Introdution

Promoting physical activity and healthy diets, as major health determinants, has the potential to substantially reduce the burden of disease and to improve quality of life. More than studying the biological changes of ageing, it is important to understand interactions between intrapersonal, social and environmental influences, in order to develop appropriate and salutogenic strategies and interventions(McNaughton et al. 2012).

A large proportion of chronic diseases affecting the elderly can be either prevented or significantly improved with adequate nutrition, in order to contribute to a healthy, active, and successful ageing (Omran & J E Morley 2000).

Currently, in Portugal, there is no updated data about individuals’ food intake and dietary habits. The first and only national food and nutrition survey was conducted 35 years ago (1980), by the National Health Institute Doutor Ricardo Jorge (INSA) in collaboration with the Ministry of Agriculture and Fishery. Lifestyle changes since 1980 have meant the  Portuguese dietary habits have also changed accordingly. The outdated data does not allow us to infer about today’s food patterns and behaviours, namely because there is evidence that in Portugal dietary habits have changed dramatically due to new lifestyles, with relevant impact in health. In the present moment, a new food survey is being developed, with recognized importance in the 2012-2016 National Health Plan (PNS) strategic guidelines, namely through the Portuguese National Program for the Promotion of Healthy Eating.

Despite this national epidemiological data deficit, there are studies alerting to the fact that malnutrition is a prevalent problem in the elderly (in community dwelling older adults: 4.3% (malnourished) and 25.4% (at risk of malnutrition). Moreover, in long-term care home residents, this prevalence raises to as high as 85%. These high prevalence figures hide serious health complications, compromising quality of life and leading to substantial costs for health care systems and society in general (Nieuwenhuizen et al. 2010). Indeed, malnutrition is acknowledged as one of the greatest threats to health, wellbeing and autonomy of the elderly.

There are multiple determinants of malnutrition: physical health problems (cachexia, sarcopenia, malabsortion or hypermetabolism) (J. E. Morley 2012), appetite changes, cognitive skills, mental health impairment (depression, alcohol abuse, among other), social isolation, functional and/or financial autonomy, socio-environmental context (when living in the community or in residential homes, for example) (Visvanathan et al. 2004). Despite the large number of risk factors, malnutrition is preventable and effective interventions exist to detect and treat it. Early recognition of malnutrition allows for a timely intervention (Nieuwenhuizen et al. 2010).

However, malnutrition is often subtle in the elderly and its diagnosis requires specific screening tools and health professionals’ awareness and adequate training (J. E. Morley 2012). So, it comes as no surprise that there is widespread demand for adequate nutritional screening in high-risk populations and environments. Healthcare organizations should have a policy and a specific set of protocols to identify patients at nutritional risk, leading to appropriate nutritional care plans (Kondrup 2003).

It is difficult to make universal recommendations about nutritional screening and intervention plans because the prevalence and types of nutritional problems vary according to country, health care setting and local resources (Elia et al. 2005). In France, for example, health authorities published guidelines to develop a tool for identifying and managing the health of older subjects who are malnourished or at risk of malnutrition. Typical guidelines address the following questions: Who are the older adults at risk of malnutrition and/or what are the risk factors? What tools may be used to detect and diagnose malnutrition? How is severe malnutrition diagnosed? Which nutritional support strategy and practical measures should be recommended? How should coordination between the different caregivers and institutions be ensured? (HAS 2007)

Food and nutrition policies aiming to improve health and nutritional status of the population require a strong evidence-base and established-capacity to measure outcomes. A nutrition surveillance system fulfils such requirements and is defined as the regular and timely collection, analysis and reporting of data on nutrition risk factors, nutritional status and nutrition-related diseases in the population (WHO 2013). However, prior to the implementation of a nutrition surveillance system, an initial assessment should be conducted to determine the type and extent of nutritional problems by population strata, to identify and describe groups at risk, to assess the reasons for the presence of malnutrition, and to identify existing data sources that could be useful for the system. (WHO 2013)

The present study includes two research components, that together aim to contribute to the knowledge about the Portuguese elderly’s nutritional status and to the development of an electronic surveillance system, aiming at the elderly’s health promotion and protection. The two research components are:

1) Food and nutrition survey of population aged 64 and over residing in the Portuguese territory (national survey);

2) Development and testing of an electronic nutritional status surveillance system both at primary care level and at elderly residential homes. This system intends to be feasible and usable by health care professionals (GP’s and nurses, as well as other health professionals), allowing nutritional risk screening among the elderly and subsequent referral to a more detailed nutritional assessment (working as a monitoring, screening and referral tool).