Grampa looks thinner: addressing resident malnutrition.(Nutrition)

Mr. Parker sits in his room awaiting the first meal of the day. Down the hall, someone rolls a squeaky meal cart full of institutional meal trays--sanitary and clean.

When the lid is lifted off, he finds a gleaming white plate with a lukewarm, solid mound of scrambled eggs, links of rubbery sausage and slices of soggy toast. He didn't even smell it coming. Does this sound familiar? Breakfast is the most important meal of the day for everyone--particularly elders, who tire as the day wears on. Yet missing simple things, like seeing the food prepared and the familiar aromas of brewed coffee and toast, affect the appetite.

In a recent supplement to the Annals of Long Term Care, Dr. John E. Morley and his colleagues discussed the concerns of weight loss in the elderly, institutionalized population in stark contrast to the nation's ever-burgeoning obesity epidemic.

While weight gain in the general population sends up red flags because of its associated health risks, weight loss in the elderly population should also raise an alarm because of its association with increased rates of disease and death.

Practitioners have long dealt with the challenges of weight loss in the elderly population. "In the last five years the health and nutritional status of our elders has declined immensely," said Ann Marie Kraus, a registered dietitian at Tioga Nursing Facility in Waverly, N.Y.

"The residents admitted today are much sicker and debilitated than in recent years. Often it is after a hospitalization or major surgery that they come to us," she said. "Weight loss and nutritional deficits already have a good start by then."

While it is impossible to uncover every cause of weight loss and guarantee positive outcomes in every situation, Morley's research has shed light on a number of causes that will give clinicians new insight and potentially new ways to meet the challenge of acute and chronic weight loss.

Morley noted many …