Arlene Astell, University of St. Andrews


  • Liz Williams, the University of Sheffield

  • Tim Adlam, University of Bath

  • Faustina Hwang, Reading University


Arlene Astell


A the time of the project, figures suggest that one in four older people are likely to be undernourished.

Under-nutrition in older people is closely linked to physical frailty, which is a major factor in the development of disability and dependency in old age.

Under-nutrition may be due to a range of factors including impaired physical function, such as problems with chewing and swallowing or reduced mobility; mental health factors such as depression or social isolation; and cognitive factors such as dementia or other neurological illnesses.

It is difficult to examine the links between diet, physical health, mental health and cognitive factors due to inadequacies and unsuitability of available methods of measurement.

Aims and objectives

The first aim was to improve the methods available for collecting nutritional information from older people using advanced technology to overcome the limitations of current pen and paper methods.

The second aim was to develop a comprehensive assessment package that integrates nutritional information with information on health status; function in activities of daily living; cognition; and mental health to improve the targeting of interventions.

The assessment package had to be suitable to monitor events over time so that changes and rates of decline or improvement could be detected.

These two aims reflected the underlying principle of the NANA project to improve recognition of poor nutritional status in older people alongside improved identification and understanding of the factors that contribute to this.


This was a multi-disciplinary programme involving Psychology, Nutrition, Engineering and Software Engineering. The programme of work and methods had three phases.

Phase one: user needs analysis

The first phase involved consulting with a broad cross-section of older people, and caregivers and health professionals who work with older people, to establish what technical approaches would be useful and acceptable to all groups.

Phase two: development of an integrated measurement toolkit

This phase contained three inter-related subsections.

The first was an iterative programme to develop the assessment technology. This was led by Engineering and Software Development, closely liaising with Psychology and Nutrition.

The second subsection focused on techniques for dietary assessment in older people and was lead by Nutrition, working closely with the other three disciplines to facilitate integration into the assessment toolkit.

The third subsection was a parallel investigation of measures of cognition and mental health in older people, led by Psychology but working closely with Nutrition, Engineering and Software Engineering to ensure integration between the three subsections.

Phase three: full validation of the assessment toolkit

This phase comprised of a comparison of the new integrated assessment with traditional ‘pen and paper’ methods with volunteers having the equipment installed in their homes.

Policy implications

NANA furthered understanding of the relationship between nutrition, physical function, cognitive function and mental health in ageing. This had broad ranging implications for the assessment, maintenance and treatment of older people both in the community and in care homes.

The NANA toolkit enabled research to place nutrition in context and potentially move it further up the government’s existing agenda of preventative healthcare.

This was likely to impact policy in the following areas:

  • Interventions to prevent or treat malnourishment in older people through improved identification of older people at risk.

  • Interventions to prevent physical frailty and its associated co-morbidities through improved identification of older people at risk.

  • Identification and treatment of older people with cognitive problems or dementia.

  • Identification and treatment of older people with mental health problems, particularly depression.

  • Provision of catering in care homes and in the community.

  • Education and dissemination of nutritional information targeting for example on food packaging.

Practice implications

NANA impacted the provision of catering for older people both in care homes and the community. NANA also impacted on practitioners in a number of disciplines, including nutrition and mental health through increased awareness of the interactions between nutrition, physical function, cognitive function and mental health. This informed education and training of relevant professionals, such as GPs and community care staff.

Product development opportunities

The main outcome of NANA was a novel measurement toolkit that allowed for more accurate, high-frequency capture of data on nutrition, cognition, physical and mental health.

The measurement toolkit was particularly appropriate and acceptable to older adults at risk of rapid decline. It was validated against the current standards of measurement in the various fields.

This is attractive to a commercial partner to develop for the healthcare market for older people living in the community and in care homes.

The NANA toolkit could be extended to other ages and groups in the population, eg people living with chronic conditions, that would benefit from high quality comprehensive assessment and monitoring over time.

Similarly there is potential for extrapolation of the NANA toolkit for studying the long-term effects of atypical nutritional status in populations such as athletes on highly controlled nutritional regimes or children with poor nutritional status.