Elderly people in developing countries are vulnerable to health related predicaments associated with low income society, poor eating pattern, under nutrition, over nutrition, chronic illness and diseases. This study assessed the nutritional risk in older adults in Ezinihite and Obowo Local Government Area of Imo State. The study was cross-sectional and descriptive in design. A multi-stage sampling technique was used to select the older adults residing the study area. A well-structured and validated questionnaire was used to collect information on socio-economic characteristics, feeding pattern of the older adults. Data were analyzed using descriptive statistics (frequency, percentage, mean and standard deviation) and correlation analysis. Significance was accepted at P<0.05. The result showed that more than half (50.8%) of the respondents were married, most of them (63.6%) were between the ages of 65-75 years, a good number of them (48.3%) were primary school certificate holders and majority (96.3%) were Christians. The result showed that some (42.1%) were at risk of malnutrition, a few (19.0%) were malnourished and 38.8% had normal nutrition status. Half of the respondents (50.4%) consumed two or more servings of legumes per week and 49.6% consumed at least one serving of diary product per day. Only 40.9% consumed two or more servings of fruit and vegetable per day. The result for method of meal preparation showed that majority (75.2%) of the older adults steam their food. The anthropometric status shows that 62.4% of the older persons used in the study were underweight, 35.1% had normal BMI while 2.5% were overweight, whereas the study recorded no case of obesity. The analysis revealed that there exist a significant relationship between nutritional risk and socio-economic status, and dietary habits of the respondents. Therefore it is recommended that geriatric care givers should employ the services of a nutritionist so as to proffer solution to the reduction in weight with increase in age prevalent among older adults. Since fruit and vegetable consumption was shown to have a significant effect on nutritional risk, elderly are advised to consume more fruits and caregivers should try as much to incorporate fruits into the diet of elderly ones.
TABLE OF CONTENTS
TITLE PAGE i
TABLE OF CONTENTS v
LIST OF TABLES viii
CHAPTER 1: INTRODUCTION
1.1 Background of the study 1
1.2 Statement of the problem 4
1.3 Objective of the study 5
1.4 Significance of the study 6
CHAPTER 2: LITERATURE REVIEW
2.1 Nutrition 7
2.2 Older adults 8
2.3 Nutrition and older adults 8
2.3.1 Fiber 10
2.3.2 Protein 11
2.3.3 Vitamin B12 12
2.3.4 Calcium, Vitamin D, and Magnesium 13
2.3.5 Potassium 16
2.3.6 Omega 3 fatty acid 17
2.4 Importance of good nutrition for older adults. 17
2.5 Malnutrition and older adults 18
2.6 Physical changes associated with aging 19
2.6.1 Changes in musculoskeletal system 19
2.6.2 Dehydration 20
2.6.3 Dentition 21
2.6.4 Sensory changes 22
18.104.22.168 Taste acuity 22
22.214.171.124 Smell 23
126.96.36.199 Vision 23
188.8.131.52 Touch 24
2.6.5 Alteration in metabolism and absorption 24
2.7 Nutritional risk 26
2.8 Nutritional risk factors of older persons 26
2.8.1 Psychological and cognitive factors 26
2.8.2 Economic and social issues 28
2.8.3 Food choices 29
2.9 Assessment of nutritional risk in older persons 31
2.9.1 Nutritional assessment 31
184.108.40.206 Dietary assessment 32
220.127.116.11 General health status self-assessment 33
18.104.22.168 Social condition 33
22.214.171.124 Clinical condition 33
126.96.36.199 Anthropometry 34
188.8.131.52 Dietary intake and eating attitudes 34
CHAPTER 3: MATERIALS AND METHODS
3.1 Study design 36
3.2 Area of study 36
3.3 Population of study 36
3.4 Sampling and sample technique 37
3.4.1 Sample size 37
3.4.2 Sampling procedure 37
3.5 Preliminary activities 38
3.5.1 Preliminary visits 38
3.5.2 Training of research assistant 38
3.5.3 Informed consent 38
3.6 Data collection 39
3.6.1 Questionnaire administration 39
3.6.2 Anthropometric measurements 39
184.108.40.206 Weight measurement 39
220.127.116.11 Height measurement 40
18.104.22.168 Body Mass Index (BMI) 40
22.214.171.124 Waist circumference 40
126.96.36.199 Hip circumference 41
188.8.131.52 Mid-upper arm circumference 41
184.108.40.206 Calf circumference 41
3.6.3 Dietary measurements 41
220.127.116.11 Food frequency questionnaires 41
3.7 Data analysis 42
3.8 Statistical analysis 45
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Background information of the older adults 46
4.2 Socio-economic characteristics of the older adults 48
4.3 Nutritional risk status of the older adult 50
4.4 Feeding habits of older adults 54
4.5 Food consumption pattern of the respondents 56
4.6 Anthropometric status of the older adults 58
4.7 Relationship between socio-economic status, dietary habit and
socio-economic status of older adults 60
CHAPTER 5: CONCLUSION AND RECOMEMNDATIONS
5.1 Conclusion 62
5.2 Recommendations 62
LIST OF TABLES
Table 3.7.1 Classification of BMI 42
Table 3.7.2 Classification of mid upper-arm circumference 43
Table 3.7.3 Classification of waist circumference 43
Table 3.7.4 Waist –hip ratio standard as stated by Center of Disease Control 44
Table 4.1 Background information of the respondents 47
Table 4.2 Socio-economic characteristics of the older adults 49
Table 4.3a Nutritional risk assessment of the older adults using MNA 52
Table 4.3b Overall nutrition risk assessment of the respondents using MNA 53
Table 4.4 Feeding habits of the older adults 55
Table 4.5 Food consumption of the older adults using food frequency questionnaire 57
Table 4.6 Anthropometric status of the older adults 59
Table 4.7 Relationship between nutritional risk, dietary habits and socio-economic status of older persons 61
1.1 BACKGROUND OF THE STUDY
Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients (World Health Organization WHO, 2016). It is more common and increasing in the older population with a report of 16% of those >65 years and 2% of those >85 years classed as malnourished (Office of National Statistics ONS, 2004). These figures are predicted to rise dramatically in the next 30 years (ONS, 2004).
Elderly people in developing countries are vulnerable to health related predicaments associated with low income society, poor eating pattern, under nutrition, over nutrition, chronic illness and diseases (World Health Organization, 2009). Poverty remains a major contributory factor to many of the diet-related disorders among the elderly (WHO, 2009). Nutritional status of the elderly is influenced by the ageing process (Roberts and Rosenberg, 2006). Malnutrition is a common problem among older people living in geriatric nursing homes (Johansson et al., 2014). This affects 37% of institutionalized elderly in Europe (Guigoz et al., 2013). Malnutrition in the elderly may be associated with diseases, social and financial conditions, and frequent hospitalization, functional status, psychological conditions, diminished sense of taste and smell (Arellano et al., 2004). This can be worsened with the possibilities associated with chronic diseases of lifestyle (Shlisky, 2017). Most elderly people (60+) 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 (Leiknes et al., 2015). Income is another major hindrance for the elderly people to eat well and have normal nutrition (Ferreira, 2014 and Bohman et al., 2017).
Malnutrition is a great hazard to which the aged appears to be more vulnerable than the younger age groups due to problems relating to ignorance on appropriate food choices, loneliness, social isolation which often times lead to depression, apathy, lack of appetite, physical disabilities, cardiovascular problems and poverty among others (Vesnaver and Keller, 2011). According to World Health Organization, the elderly are defined as persons above the age of 60 years with women comprising a majority of this population (WHO, 2010). The elderly population in the recent decade especially in Africa and other developing countries appear to be increasing (Charlton and Rose, 2013). Govender (2011) noted that the elderly are the gemstones of any society that are often ignored. Their care and wellbeing especially in rural communities depend largely on their children, relatives and sometimes government resources which places a huge financial burden on their caregivers with a consequent lack in adequately providing for the nutritional and health needs of the aged in their care (Govender, 2011). Inadequate household food security, war and famine, and the indirect impact of HIV infection and AIDS among others have been documented as important determinants of poor nutritional status of elderly Africans (Charlton et al., 2001). All these increases in the cost of living affects to a great extent dietary intakes and nutritional status of not only the general populace, but the often neglected elderly population (Charlton et al., 2001). Furthermore, the vulnerability of the aged being far greater than that of the younger population shows the need for continuous monitoring of the aged with a view to identifying the extent of malnutrition among them in Nigeria. Studies have documented poor nutritional status among the aged (Fadupin, 2012). Similarly, previous studies have documented that the energy and nutrient intakes of the elderly were low compared to recommended dietary allowances (Charlton et al., 2001). Older people are at nutritional risk, not only because of impaired digestion, absorption or utilization of nutrients associated with chronic disease or drug–nutrient interactions, but also due to an interaction between physiological, psychological and socioeconomic factors (Charlton and Rose, 2013). In addition, it is evident that the elderly in developing countries were vulnerable to health related predicaments associated with very low income, inadequate food intakes, poor food patterns, under nutrition, over-nutrition, chronic illness and diseases (WHO, 2009). In many developing countries including Nigeria, there is a dearth of information as well as epidemiological data on the nutritional status of the aged since studies regarding the nutrient intakes of these groups are limited and isolated. Studies on children particularly infants and preschool children appears to be more common than studies on the aged who are equally as vulnerable as young children to changes in social and economic conditions.
Therefore, the great role of nutrition in the maintenance of the health and functional rehabilitation of the elderly has awakened public interest and research. While only little information is available about them in literature in Nigeria (Pirlich and Lochs, 2001).
1.2 STATEMENT OF THE PROBLEM
According to World Health Organization (2009), many of the diseases suffered by older persons are the result of dietary factors, some of which have been operating since infancy. These factors are then compounded by changes that naturally occur with the aging process (WHO, 2009). Dietary fats seem to be associated with cancer of the colon, pancreas and prostate (WHO, 2009).
Atherogenic risk factors such as increased blood pressure, blood lipids and glucose intolerance, all of which are significantly affected by dietary factors, play a significant role in the development of coronary heart disease (WHO, 2009). Degenerative diseases such as cardiovascular disease, diabetes, osteoporosis and cancer, which are among the most common diseases affecting older persons, are all diet-related (WHO, 2009). Increasingly in the diet/disease debate, the role that micronutrients play in promoting health and preventing non communicable disease is receiving considerable attention (WHO, 2009). Micronutrient deficiencies are often common in elderly people due to a number of factors such as their reduced food intake and a lack of varieties in the food they eat (WHO, 2009). Another factor is the price of foods rich in micronutrients, which further discourages their consumptions. Compounding this situation is the fact that the older people often suffer from decreased immune function, which contributes to this group’s increased morbidity and mortality (WHO, 2009). Furthermore, other significant age-related changes include the loss of cognitive function and deteriorating vision, all of which hinder good health and dietary habits in old age (WHO, 2009).
Elevated serum cholesterol, a risk factor for coronary heart disease in both men and women, is common in older people and this relationship persists into very old age (WHO, 2009). Intervention trials have shown that reduction of blood pressure by 6 mm Hg reduces the risk of stroke by 40% and of heart attack by 15% and that a 10% reduction in blood cholesterol concentration will reduce the risk of coronary heart disease by 30% (WHO, 2009).
Dietary changes seem to affect risk-factor levels throughout life and may have even greater impact in older people (WHO, 2009). Relatively modest reductions in saturated fat and salt intake, which would reduce blood pressure and cholesterol concentrations, could have a substantial effect on reducing the burden of cardiovascular disease. Increasing consumption of fruit and vegetables by one to two servings daily could cut cardiovascular risk by 30% (WHO, 2009).
1.3 OBJECTIVE OF THE STUDY
The general objectives of the study is to assess the nutritional risk in older adults in Eziniihite and Obowo Local Government Areas of Imo State.
The specific objectives will be to:
i. Assess the socio-economic status of older persons in Eziniihite Local Government Area of Imo State.
ii. Determine the nutritional risk level of the respondents and the factors.
iii. Determine their feeding pattern and eating habit.
iv. Determine the anthropometric status of the older adults.
iv. Determine the relationship between socio-economic status, feeding pattern and nutritional risk and anthropometric status of older adults in Eziniihite Local Government Area, Imo State.
1.4 SIGNIFICANCE OF THE STUDY
Malnutrition has become a global problem which affects every individual both the poor and affluent, no family is left untouched according to report and findings of Food and Agricultural Organization FAO, 2015). However, nutritional assessment is very essential to achieve a healthy status and to combat malnutrition because it reveals the current state of food and nutrient intake of individuals. Therefore assessing the nutritional risk in older adults will be of great importance to prevent the high degree of morbidity and mortality rates among them.
This study will be of great benefit to medical professionals which include nutritionist, dietitians and clinicians to educate all the population groups on good dietary lifestyle which influences nutritional status. Furthermore, encouraging them to maintain ideal body weight which is the path to healthy living.
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