ABSTRACT
The goal of people is to grow old. But as people age, their health faces various kinds of disabilities in the form of physiological, physical, mental and social impairment, chronic diseases become increasingly common with age and are often considered an inevitable part of aging. This study was designed to assess the health seeking behaviour and nutritional status of adults in Ideato south local government area in Imo state. The specific objectives were to assess the personal data of the adults and their socioeconomic status, assess the health seeking behaviour, determine their food habits, assess their anthropometric status such as weight, height, waist and hip circumstances and to determine the association between the health seeking behaviour of the older persons and their nutritional status. The study employed the ex-post facto research design. A total of 399 adults were selected using multi-staged sampling technique. A structured questionnaire was used to collect data on the dietary habit, anthropometric measurement and health seeking behaviour of the adults study revealed that a more than half of the adults were 60 years and above. The study affirmed a high level of literacy amongst the adults in the study area. It was revealed that a good number of the adults were civil servants. The study affirmed that more than half of the adults ate 3 times daily across the age group. The study revealed that the adults visited the hospitals and the alternative places when sick or battling with health changing conditions. Some of the places they visited were traditional/herbal clinics and chemist shops. The result revealed that majority of the adults were at risk of cardiovascular diseases. It was also found that few of them were overweight. Significant association was found between the BMI of the adults and their age, occupation, number of children, alcoholic drinks intake and its brands. In conclusion, nutrition education as an intervention strategy is needed to increase the awareness of the adults about the problem of underweight and overweight, including abdominal obesity as to ensure that they would maintain lifestyle that would prevent these problems. The study among others recommended that the government should embark on massive enlightenment programme for the aged in other to educate them and encourage them and encourage them to health service available to them on health seeking service available to them and also seek them when needed. Cost reduction and disease management should be considered.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of Contents v
List of Tables ix
Abstract v
CHAPTER 1
INTRODUCTION
1.1 Statement of Problem 4
1.2 Objectives of the Study 6
1.3 Significance of the Study 6
CHAPTER 2
Literature review
2.1 Concept of Aging 4
2.2 Concept of Health Care 6
2.3 Concept of Health Behaviour 10
2.3.1 Theoritical Framework on Health Seeking Behaviour 11
2.3.2 Perceived severity on health seeking behaviour 12
2.3.3 Perceived benefits on health seeking behaviour 13
2.3.4 Modifying variables on health seeking behaviour 14
2.3.5 Cues to action on health seeking behaviour 14
2.3.6 Self-efficacy on health seeking behaviour 15
2.4 Application of health belief theory on health seeking behaviour among the aged 16
2.5 Challenges to health seeking behaviour among the aged 17
2.5.1 Nutrtional assessment methods 19
2.5.2 Anthropometric assessment among the elderly 21
2.6 awareness of health care service among the aged persons 22
2.7 practice of the aged persons toward health care 23
2.8 Health problems associated with aging 24
2.9 Utilization of health care services and support for the aged persons 28
2.10 Strategies for promoting healthy aging 36
2.11 malnutrition in care settings 41
2.12 Food safety and physical activity for promoting healthy aging 42
2.12.1 Increasing practical skills to promoting healthy aging 43
2.12.2 Physical Activity for promoting healthy aging 45
2.13 Empirical studies on health care seeking behaviour and nutritional status of older adults 46
2.14 Meaning of Nutritional status 48
2.14.1 Anthropometric techniques in the assessment of obesity and overweight 48
2.14.2 Ways of assessing nutritional status 50
2.14.3 Dietary habits and patterns 55
CHAPTER 3
MATERIALS AND METHODS
3.1 Study design 59
3.2 Area of study 59
3.3 population of the study 60
3.4 Sampling and Sampling techniques 60
3.4.1 Sample size 60
3.4.2 Sampling techniques 61
3.5 Preliminary activities 61
3.5.1 Preliminary visits 61
3.5.2 Training of research assistants 61
3.5.3 Informed consent 61
3.6 Data collection 63
3.6.1 Questionnaire administration 62
3.6.2 Interview 62
3.6.3 Anthropometric measurement 63
3.6.4 Assessment of health seeking behaviour 64
3.6.5 Assessment of dietary habit 65
3.7 Data analysis 66
3.8 Statistical analysis 67
CHAPTER 4
RESULT AND DISCUSSION
4.1 Personal and socioeconomic status of the adults 68
4.2 Dietary habits of the adults 72
4.3 Health care seeking behaviours of adults 77
4.4 Frequency of different foods consumed by the adults 82
4.5 Anthropometric status of the adults 86
4.6 Association between the personal/socio-economic status and anthropometric status of the adults 87
4.7 Association between the dietary habits and BMI status of the adults 89
4.8 Association between their lifestyle patterns and BMI status of adults 90
4.9 Association between the personal/socio-economic status and WHR of the adults 92
4.10 Association between their dietary habits and WHR of the adults 94
CHAPTER 5
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 96
5.2 Recommendations 96
REFERENCES
LIST OF TABLES
Tables Pages
2.1 WHO BMI classification for adults 51
2.2 Risk of metabolic complications 54
4.1a Personal information of older persons 69
4.1b Socioeconomic characteristics of the older persons 71
4.2 Dietary habits of older persons 73
4.2b Dietary habits of the older persons 75
4.3 Health care seeking behaviour of older 76
4.3b Continuation of Health Care Seeking Behaviour of the Adult 77
4.4a Frequency of cereals, roots, legumes, meat and its products, milk
And its products consumption of the respondents 79
4.4b Frequency of nuts, fat and oil, fruits and vegetables, fat and oil
and vegetables consumption among the older persons 81
4.5 Anthropometric status of adults 83
4.6 Relationship between the personal/socio-economic status,
and BMI status of the adults 84
4.7 Relationship between their dietary habits and BMI of the adults 85
4.8 Relationship between the personal/socio-economic status,
and WHR of the adults 87
4.9 Relationship between their dietary habits and WHR of the adults 88
CHAPTER 1
INTRODUCTION
Aging is a process of becoming older and it represent the accumulation of changes in a person overtime (Bowen et al., 2004). Aging is the gradual change in the structure of any organism that occur in the passage of time, that does not result from disease or other gross accidents and that eventually lead to the increased probability of death as the individual grows older (Young, 2003). Increased longevity changes have resulted in increasing numbers and hence proportions of the adult population aged over the age of 60. The time when older people will out number younger people is rapidly approaching, as it is estimated that by the year 2025 the number of people worldwide aged 60 and over will exceed 1.2 billion. (Surekha, 2015). This projected growth in the older population will create significant additional demands on healthcare and support services (Prince et al., 2015).
Diet and lifestyle, coupled with maintenance of a healthy body weight are important in the maintenance of health for all age groups but are crucial for healthy aging. Maintaining a good nutritional status has significant implications for health and wellbeing, delaying and reducing the risk of developing disease, maintaining functional independence and thus promoting continued independent living (Jones et al., 2015). Aging is accompanied by an increased likelihood of suffering from one, or more, chronic diseases such as respiratory disease, arthritis, stroke, depression and dementia. These conditions may affect appetite, functional ability or ability to swallow, all leading to altered food intake and impairment of nutritional status (Heuberger, and Caudell, 2011).
Medications used in the treatment of chronic illness can also have a detrimental effect on nutritional status through loss of appetite, nausea, diarrhoea, reduced gastrointestinal motility and dry mouth (Ortolani et al., 2013). Taste and smell diminish with age and poor dentition may limit food choice to soft foods. Dry mouth (xerostomia) is common, making swallowing difficult with subsequent avoidance of foods. Malabsorption of essential nutrient may arise as a result of gastrointestinal changes such as atrophic gastritis. Gastric emptying slows with aging with a potential detrimental effect on appetite. All of these factors, independently or collectively, can lead to a reduction in food intake (Watson et al., 2006). As we age body composition changes, fat mass increases and lean body mass (muscle) decreases (sarcopenia). Loss of muscle mass begins at around age 50 but becomes more accelerated after the age of 60 years of age, and fat mass continues to increase until around the age of 75 years. Loss of muscle mass leads to a reduction in basal metabolic rate by approximately 15% between the age of 30 and 80, and this results in a subsequent reduction in energy requirements, of around 150kcal per day after the age of 75 (Ortolani et al., 2013). However, ageing has become a global phenomenon and indeed a critical policy issue receiving some recognition by governments of developed countries where it is reflected in the government‘s vital document of economic and social development strategy (Okoye, 2012). Furthermore, globally, the greatest increase in the number of older people is occurring in the developing and middle income countries, Nigeria is not an exception. Nigeria still has a relatively young population when compared to most European countries and other countries where life expectancy is high. However, as medical advances allow people to live longer, the proportion of the elderly will increase in Nigeria. (Okoye, 2012).
Abdul Raheem (2007), stated that it may be necessary for policy makers to consider establishing neighborhood adult day care centers where elderly persons can meet each other during the day. Other services like medical, nutritional, recreational and educational services can also be incorporated into the neighborhood day care centers. According to Okoye (2012), the use of adult day care centers has been reported by many scholars to be very advantageous to elderly persons and their families. (Sulakshana, 2013). Stated that the severity of disease among elderly is influenced by one important factor which is health seeking behaviour. Healthcare seeking behaviour refers to a decision or an action taken by an individual to maintain, attain, or regain good health and to prevent illness (Sulakshana, 2013). Healthcare is the maintenance or improvement of health for prevention, diagnosis and treatment of diseases, illness, injury and other physical and mental improvement in people. Healthcare is delivered by health professional in allied health field. Integrated care for older people means putting the comprehensive needs of older people, not only diseases but provides healthcare. This usually influences them choosing a public or private facility for health service. Few may go for traditional medicines, self-medication or home remedies. (Ramesh, 2014). Health seeking behaviour is influenced by few factors like illiteracy, misconception, income, family composition, social isolation and dependency (Soe, 2012). This can increase the magnitude of suffering and disability among elderly.
According to Mion (2003), the delivery of healthcare to the older adults has been recognized to be more complex than that of younger adults. This is because the elderly persons utilize the majority of healthcare services while their complex needs have implication for future healthcare delivery to the geriatric population. Specifically in Nigeria, where the number of elderly citizens has been on the increase and their health needs are receiving popular recognition. Findings on elderly health issues can be used to guide the formulation of comprehensive health services and health education policies and intervention programs for elderly men and women in Nigeria, (WHO, 2005).
While many older adult improve in health seeking behavior and eat well, those in poorer health may experience difficulties or poor nutritional status in meeting their nutritional needs. Meeting the diet and nutrition needs of older people is crucial for the maintenance of health, functional independence and quality of life (Frongillo and wolfe, 2010). Failure to do this is likely to lead to a loss of independence with subsequent increased demands on social care provision and increased hospital admissions with the potential for more invasive and expensive healthcare requirements (Kyrou and Tsigos, 2009). Previous study on health seeking behavior and nutrional status of older adults stated that older people are vulnerable to malnutrition which is associated with an increased risk of morbidity and mortality (Margetts et al., 2003). Increased falls, vulnerability to infection, loss of energy and mobility, poor wound healing and confusion are reported consequences of under nutrition (kenkman et al., 2010). Increased health seeking behaviour of older adults helps to improve their nutritional status.
Nutrition assessment includes taking anthropometric measurements and collecting information about a client’s medical history, clinical and biochemical characteristics, dietary practices, current treatment, and food security situation. Full nutrition assessment can be preceded by rapid and simple identification of people who may be malnourished or at risk of malnutrition and need more detailed nutrition assessment. Simple nutrition screening can include checking for bilateral pitting edema, measuring weight and mid-upper arm circumference (MUAC), and asking about recent illnesses and appetite and these requires standardized training in line with national and local health policy (Feldman et al., 2010).
1.1. STATEMENT OF PROBLEM
As people age, their health needs tend to become more complex with a general trend towards declining capacity and the increased likelihood of having one or more chronic diseases (Kenkmann et al., 2010). Health services are often designed to cure acute condition or symptoms and tends to manage health issue in disconnected and fragmented ways that lack coordination across care providing setting and time (WHO, 2013). Old age faces various kinds of disabilities in the form of physiological, physical, mental and social impairment. While old age cannot be called a disease but because of the impairments, people are unable to do their own basic things. (Dewa and Dagendra, 2014). And the impairment include diabetes, respiratory problems, heart disease and related conditions, oral health which is associated with loss of teeth, anaemia, cervical and breast cancer, increased falls and injuries (Kobusingye et al., 2001). Others are vision problems, hearing impairment, depression, dementia (Pedersen et al, 2017). The goal of healthy aging is not only to increase years of life but also, and importantly, to extend healthy active years. Unfortunately, chronic diseases become increasingly common with age and are often considered an inevitable part of aging. However, accumulating research shows that the increasing prevalence of many of these conditions at younger ages is not a normal function of aging, but rather a consequence of inadequate practice of important health behaviors (Fang et al., 2015). The World Health Organization (WHO), estimates that the elimination of the major risk factors for chronic disease (smoking, lack of exercise, and poor diet) would reduce the risk of CVD, stroke, and type 2 diabetes by 80% (WHO, 2005).
There is an increased morbidity of the elderly (Addo et al., 2011). Some of the health problems affecting old people and their proportions are respiratory problems 5% (Biritwum et al, 2013), heart disease and related conditions 18% (Agyemang et al., 2006), oral health 5%, musculo skeletal conditions (Woolf and Pfleger, 2003). comorbidities like hypertension, diabetes (8%), asthma, depression, chronic lung disease 15.2% (Biritwum et al., 2013), anemia 2.5% (Togbe, 2001), cervical and breast cancer 6% (Blankson, 2010), increased falls and injuries (Kalula,2007), elderly abuse (Blankson, 2010) overweight and underweight (WHO, 2005), vision and hearing impairment (Opoku, 2011), cognitive and mental health , trauma 4.2%, cardiovascular accident 25.1%, congestive cardiac failure 6.2%, septicaemia 5.2%, chronic renal failure 3.9%, gastro intestinal disease/ulcer 2.8%, HIV/AIDS 2.5%, toberclosis 2.3% (WHO, 2013). This research therefore seek to assess healthcare seeking behaviour and nutritional status among the aged in Ideato South Local Government Area in Imo State Nigeria.
1.2. OBJECTIVES OF THE STUDY
The general objective of this study is to assess the health seeking behaviour and nutritional status of older adults in Ideato South Local Government Area Imo state. The specific objective are to:
I) Assess the personal data of the older adults and their socioeconomic status.
ii) Assess their health seeking behaviours.
iii). Determine their food habits.
iv). Assess their anthropometric status such as weight, height, waist and hip circumferences.
V) Determine the association between the health seeking behaviour of the older persons and their nutritional status.
1.3 SIGNIFICANCE OF THE STUDY.
The findings or outcome of this study will be of greater benefits to future researchers while researching into similar studies.
It will motivate the health educators to create awareness that exercise, proper diet and health information can promote heath while been aged in Ideato south local government area Imo state.
It will enable the community based health workers organize health program for the aged in Ideato south local government area Imo state.
It will also motivate law makers to formulate policies regarding health of the aged persons by making sure that appropriate provision of health facility are made available for aged persons to access easily when needed in ideato south local government area Imo state.
Non -governmental organization would also find this study useful in designing health education campaign for the aged persons in ideato south local government area Imo state.
Enlighten individuals and health workers on how to care for the aged in ideato south local government area Imo state.
With this significance I believe that Heath seeking behaviour and nutritional status of older adults in Ideato South Local Government Area Imo State will be promoted. And it will be highly beneficial to the older adults who has been neglected in so many areas.
This will also reduce mortality because when the older adults are taken care of they tends to live longer than the one's that are been neglected because an adage says "whatever you do not take care of die".
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