function has expanded greatly.42 Such measures include the Activities of Daily Living scale, as well as assessments of social competence (the Instrumental Activities of Daily Living scale) and mobility measures. In the field of nutrition, however, none of these measures or any other measures of disability have been used frequently, especially in studies in highly industrialized countries.51 The effects of the diseases themselves and the treatments for the diseases (nutritional or other types) are rarely separated and measured. Thus, the effects of many nutritional therapies on function, quality of life, morbidity, and mortality are unavailable. Even more unfortunate, function in relation to eating is often not even considered in medical assessments. A recent survey revealed that the specifics of dietary history (either diet restrictions or details of food intake with respect to calories, the types of food actually eaten, and physical limitations on eating) and other functional measures were rarely found on standard history-taking forms used in hospitals and long-term care facilities.60 These forms also neglected subjective comments by patients on the degree of their health, specifics of home living arrangements, the supporting services they received, and their dietary histories.60

Currently, the most common type of nutritional assessment used for older individuals comprises a clinical examination and one or more objective indices of functional impairment. The major advantage of a clinical examination, if it truly involves an assessment of functional status, is that it can incorporate observations of the individual actually performing the activities essential to preservation of independent function. When clinical assessments are combined with functional assessments of an objective nature, using such instruments as mental status measures, dietary intake and nutritional status measurements, measures of visual acuity and gait, and the Activities of Daily Living scale, more moderate cases of functional impairment are often revealed.86 (A more typical clinical assessment that does not involve such functional assessments is useful in identifying severe impairments but may miss more moderate degrees of deficits in function.) Given the limited training most physicians, nurses, and dietitians receive in the specifics of functional assessment and, indeed, in many areas of care and assessment of the problems of the elderly, such care givers often find it difficult to assess the self-maintenance skills of elderly patients by clinical means. When fuller assessments of function or home visits to the elderly are conducted, however, they often reveal insights on function related to diet and eating.88 Such a complete geriatric assessment is often



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