating and swallowing hard.

How to help. Let’s start with the most obvious – enrich the diet. Spread peanut butter, our own "matamis na bao," jams on crackers or fresh fruits like bananas and papayas. Melt cheese on bread, vegetables, and meats. The way around restrictions on salt in the diet (making food bland) is to experiment with herbs and spices. Flavorful food should help put back Lolo’s appetite. Three square meals a day is a rule to throw out. Instead, prepare for in-between snacks like a piece of fruit, cheese, or if not diabetic, native cakes and pastries (as merienda). Consider using nutritional supplements because the malnourished senior lacks protein, calcium, zinc, vitamins B-6 and B-12, folate and niacin. Please remember that vitamins and minerals are not substitutes for food but rather substances that draw out nutrients from food.

Most hospitals employ registered dietitians/nutritionists and they are the experts in designing diets for malnourished elderly people. Your favorite doctor can give a referral for professional nutritional support.

Finally, there is always room for exercise. Daily exercise beats depression, restores appetite, strengthens bones and muscles and boosts the immune system. If, to Leon Trotsky, "old age" is "most unexpected" perhaps the revelation that the old also suffer malnutrition is even more unexpected.

Billboard. Our sympathies to the family of the late Col. Ruben Dario (died Oct. 3) – Tita Maribel, Teddy and Janine, Manolet, Robert and Kirsty, and Jed. Tito Ruben was a great pilot and flew for no less than President Ferdinand Marcos. May you rest in peace.

Why not a day trip to Our Lady of Manaoag in Pangasinan? After the 8 a.m. mass, a full breakfast of boneless bangus (milkfish), eggs and rice is just about right at Gianna’s Restaurant, a stone’s throw from the church. Thank you to proprietor Mrs. Elma Espejo-Cordova for the hearty fare.

Fact/Factoid. 15 percent of women struggle with pregnancyrelated depression. (MSN Health).

Dr. Pujalte is an orthopedic surgeon. Email jsp@pldtdsl.net Webpage http://www.webspawner.com/users/jspujalte/index.html