can cause malnutrition as well. Food and eating have potent aesthetic and psychological attributes that are of great importance to maintaining the quality and enjoyment of everyday life. If a person's dietary intake is devoid of such characteristics owing to pathology arising from a physiological, psychological, or social cause, metabolism is deranged, appetites fall off, and eventually physical as well as emotional well-being may suffer. When malnutrition results from one or more of these causes, it is referred to as secondary malnutrition. Diet-drug or drug-drug interactions may also affect nutritional status adversely. Because this form of nutritional derangement is iatrogenic, it too is regarded as secondary malnutrition.

Favorable nutritional status throughout life can increase life expectancy. The increased expectation of life at birth that has taken place since 1900, as well as the growth in the expectation of life after 65 years of age, has been due in part to more favorable environmental conditions. Among these conditions has been an improvement in certain aspects of the food supply and dietary intakes, which have led to decreased prevalence of undernutrition and dietary deficiency diseases. Yet at the same time, other dietary factors have changed in the opposite direction—including several risk factors for chronic degenerative diseases (in particular, coronary artery heart disease, high blood pressure, and storke) and certain cancers, which now account for at least 75 percent of all deaths and half of all bed confinement days among the elderly.⁷⁶

Common chronic degenerative diseases with diet-related components as well as other diseases and cognitive impairments prevent functional independence. In 1985, more than 5 million people 65 years of age and older needed special care to remain independent; by the year 2000, more than 7 million people are likely to need such care. Many of these same individuals will need assistance with shopping, meal preparation, and eating.^34,87 The oldest old, that is, those over 85 years of age, are likely to be in special need of assistance in preparing food, eating, or planning their diets. Others, especially those with multiple, complex conditions, are also likely to require long-term care, either in or outside of institutions. Many residents of nursing homes and other long-term care facilities require therapeutic diets to deal with their health problems.⁷⁶ However, a lack of choice, limited variety, and poor quality of food may limit the enjoyment an individual derives from eating, even though minimal standards for nutrient intake are met in such facilities, in boarding