ABSTRACT
The quality of health of older persons is strongly tied to their nutritional status. Therefore, thorough nutritional assessment is necessary for both successful diagnosis and development of appropriate and comprehensive treatment plans for under nutrition in this sub-population. The study was descriptive and cross-sectional in design. A two-stage sampling technique was used to select 305 respondents. A structured questionnaire was used to elicit information on the socio-economic status, food frequency consumption and anthropometric status. Mini Nutritional Assessment (MNA) form and, Malnutrition Universal Screening Tools (MUST) was used to categorize the respondents’ nutritional risk. Anthropometric measurements of (Calf circumference, waist-hip ratio, Mid-upper arm circumference and Body mass index) were determined and compared with their standard. Descriptive statistics such as frequencies and percentages were used to analyze the data. Binary Logistic Regression was used to determine the significant relationship between socio-economic and nutritional risk, and significance was judged at P<0.05. The study findings revealed that a good number (43%) of the older persons in the study area were between 60-64years. Most (59%) of the respondents’ family size were between 4-6. The source of income/allowance was majorly (49%) pension allowance. The highest range of monthly income or allowance of the older persons fell between N30,000 – N50,000 (51%).Majority (59%) of older persons ate twice daily. The older persons’ majorly skipped breakfasts which represent (59%). The study findings using MNA revealed that (89%) of the respondents were normal, (8%) were at risk while 3% were malnourished. MUST reveal that majority (93%) had low nutritional risk, (5%) had medium nutritional risk and (2%) had high nutritional risk. Most male (67%) had normal BMI, (22%) were overweight while few (8%) were obese. For the females, majority (86%) had normal BMI, (6%) were overweight while few (3%) were obese. More (59%) of the respondents has waist-hip ratio at safe level. The study further revealed that there is a significant (P<0.05) risk between education and nutritional risk (in low education, p=0.036; High education p=0.000). Income class was also found to significantly (High income, p= 0.001; low income p=0.000) influence the older person’s nutritional risk. Based on the findings of the study, it is recommended among others that the government and other stakeholders should be monitoring the health of elderly persons periodically to identify those at risk for prompt action to be taken and a social security system to cater for the income.
TABLE OF CONTENTS
Title Page i
Certification ii
Dedication iii
Acknowledgement iv
Table of contents v
List of tables’ vii
Abstract viii
CHAPTER 1: INTRODUCTION 1
1.1 Background of study 3
1.1 Statement of the problem 4
1.2 Objectives of the study 4
1.3 Significance of the study 4
CHAPTER 2: LITERATURE REVIEW 6
2.1 Ageing 6
2.1.1 Older persons 6
2.1.2 Active ageing 9
2.2 Nutrition in older persons 10
2.2.1 Nutritional requirements of older people 11
2.2.1 Aging and nutrition 12
2.2.2 Heterogeneity of functional health, and nutritional needs of older persons 13
2.2.3 Nutrition and health challenges in an ageing population 14
2.3 Malnutrition in older persons 15
2.3.1 Physiological changes associated with malnutrition 16
2.3.2 Consequences of malnutrition 17
2.3.3 Risks factors for malnutrition in older persons 17
2.3.3.1 Poor oral health 17
2.3.3.2 Cognitive impairment 18
2.3.3.3 Polypharmacy 18
2.3.3.4 Depression 19
2.3.3.5 Overly strict therapeutic diets 19
2.4 Nutritional assessment methods 19
2.4.1 Anthropometric measurements 20
2.4.1.1 Height 20
2.4.1.2 Weight 20
2.4.1.3 Body Mass Index (BMI) 21
2.4.1.4 Skin fold thickness 21
2.4.1.5 Waist circumference 21
2.4.1.6 Hip circumference 21
2.4.1.7 Calf circumference 22
2.4.2 Dietary intake assessment 22
2.5 Nutritional risk screening tools 24
2.5.1 Mini Nutritional Assessment (MNA) 24
2.5.2 Malnutrition Universal Screening Tool (MUST) 25
CHAPTER 3: MATERIALS AND METHODS 27
3.1 Study design 27
3.2 Area of study 27
3.3 Population of study 27
3.4 Sampling and sampling techniques 27
3.4.1 Sample size 27
3.4.2 Sampling procedure 28
3.5 Preliminary activities 29
3.5.1 Preliminary visits 29
3.5.2 Training of research assistants 29
3.5.3 Ethical approval 29
3.6 Data collection 29
3.6.1 Questionnaire administration 29
3.6.2 Interview 30
3.6.3 Anthropometric measurement 30
3.6.3.1 Height measurement 30
3.6.3.2 Weight measurement 31
3.6.3.3 Waist circumference 31
3.6.3.4 Hip circumference 31
3.6.3.5 Calf circumference 31
3.6.3.6 Mid Upper Arm Circumference (MUAC) 31
3.6.3.7 Tools for assessing nutritional risks 32
3.6.3.8 Malnutrition Universal Screening Tool (MUST) 33
3.6.4 Dietary measurement 33
3.7 Data analysis 33
3.8 Statistical analysis 34
CHAPTER 4: RESULT DISCUSSION 35
4.1 Background of the older persons 35
4.2 Socio-economic status of the older persons 37
4.3 Feeding pattern and eating habit 39
4.4 Food frequency of the older persons 42
4.5 Anthropometric measurement of the older persons 45
4.6 Nutritional risk factors of the older persons using MNA 48
4.6.1 Categorized nutritional risk of the older persons using MNA 50
4.7 Nutritional risk factors of the older persons using MUST 51
4.7.1 Categorized nutritional risk of the older persons using MUST 53
4.8 Socio-economic determinants of nutritional risk among the older persons 54
CHAPTER 5: CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 57
5.2 Recommendations 57
REFERENCES 59
APPENDIX 63
LIST OF TABLES
Table 3.1: Mini Nutritional Assessment (MNA) Form 32
Table 3.2 World Health Organization BMI classification 33
Table 3.3 Waist-hip ratio standard as stated 34
Table 3.3 Mid-upper arm circumference 34
Table 4.1a: Background status of the older persons 36
Table 4.2: Socio-economic status of the older persons 38
Table 4.3a: Feeding pattern and eating habit of the older persons 40
Table 4.3b: Feeding pattern and eating habit of the older persons 41
Table 4.4a: Food frequency consumption of the elderly 43
Table 4.4b: Food frequency consumption of the elderly 44
Table 4.5: Anthropometric measurement of the older persons 47
Table 4.6: Nutritional risk factors of the older persons using MNA 49
Table 4.6.1: Categorized nutritional risk of the older persons using MNA 50
Table 4.7: Nutritional risk factors of the older persons using MUST 52
Table 4.7.1: Categorized nutritional risk of the older persons using MUST 53
Table 4.8: Binary logistic regression between socio-economic status and nutritional risk of the older persons 56
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF STUDY
The percentage of the older persons is growing rapidly worldwide. The global number of older persons projected to rise from an estimated 524 million in 2010 to nearly 1500 million in 2050, with most of this increase in developing countries (Global Health and Agency, 2011). The factors underlying this transition are increased longetivity, declining fertility and aging of “baby boom” generations (Bloom et al., 2011). There is no United Nations (UN) standard numerical criterion, but the UN, agreed cutoff is 60+ years when referring to the older person’s population (Registrar General of India, 2011). The lack of guaranteed sufficient income to support themselves, the absence of social security, loss of social status and recognition, unavailability of opportunities for creative use of time and persistent ill health are some of the daunting problems the older persons face in the country (Panigrahi, 2019).
Sub-Saharan Africa has the smallest proportion of older persons which is ageing slower than the developed regions and is projected to see the absolve size of its older population grow by 2-3times between 2000 and 2030 (United Nations Department of Economics and Social Affairs, UNDESA, 2015). Like any other country in Sub-Sahara African, Nigeria’s older persons too are increasing rapidly. In Nigeria, those aged 65 years and above (older persons) make up 3.1% or 5.9 million of the total population of 191 million, which in crude numbers represents an increase of 600,000 during the 5-years period 2012-2017 (Population Reference Bureau, 2012; National Council on Ageing, 2016). The rising numbers of the older persons in Nigeria are among others attributed to the crude mortality rate that is gradually decreasing (Adebowale et al., 2012). Ageing in Nigeria is occurring against the background of socio-economic hardship, widespread poverty, the HIV/AIDS epidemic and the rapid transforming of the traditional extended family structure (Adebanjoko and Ugwuoke, 2014). Another cause for the increase in the older segment of the Nigerian population can be found in the declining fertility rate (although still one of the highest in Africa), that has continued to drop since the 1980s (United Nations Population Division and United Nations Statistical Division, 2015; Population Reference Bureau, 2017). In 2017, the total fertility rate registered at 5.5 compared with 6.8 in 1980 (Population Reference Bureau, 2017; United Nations Population Division and United Nations Statistical Division, 2015).
Apart from the decline in fertility, improved health, sanitary conditions have also contributed to the rise in life expectancy (American Dietetic Association (ADA) (2005). Ageing causes people to be less active, frail and exposed to more risk of contracting a disease, leading to prejudice or discrimination against the older persons, social isolation, and sometimes, abandonment. Older persons are vulnerable to malnutrition for many reasons including physiological and functional changes that occur with age, lack of financial support, poor health services, lack of care givers, and inadequate access to food (Ahmed and Haboubi, 2010). The functional status of older persons is their ability to carry out their day-to-day activities including preparation of food and intake, thereby affecting their nutritional status.
In Nigeria, the problem of the health of the older persons is compounded by poor nutrition with medical issues, including both communicable and non-communicable diseases. The nutrition and health of the older persons is often neglected. Most nutritional intervention programs are directed towards infants, children, adolescents and pregnant and lactating mothers. However, nutritional interventions could play a part of the prevention of degenerative conditions of the older persons and an improvement of their quality life. A timely intervention can stop weight loss in those at risk of malnutrition. Unfortunately, not much explanation has been given for the precise estimate of under-nutrition in this age group in research. An evaluation of the nutritional status of older persons is important for the creation of a database to assist with the initiation of important intervention programs and formulation of policies for this age group.
1.2 STATEMENT OF PROBLEMS
Worldwide, the elderly population is increasing, and with it, the prevalence of malnutrition. Despite insignificant medical advances, under nutrition remains a significant and highly prevalent public health problem of developed countries (Nigeria). Estimates of the prevalence vary, as methods for detection are not standardized. However, the prevalence of malnutrition is undeniably high: the overall prevalence is 22.6% (Food Standards Agency (FSA) (2007). Nearly 40% of hospitalized older persons and 50% of those in rehabilitation facilities are malnourished, and 86% are either malnourished or at risk of malnutrition (FSA, 2007). Up to 67% of older persons in nursing homes are malnourished or at risk of malnutrition (FSA, 2007). Of older persons living in the community, 38% are malnourished or at risk of malnutrition (FSA, 2007). Malnutrition significantly increases morbidity and mortality and comprises the outcomes of other underlying conditions and diseases. A gradual decline in general body function disorders, mobility etc and increasing level of dependency for livelihood due to aging as problems identified.
Malnutrition may delay recovery and prolong hospitalization, leading to increased susceptibility to infection, impede individuals’ dependence and quality of life, and even increases the risk of death in many patients (Wadas-Enright and King, 2015). Malnutrition poses a huge economic cost to society. The malnourished older persons are more likely to require health and social services, have more hospitalizations, and cause a burden on caregivers (Stratton et al., 2004). To reduce the burden on caregivers, there is need to study the nutritional risk in older persons. Therefore, this study is designed to assess the nutritional risk in older persons (≥60 years) in Umuahia Metropolis.
1.3 OBJECTIVES
1.3.1 General objectives:
The general objective of this study is to assess the nutritional risk in older persons (≥60 years) in Umuahia Metropolis.
1.3.2 Specific objectives
The specific objectives are to;
1. Assess the socio-economic status of the older persons
2. Assess the nutritional risk factors of the older persons in Umuahia Metropolis using different tools (MNA, MUST).
3. Determine the anthropometric measurement of the older persons
4. Determine their feeding pattern and eating habit
5. Determine the relationship between socio-economic status and anthropometric status among the older persons in Umuahia Metropolis.
1.4 SIGNIFICANCE OF THE STUDY
The study will reveal the various nutritional risks older persons are faced with as well as reveal some of the determinant causes of malnutrition in the older persons. This study would be beneficial to Nutritionists and Dietitians in various health sectors and various fields to see some of the nutritional risks older persons are faced with. This study will also provide information that will help in the intervention process, enabling the health sector to intervene in the right way so as to prevent a deteriorating effect in the health condition of older individuals. The study findings would also help to promote the identification of malnourished older people and assist the health policy makers in increasing the awareness of the importance of proper health and nutrition care among this age group. The study would also help to reveal crucial areas of malnutrition among the growing older person’s population that would help to start off opportunities to correct malnutrition in older persons.
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