NUTRITIONAL AND HEALTH STATUS OF OLDER PERSONS AGED 60 YEARS AND ABOVE IN NGWO, UDI LOCAL GOVERNMENT AREA OF ENUGU STATE

ABSTRACT

Poor or unbalanced diets as in the case of excessive eating and under nutrition are risk factors for several chronic diseases. Poor food intake reduces the level of nutrients in the body thereby exposing the body to nutrition related problems. This study was carried out to assess nutritional and health status of the older persons in Ngwo, Udi Local Government Area of Enugu State. Questionnaires were administered to 238 randomly selected older persons aged 60 years and above, to get information on their background, socio-economic data, dietary pattern and geriatric health which comprised of general health, functional ability (ADL and IADL) and nutrition health check list. Anthropometric indices of weight, height, calf circumference, waist circumference, hip circumference and MUAC were collected and stratified using their different standards. Data were analyzed with the computer programme, Statistical Package for Social Science (SPSS) for windows version 21 using descriptive statistics, Pearson correlation coefficient and analysis of variance and significant difference judged at p<0.05. The result showed that more than half (58.4%) of the respondents were within the age of 60-69 years. About 33.2% sourced their income from their children and 42.9% earned between N18,000-N36,000 a month. Most (68.1%) skipped meals while 57.4% skipped breakfast, 23.1% ate heaviest at dinner. About 39.9% consumed pastries/snacks twice a week while 23.5% consumed it four times. Some (49.2%) preferred garri and soup, 25.2% took fruits five times a week. Some (40.3%) consumed beer. Only 31.5% consumed snuff, out of which 64% took it daily. BMI classification showed that 34.5% were overweight, 26.1% were obese, 1.7% underweight, and 56% and 55.9% were at risk of cardiovascular disease from their waist circumference and waist hip ratio classification respectively. About 37.4% and 31.9% described their health to be good and very good. Some (49.6%) had experienced moderate body pain in the past 4 weeks. According to their activities of daily living, 92.4% were very independent. In their instrumental activities of daily living, only 10.1% and 17.6% were unable and needed assistance in performing daily activities. From their nutritional health checklist, most of them (62.6%) were at high nutritional risk while 25.2% were moderately at risk.

TABLE OF CONTENTS

LIST OF TABLES

CHAPTER 1

INTRODUCTION

1.0    BACKGROUND OF THE STUDY

In old age, health concerns transform, since there is a shift away from the incidence of communicable diseases to non-communicable diseases, characteristically chronic, degenerative and mental illnesses (Charlton et al., 2008). Moreover, these transformations are accompanied by an advanced incidence of disability. In addition these circumstances have extensive implications for health service provision, particularly since there is a widespread lack of specialist services and personnel to serve the health needs of the increasing numbers of older persons in most African countries (Haan, 2000).  Charlton and Rose (2001) stated that the majority of Africans enter old age after a lifetime of poverty and deprivation, poor access to health care and a diet that is frequently inadequate in quantity and quality. However, the older persons in Sub-Saharan Africa have particular vulnerabilities, which are exacerbated by social, economic, cultural, political as well as environmental factors (Charlton and Rose, 2001; Ferreira and Kowal, 2006). Poverty is widespread and the majority of African countries lack formal social protection and in addition the older persons are consistently among the poorest of the poor (Ferreira and Kowal, 2006). Chronic disease patterns are characterised by a combination of poverty-related diseases associated with urbanisation, industrialisation and a Westernised lifestyle (Steyn et al., 2006). A study by Charlton and Rose (2001) noted that nutrition interventions in African countries, when available, are directed primarily toward infants, young children, as well as pregnant and lactating women, therefore, lacking in concentration on the older persons in policies and programmes which is mirrored by the rareness of data from studies on the older persons’ health situation, nutritional status as well as dietary intake patterns. The older persons’ nutritional status is principally influenced by the ageing process thus encompassing a direct effect on the requirements of macronutrients and micronutrients, which affect absorption and metabolism of the required nutrients (Oldewage-Theron et al., 2009). A nutrition, health and ageing study by Kimokoti and Hamer (2008) indicated that the demographic transition has been accompanied by an epidemiologic transition which is a change from infectious diseases and under nutrition to chronic and degenerative diseases as major foundation of mortality, which is being aggravated by a nutrition transition that causes a shift to diets high in fat, sugar, and refined grains, as well as greater tobacco use and sedentary behaviour. 

The HIV and AIDS pandemic in Africa is the highest in the world and is posing an evidently huge burden including responsibilities on the older persons in Africa generally (Human Science Research Council (HSRC), 2004). Older persons in their fragile health state are expected to look after their grandchildren who have lost their parents to HIV and AIDS, and have to support them financially, care for them and even care for other adults who are also ill with HIV and AIDS. The older persons over and above that perform other household chores and, however, have the insinuation of the older persons being strained financially and physically and unable to care for themselves including their health (Makiwane et al., 2004; Collier, 2009). Care, medical treatment and funerals carry a substantial expense and this could be even more of a burden when the older persons are the main caregivers. Natural and manmade disasters have an impact on older persons’ livelihood, security and wellbeing (HSRC, 2004; Ferreira and Kowal, 2006; Kimokoti and Hamer, 2008). Changes in family structures as a consequence of urbanisation and additional contributing aspects diminish relative support for the older persons as suggested by Ferreira and Kowal (2006). Makiwane et al. (2004) reported that protein-energy malnutrition is prevalent in association with chronic disease and is related to increased morbidity and mortality, while the key predictor of malnutrition is loss of appetite resulting in anorexia in the older persons. The process of aging affects their nutrient intake thus resulting in the various deficiencies and disorders, certain nutrients are required in an increased amount to assist with the aging process (Makiwane et al., 2004).  Due to the number of older persons that encounter reduced food intake in addition to a reduced variety in their diet, micronutrient deficiencies are common amongst this age group (Makiwane et al., 2004).   

Marais et al. (2007) further mentioned that factors such as nutrient intake, socio-economic status, functional status, psychological conditions, oral health and pharmacological treatment are known to reduce appetite, induce malabsorption, and diminish sense of taste as well as smell.  In addition to the psychological changes that negatively affect nutritional status, simply consuming enough food can become a major challenge to many older persons.

1.1   STATEMENT OF PROBLEM

Population ageing is a world-wide phenomenon as the increase of the older persons world population aged 60 years and above is increasing rapidly (Ferreira and Kowal, 2006). In 1950 the older persons’ statistics indicated 200 million; by 1975 the older persons’ population increased by 75% to 350 million, and by 1999 it had shot up to nearly 600 million. It is projected that by 2025, the world population will reach 1.2 billion and by 2050, 2 billion (United Nations Population Division, 2003).

The World Health Organisation (WHO), (2010) defines the older persons as all persons over the age of 60. As noted by the World Health Organisation (2009), females encompass the majority of the older persons' population around the world as they tend to outlive males. There has been recognition that nutrition plays a significant role in the older persons' health status, and both undernutrition and overnutrition are associated with greater risk of morbidity and mortality (Chandra et al., 1991). The older persons are the gemstones of society that are often ignored and, therefore, need to be preserved and respected as they are the building blocks for the future generations. 

Older persons in developing countries are vulnerable to health related predicaments associated with near to the low income society, poor eating pattern, undernutrition, overnutrition, chronic illness and diseases (WHO, 2009; Oldewage-Theron et al., 2005). Poverty remains a major contributory factor to many of the dietary related disorders among the older persons (Ogden et al., 2006; WHO, 2009).

Nutritional status of the older persons is influenced by the ageing process (Oldewage-Theron et al., 2009). Malnutrition is a common problem among older people living in geriatric nursing homes (Saeidlou et al., 2011). This affects 37% of institutionalized older persons in Europe (Guigoz et al., 2002). Malnutrition in the older persons may be associated with diseases, social and financial conditions, and frequent hospitalization, functional status, psychological conditions, drugs  and diminished sense of taste, smell and touch (Arellano et al., 2004; Marais and Labadarios, 2007; Genser, 2008). This can be worsened with the possibilities associated with chronic diseases of lifestyle (Mathey et al., 2000; Solomons, 2001).   Older persons (60 and above) are prone to the consumption of fatty and sugary foods because they are most affordable and tasty (Canon, 2001).  They are also vulnerable to abuse and neglect from family members and caregivers (Steyn and Temple, 2008). Income is another major hindrance for the older persons to eat well and have normal nutrition (Ferreira, 2004; Bohman et al., 2007; Ogunmefun, 2008; Ogunmefun and Schatz, 2009). Therefore, the great role of nutrition in the maintenance of the health and functional rehabilitation of the older persons has awakened public interest and research. While only little information is available about them in literature in Nigeria (Ojofeitimi et al., 2002).

As individuals enter old age their basic nutrition, genetics, physical activity and everyday stress affect their psychological wellbeing and are an imperative resource to their families and communities Whitney and Rolfes (2008). Research conducted by Clausen et al. (2005)  stated that the nutritional problems relating to the older persons can be expected if there are several high risk factors present for example, living alone, physical or mental disability, recent loss of spouse or friend, weight loss, use of multiple medications, poverty, and high consumption of alcohol (Ferreira and Kowal,2006). The attainment of adequate nutrition during the adult stages can add value thus reducing certain illness experienced during the elderly stages. Therefore there is need to know the nutritional and health status of the older persons in Ngwo in order to maintain the nutritional status of the well-nourished, provide effective preventive care to those at risk and rehabilitate the malnourished persons in order to prevent progression to non-communicable diseases.

1.2                  OBJECTIVES OF THE STUDY

General objective:

The general objective of this study is to determine the nutritional and health status of the older persons aged 60 years and above in Ngwo, Udi Local Government Area of Enugu State.

Specific objectives

The specific objectives of the study are to:

1. determine the socioeconomic status of the older persons;

2. assess the nutritional status of the older persons in Ngwo using anthropometry;

3. assess the dietary pattern of older persons in Ngwo;

4. assess the health status of the older persons using geriatric health questionnaire;

5. identify the relationship between the nutritional status and health status of the older persons in Ngwo.

1.3   SIGNIFICANCE OF THE STUDY

It is hoped that this study will provide basic information on the effects of nutrition on the health of the older persons. It will help to ascertain the percentage of the population that are healthy and the ones that are not. It can also attract nutrition intervention actions on the older persons in Ngwo.

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