The right of older persons to enjoy optimal health and live
in a dignified manner is protected in various international
documents and national legislation.1-4 The South African
government embraced this obligation by embedding
these socio-economic human rights in the Constitution of
the Republic of South Africa (1996).5 Cognisant of the poor
socio-economic status of individuals from various vulnerable
demographic groups, the South African government
implemented a social protection system to improve access to
food and provide for living expenses.6
It is possible that this
grant system contributed to the reported decrease in food
insecurity in the last decade,7
since social grants have been
reported to contribute to 42% of the household income for
poor families.8
Yet, single interventions such as cash transfers,
on their own, are not adequate to ameliorate malnutrition
amongst older persons and children.9
Furthermore, research
shows that South African older persons often act as heads of
households and their old age grants commonly contribute
to the general household income instead of taking care
of the beneficiaries’ own needs.10 In this regard, current
evidence indicates that a large proportion of older adults
are classified to be at nutritional risk.11,12 Malnutrition,
in otherwise healthy older persons, is classified as nondisease
related, and has socioeconomic, psychological and
hunger related components.12 Associated micronutrient
deficiencies contribute to impaired bodily function which
may be less obvious but have been associated with increased
susceptibility to infections, for instance.12 Nutritional status
deteriorates as dependency and care needs grow,11,13 and it
is of special concern that only a mere third of older persons
in care facilities are reported to be well nourished.11 Thus,
multi-model interventions that target frail and pre-disabled
older persons could prevent or reverse dependency.14,15 For
instance, supplementation has led to small and consistent
weight gain, and a decrease in mortality in an undernourished
group of frail older persons.16 Preventive measures include an
increased protein intake,14,15,17-19 increasing energy intake,14,15
optimising fruit and vegetable intake,19 participating in
resistance exercise to increase muscle strength and physical
performance,14,15 reducing polypharmacy, and preventing
vitamin D deficiency by supplementation.14 The role of
pharmaco-therapy in the intervention domain remains
limited.20 Malnutrition imposes an increased financial
burden on health care costs12 and efforts are being made
to curb expenses incurred by unwarranted hospitalisation
to mitigate the impact of the economic recession on health
systems.21 In this context, it is crucial to limit the development
of malnutrition in the increasing older population group, as
caring for the frail persons increases the burden on community
resources, hospital care costs and care facilities.14,22 Ideally, the
health care budget requires adjustment to make provision for
the rising costs of health care for the increasingly older and
vulnerable population.10 Measures for the early identification
and prevention of unintentional weight loss (UWL) – defined
as 5% body weight in one month/ 10% over 6 months –
are crucially important.12,20,23 Longitudinal studies have
documented that the clinical outcome of older persons with
UWL, who were followed up long-term, improved markedly,
therefore yearly follow-ups have been recommended.19,21
Furthermore, oral pathology has been reported to be the
strongest predictor of substantive UWL during the year prior
to hospital admissions.20 Systematic inspection of the oral
cavity is, therefore, crucial as a part of the medical history
and physical examination.21 As the latter has the greatest
potential for eliciting the causes of UWL, it is vital to obtain
information about functional limitations, dietary intake
issues, psychological dysfunction, reduced social activity,
financial constraints and the review of current medications.