OBJECTIVES. The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS. All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS. Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS. Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.

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Among free-living frail elders, weight loss is a predictor of early mortality after controlling for smoking, and functional and health status indicators. From our observations, however, we cannot conclude that prevention of weight loss would lead to increased survival. This needs to be explored in an intervention study.

Objectives: (1) To describe body composition of the frail elderly, (2) To relate lean body mass to muscle strength and functional ability, and (3) To assess temporal stability of strength measures and index of functional ability. Design: Cross-sectional study. Setting: Community-dwelling. Subjects: Thirty frail elderly women (81.5 AE 7 y) recruited from residences or out-patient facilities. Methods: Total body fat and fat-free mass (FFM) were determined using multi-frequency bioelectrical impedance analysis and predicted from anthropometry. Handgrip strength, biceps and quadriceps strength, functional capacities (Timed`Up & Go') as well as self-perceived health and functional status were measured. Reliability was assessed using two separate observations made one week apart by the same examiner. Results: Mean height, weight and body mass index were 1.52 AE 0.04 m, 60.4 AE 10.7 kg and 26.0 AE 4.8 kg/m 2 respectively. FFM (34.1 AE 4.6 kg) was lower than previous reports for autonomous elderly females and associated with all measures of muscle strength (Pearson's r 0.42±0.62, P 0.02), but not with performance on the Timed`Up & Go' or self-perceived health and functional status. Strength measures correlated signi®cantly with different subscales of self-perceived functional capacities and were signi®cantly lower among women with a low %FFM (n 19) and those reporting pain (n 11) as compared to other women. Excellent temporal stability for muscle and functional measures was observed (ICC 0.80±0.90). Conclusions: Muscle strength was strongly related to FFM in free-living frail elderly women especially in the absence of pain.

Homebound elderly were at high risk of inadequate protein and energy intake. Dietary supplementation in high risk individuals was well tolerated and led to modest weight gain and improvements in general well-being.

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