ABSTRACT
Adequate nutrition and good lifestyle are important determinants of health in older persons in order to reduce risks of many degenerative diseases. This study was carried out on older persons in Etinan Local Government Area of Akwa ibom State to assess their nutritional status and cardiovascular risk factors. A multi- stage sampling technique was used to select the. 373 older persons (comprising of 167 male and 206 female). Data on personal information, Socio-economic , dietary habits, cardiovascular risk factors, 24- hour dietary recall, section food frequency questionnaire, and anthropometric measurements were obtained using well - structured questionnaire. Data on anthropometric measurements were analyzed using WHO references while blood pressure were analyzed using international business machine- statistical package for service solution (IBM- SPSS) Windows version 22.0. Result from the study reveal that slightly more than half (55.2%) of the older persons were female while about 44.8% are male. More than half (65.4%) of them are aged between 60-65 years and 30.8% of them had their tertiary education. Some (26.3%) and (22.5%) earned less than N5,000 and between N5,000-N10,000 monthly respectively. Some (42.4%) of the older persons ate 3 times a day while some of them ate 2 times a day. Slightly above half (55.0%) skipped meals while some (31.9%) and (11.8%) skipped lunch and breakfast respectively. Some (34.9%) of the older persons ate when they were hungry. A few (12.9%) of the older persons smoked daily (7.0%). Majority (81.0%) of the older persons take between 0-3 teaspoons of sugar in hot drinks added to food daily. However, majority (83.9%) of them engaged in physical activity such as walking, washing and running. Result from the study revealed that 42.9% of the older persons had normal BMI status, 29.2% were Overweight, 15.8% were obese while 7.0% were underweight. However, frequency of physical exercise was seen to be significantly related (p-0.000) to the BMI status of the older persons. The more physical exercise they engage, the more normal their BMI. Result further showed that there was a significant relationship (X2 =70.373, P=0.000) between frequency of smoking and their blood pressure. Those who smoked twice daily (14.7%) had high normal blood pressure. In addition, frequency of fried food consumption was also found to be related (X2=42.191, P=0.0001) to blood pressure. The older persons are advised against intake of fried foods. Smoking and intake of alcohol should also be reduced while the older persons are advised to engage more in physical exercises.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of content v
Lists of tables x
Abstract xi
CHAPTER 1: INTRODUCTION
1.1 Statement of Problem 3
1.2 Objectives of the Study 5
1.3 Significances of the Study 5
CHAPTER 2: LITERATURE REVIEW
2.1 Ageing 7
2.1.1 Theories of Ageing 8
2.2 Bio- Psychological Challenges of the Aged in Nigeria 8
2.3 Nutritional Status of Older Persons (65 Years and Above) 9
2.4 Nutritional Requirements of the Older Persons 10
2.4.1 Energy Requirement 10
2.4.2 Protein 11
2.4.3 Fats and Cholesterol 14
2.4.4 Iron 14
2.4.5 Calcium 15
2.4.6 Magnesium 16
2.4.7 Selenium 16
2.4.7 Vitamins 17
2.4.7.1 Vitamin C 18
2.4.7.2 Vitamin D 19
2.4.7.3 Vitamin E 20
2.4.7.4 Vitamin K 20
2.5 Factors that affect the Nutritional Status of the Older Adult 20
2.5.1 Appetite. 20
2.5.2 Taste and Smell 21
2.5.3 Disease and Disability 21
2.5.4 Social Factors 22
2.5.5 Physiological Changes 22
2.6 Nutritional Assessment of Older Person 22
2.6.1 Nutritional Status 23
2.6.2.1 Anthropometric Measurements 23
2.7 Cardiovascular Disease and Risk Factors 26
2.7.1 Cardiovascular Disease 26
2.7.1.1 Coronary Heart Disease (CHD) 26
2.7.1.2 Cerebrovascular Accident/Diseases (CD) 27
2.7.1.3 Peripheral Artery Diseases 28
2.7.1.4 Rheumatic Heart Diseases 28
2.7.1.5 Congenital Heart Disease (CHD) 29
2.7.2 Risk Factors of Cardiovascular Diseases 30
2.7.2.1 High Blood Pressure (Hypertension) 30
2.7.2.2 Smoking 32
2.7.2.3 High Blood Glucose 33
2.7.2.4 Physical Inactivity 34
2.7.2.5 Obesity 36
2.8 prevalence of Cardiovascular risk factors in older persons 40
CHAPTER 3: MATERIAL AND METHODS
3.1 Study design 41
3.2 Area of study 41
3.3 Population of the study 41
3.4 Sampling and Sampling techniques 42
3.4.1 Sample size determination 42
3.4.2 Sampling Procedure 43
3.5 Preliminary activities 43
3.5.1 Preliminary visits 43
3.5.2 Training of research assistants 44
3.5.3 Informed consent 44
3.5.4 Validation and pretesting of Questionnaires 44
3.6 Data collection 44
3.6.1 Questionnaire administration 44
3.6.2 Interview 46
3.6.2 Anthropometric measurements 46
3.6.3.1 Weight measurement 46
3.6.3.2 Height measurement 46
3.6.3.3 Body Mass Index 47
3.6.3.4 Hip circumference measurement 47
3.6.3.5 Waist circumference measurement 48
3.6.3.6 Waist Hip ratio (WHR) 48
3.6.4 Clinical analysis 50
3.6.4.1 Blood pressure 52
3.6.4.2 Procedure 54
3.7 Data analysis 58
3.8 Statistical analysis 60
CHAPTER 4: RESULT AND DISCUSSION
4.1 Personal information of older persons 65
4.2 Socio-economic characteristics of older person 68
4.3 Dietary habits of the older persons 68
4.4 Information on Cardiovascular risk factor 69
4.5 Twenty four (24-hours) Dietary recall of the older persons 68
4.6 Food frequency of the older persons 70
4.7 Anthropometric indices of older persons 73
4.8 Information on the blood pressure of the older persons
4.9 Relationship between Body Mass Index and Cardiovascular risk factors of
the older persons 73
4.10 Relationship between blood pressure and Cardiovascular risk factors of
the older Persons 75
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATION
5.1 Conclusion 77
5.2 Recommendations 77
Appendix: Questionnaire 79
List of Tables
Table3.1 BMI classification 48
Table 4.1 Personal information of the older persons 48
Table 4.2 Socio-economic characteristics of the older persons 50
Table 4.3a Dietary habits of the older persons 53
Table 4.3b Dietary habit of the older persons 56
Table 4.4 Information on cardiovascular risk factor 57
Table 4.5a 24 Hours Dietary Recall of the Older Persons 59
Table 4.6a Frequency of consumption of food by respondents 62
Table 4.6b Frequency of consumption of food by respondents 63
Table 4.7 Anthropometric indices of the respondents 64
Table 4.8 Information on the blood pressure of the older persons 66
Table 4.9a Relationship between body mass index and cardiovascular risk factor of older persons 69
Table 4.9b Relationship between body mass index and cardiovascular risk factor of older persons 71
Table 10 Relationship between blood pressure and cardiovascular risk factors 78
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Nutrition is an important determinant of health in older persons. Over the past decades, the importance of Nutritional status has been increasingly recognized in a variety of morbid conditions including cancer, heart disease and dementia in persons over the age of 65 (Basran and Hogan, 2012). Nutrition is one of the characteristic of living things. The American Medical Association (AMA, 2014) defined nutrition as the science of food, the nutrients and the substance therein, their actions, interaction and balance in relation of health and disease, and the process by which the organisms digests, transports, utilizes and excrete of food substances. The nutrients and other substances in food affect an individual's nutritional status. Nutritional status is the nutritional health of a person, which is a component of physical and mental health which is determined by anthropometric measurement (height, weight, and circumference), biochemical measurements of nutrient, clinical and dietary analysis (WHO, 2015).
Adequate nutrition is essential to a healthy life and healthy aging on an individual as well as on a societal level (Eggersdorfer, 2014).For an individual to attain good nutritional status, he or she must select, obtain and consume foods that will meet the Nutritional status of the individual which is the end result of utilization of the nutrients by the body. Degenerative disease such as diabetes, osteoporosis and cancer, which are among the common diseases affecting older persons, are all diet - affected. Increasingly in the diet/ disease debate, the role that micronutrients play in promoting health and preventing non-communicable disease is receiving considerable attention. Older people often suffer from decreased immune function, which contribute to increased morbidity and mortality (WHO, 2019).The association between support and health has long been recognized. Report indicates that less physical and emotional support from the family were associated with more depressive and anxiety symptoms than other general support for the older persons (Leung and Men, 2007).
Ageing result from the impact of the accumulation of a wide variety of molecular and cellular damage over time. It leads to a gradual decrease in physical and mental capacity a growing risk of disease, and ultimately death (Amrya, 2018). According to (Shlisky et al, 2017), ageing is defined as the age of retirement, for it is the time that the combined effect of ageing, social change and disease are likely to cause a breakdown in health. Among numerous environmental factors that modulate ageing, nutrition plays a significant role and is found to be a key factor for successful ageing. Ageing is not a disease, but a normal part of the life cycle (Ene-obong, 2017).
Cardiovascular risk factors is the likelihood of a person developing an atherosclerotic Cardiovascular disease (this is a condition where there is a focal accumulation in the intimal lining of the arteries and the accumulation consist of fibrous tissues, blood and blood products, lipids, complex carbohydrate etc.) even over a defined period of time according to European Society of Cardiology (ESC), (2012). Cardiovascular Diseases (CVD) is so strongly age-related that it has been proposed as a biomarker of aging (Arvind, 2014).Over three quarters of CVD deaths take place in low- and middle -income countries (WHO, 2017).The cause of heart attack and strokes are usually as a result of the presence of a combination of risk factors such as tobacco use, Hypertension, physical inactivity, obesity unhealthy diet, harmful use of alcohol, diabetes and hyperlipidemia (WHO, 2015). Malnutrition is related to a decline in general functional status and to decreased bone mass, immune dysfunction, delay post-surgery recovery, high hospitalization and readmission rates, and increased mortality among other problems (Muller, 2013). This study was designed to Malnutrition as the cause of death to the aged ones because their body system is no longer able to carry some diet (Keller et al., 2018)
1.2 STATEMENT OF PROBLEM
Cross-sectional studies have shown that body weight and body mass index (BMI) increase with age until approximately 50 to 60 years, after which they both decline (Villarreal et al, 2008). With age, body fat increases and fat-free mass decreases because of loss of skeletal muscle, with a loss of up to 3kg of lean body mass per decade after the age of 50. The mean body fat of a 20years - old man weighing 80kg is 15% compared to 29% in 75-years old man of the same weight (Marcella, 2010). The cause of increase fat is multifactorial: reduced physical activity, reduced by growth hormone secretion, diminished sex hormones and decreased resting metabolic rate. An individuals with an upper body fat pattern, reflecting an excess of intra-abdominal or visceral fat, have significantly greater risk for diabetes, ischemia heart disease, some cancers, and death from all causes (Fisher, 2017).
The five leading risk factors for death especially in older persons, are high blood pressure, smoking, high blood glucose (hyperglycemia), hyperlipidemia and obesity (Fam, 2015). A Glance at these risk factors reveals that high blood pressure and glucose levels as well as obesity are connected with poor nutritional status (WHO, 2015). Over 66% of stroke patients in Lagos were found to be hypertensive leading to complications such as stroke, angina pectoris, myocardial infarction, heart failure and left ventricle failure (Onyemelukwe, 2008). Renal diseases are mainly caused by hypertension as the major risk factor (Stanner, 2005). Dyslipidemia, which is just the disproportion of the lipid component high density lipoprotein (HDL), low density lipoprotein (LDL), total serum cholesterol in the body is also pointed as a risk factors for Cardiovascular disease (Stanner, 2005). For instance, the optimum ratio between serum total cholesterol to HDL- cholesterol is 3:5:1 (Stanner, 2005). Any reduction in this ratio could lead to alteration disposition of fatty materials and pressure, which can predispose one to Cardiovascular risk (National institute of Health, 2014). Cardiovascular disease is so strongly age-related that it has been proposed as a biomarker of aging (Arvind, 2014). The problems are a result of poor nutritional status which is due to lack of nutrition knowledge and to a lack of nutrition knowledge and to a large extend, poverty. In view of the problems identified, it is important to carry out the research which is aimed at looking at the Nutritional status and cardiovascular risk factors of older persons.
1.2 OBJECTIVES OF THE STUDY
The general objective of this study is to determine the nutritional status and cardiovascular risk factors of the older persons.
The specific objectives are to:
i. Determine the personal and socio-economic characteristics of the older persons.
ii. Identify the presence of cardiovascular risk factors among the subject
iii. Assess the nutritional status of the older persons using Anthropometric measurements (BMI), and clinical examinations.
iv. Determine the dietary pattern of the older persons using 24-hours dietary recall and food frequency.
v. Determine the relationship between Nutritional status and cardiovascular risk factors of the older persons.
1.3 SIGNIFICANCE OF THE STUDY
The study of nutritional status and cardiovascular risk factors of the older persons will be of great importance to the masses because it will provide them with adequate information on their nutritional status and also be a guide for them to know their state of health. It will help the Health workers and Nutritionists in Etinan Local Government Area to know the nutritional status and cardiovascular risk factors in older persons in order to profer solution.
The findings of this research will help the community health care centers in the state to create a laboratory center where the older persons can go for monthly checkup in order to know their nutritional status. It will also assists households and caregivers to make proper selection of food, good meal preparation and service to the older ones in other to stay healthy.
Furthermore, it will provide information which would be useful to the Government, public health workers, health professionals on planning and executing programs for the well-being of the older persons. This study will help nutrition workers in the local government to plan and carry out nutrition education program that will help to improve nutritional status of older persons.
Attempts to provide older persons with adequate nutrition encounter many practical problems. This study will be particularly useful to World Health Organization (WHO) to define adequate nutritional requirements for older persons because older persons are particularly vulnerable to malnutrition.
The information derived from the study will be of utmost importance of National Nutrition Agency (NNA) as it will aid them in meeting the increasing demand Worldwide to address the Nutritional needs of growing elderly populations.
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