A new nutrition screening tool has recently been launched to help correct the neglect of the problem of malnutrition in elderly Australians. It is estimated that up ro 30% of people over 60 years of age living independently in the communiv QW suffedngfrom malnutrition Poor nutrition increases the time an older person requires to recoverfrom acute illness, and leads to longer hospital stays, more complications and higher readmission rates. lhese factors all lead to a poor health outcome and increased health care costs. lhe Austmlian Nutrition Screening Initiative is a checklist to be used to identi& those elderlypeople who may be at rbkfrom malnutrition lhis screening initiative represents thefZrst national effort to raise the awareness of the problem of malnutrition among elderly people by bringing together organisations with a common interest in this problem Addrrss ciJm~sporrderrce lo Dr Perer S Lipski, SraflSprc'ialisr irr Geriarric rbledicirie, Cerirml Comr .4ma Healrli Srnice Depr r f Grriarric ,Medicine, Heolrll Senicc.s Biii/diirg / i w l 2, Gosfirrd Hmpiral. Go.sford, iVSIC: ??50. REFERENCES Buiikcr. V.W. & CI:iyton. B.E. (1989) Research review studies in tlie nutrition of clderly people with pnniculnr reference to esselitiiil trace clciiients..4ge arid Cobiiic. L & Syrette. JA (1995) What is tlie nutntionnl sliitus of oldcr Auslr:ili:iiis'? h x w d b i g r rfrlre .Vtrmriorial Socien cl/lirsrmlia. 19. 139-145. Davics. L. (1990) Socioccoiiomic. psychologic;d ;id cducutional aspects of intiintion in old age. ,Age aiid.4geirig. 19. S37-S41. Delnii. M. ct :iI. (1990) Dietilly siippleciie~ilntio~i in elderly p:itieiits with fractured neck o f femur. Laircer I. 1013-1016. Dcp;inmciit of Hc.;ilth ;ind SOCI;~ Securiry ( 1979) iVrrrnrioii and Healrli iri O/d.-lge. Rep Hciilth SOC Sub N o 16. London: HMSO. Depmnieiit of Health aiid Social Security (1991) Diefar!' Rejemice Valires j J r fi~id Eiierg~. a d .Vttrneiirsfor rlie Uriired Kingdom Repon Hcnlih Soc Sub N o 41. London: HMSO. Metabolic evidence that the deliciences of viraiiiin BI? (cobalamin). folate and vitamin 86 occur commonly in elderly people. Americari Joirnial of Cliriical Ntlmrion 58. 468-476. Lehniann. AB. (1991) Nutrition in old age: update and questions for future research: pan I & 1. Reviews in Cliriieol Gerunrolofl. I. 135-145. !31-140. Lipski. PS. ( 1992) Gut Bacteria. Nirfririori and rbe SmaN Bowel iri rlte Elder!!. MD Thesis. Sydney Sydney Uniwnity. Lipski. P.S. (1993a) Undernutrition in the elderly B ciuse for concern. Modem Medicirie Aiisrmlia. 36(4). 108-120. Lipski. P.S. et d. (1993b) A study o f nulntioii~il deficits of long-stay geriatric potieiits. .Age aiid Ageirig. 22. !44-155. McWhiner. J.P. & knnington. C.R (1994) Incidence aiid recognition of miiliiutrition in liospital. Brifalr Medical Joitmal. 308. 945.948. Posner. B.M. et A. (1993) Nutritioii and health nsks iii [lie elderly: the Nurnuon Scnxniiig liiitiative. Arnericaii Joirnial of Riblic Healrli. 83(7). 972-918. Russell. RM. B Suter. P.M. (1993) Vitmiin requirements of elderl...

Bacterial contamination of the small bowel is probably the commonest cause of occult malabsorption in the elderly. It may occur in patients without a 'blind loop' or suggestive symptoms of diarrhoea and weight loss. We have prospectively studied the apparent prevalence of presumed bacterial contamination of the small bowel and its effect on nutritional state. Subjects were divided into three groups: (A) 54 young fit subjects; (B) 103 fit community elderly subjects; (C) 73 elderly long-stay hospital patients. All subjects had simultaneous lactulose hydrogen breath test and 14C-glycocholic acid breath test. Nutritional state was assessed by anthropometry, haematology and biochemistry. There were significantly fewer positive 14C-glycocholic acid breath tests in the young than in the elderly subjects (3% vs. 20% and 17%, p less than 0.0001) but no difference in the number of positive hydrogen breath tests between groups. There was no association between positive breath tests and anthropometry, haematology and biochemistry except for a lower albumin in group B and a lower red blood cell folate in group C with positive breath tests. These abnormal breath tests indicate that bacterial contamination of the small bowel may be common in normal fit elderly people and in elderly long-stay hospital patients and may be a concomitant of 'normal' ageing, not necessarily leading to ill-health.

Current information suggests that dietary intake of nutrients declines with age and that undernutrition in elderly long-stay hospital patients may be under-recognized. We undertook to describe the daily dietary intakes of a group of elderly long-stay hospital patients (n = 92) (group A), using 7-day weighed dietary records. The aim of the study was to determine the adequacy of the diet and investigate whether any differences existed in the intakes of the hospital patients. An assessment of nutritional status was carried out by anthropometry, haematology and biochemistry and was validated by comparison with two further groups: fit young subjects (n = 41) (group B) and fit community elderly subjects (n = 92) (group C). Men in group B had the highest mean values for mid-arm circumference, arm-muscle circumference, corrected arm-muscle area and arm-fat area while women in group A had the lowest mean values for all measured anthropometric indices. There were significant correlations between daily energy intake and anthropometry for men in groups B and C. In group A 68% had intakes < 2/3 recommended daily allowance for energy, 100% for vitamin D, E, B6, folic acid; 98% for magnesium and zinc; and 90% for retinol. Serum calcium and serum alkaline phosphatase were correlated with vitamin D intake in men in group A. There was no biochemical or haematological evidence of undernutrition in the three groups. Elderly long-stay hospital patients were grossly undernourished and their dietary intake did not satisfy basal metabolic demands, based on recommended daily allowances.

Small bowel morphometry was studied in 25 subjects under the age of 70 years and 22 over the age of 70. There was no evidence of malabsorption or malnutrition in either group. Two distal duodenal endoscopic biopsy specimens were examined morphometrically. There were no significant correlations between age and areas of duodenal surface epithelium, crypts and lamina propria, heights of villi and surface epithelium, depth of crypts, crypt to villus ratio, number of intraepithelial lymphocytes, duodenal architecture, enterocytes, brush border and Brunner glands. Contrary to previous reports there was no evidence for a significant effect of age on proximal small bowel morphometry.

Objective: To investigate the attitudes of General Practitioners to older drivers on the New South Wales Central Coast.Method: Postal survey.Results: 275 General Practitioners (GP's) were surveyed, with a response rate of 173 (63%). 61% of GP's allowed an older driver with mild Alzheimer's disease to still drive a motor vehicle. 21% of GP's would allow the frail, medically unfit driver to still drive with a restricted licence locally if there was no public transport near by. Only 41% of GP's thought they had enough training to make an appropriate medical driver assessments. Only 29% of GP's routinely asked about driving habits and medical fitness to drive in all of their older patients. 55% of GP's felt that there should be another medical body to oversee all medical driver assessments rather than the GP.Conclusions: These survey results suggest that not all GP's are aware of the regulations for medical driver assessments, are not routinely screening older drivers, are not adequately trained in medical driver assessments, allowing medically unfit drivers to continue to drive, are concerned about the consequences of cancelling an older driver's licence and are unhappy in dealing with these issues.