Assessment of nutritional status among geriatric population in rural Mangaluru: a cross sectional study

INTRODUCTION

In January, 1999 Govt of India adopted National Policy on elder persons which defines senior citizens or elderly as a person who is of 60 years or above.¹ The percentage of elderly is growing rapidly worldwide. The global number of elderly is projected to rise from an estimated 524 million in 2010 to nearly 1500 million in 2050, with most of this increase in developing countries.² The lack of guaranteed sufficient income to support themselves, absence of social security, loss of social status and recognition, unavailability of opportunities for creative use of time and persistent ill health are some problems faced by elderly in the country. Older adults are at a risk of malnutrition due to physiological, psychological, social, dietary and environmental factors.² Malnutrition is defined as ‘a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients'. It comprises four forms: under nutrition, over nutrition, imbalance and specific deficiency.³

Different studies have shown that more than 50% of elderly population of India are suffering from malnutrition and more than 90% have less than the recommended intake.¹ Studies reported the following significant risk factors for malnutrition: age, general health decline including physical functions, Parkinson’s disease, constipation, poor or moderate self-reported health status, cognitive decline, dementia, eating dependencies, poor appetite, loss of interest in life, basal oral dysphagia, signs of impaired efficacy of swallowing and institutionalization.²⁰

These risk factors for malnutrition in older adults may be considered by health care professionals when developing new integrated assessment instruments to identify older adult’s risk of malnutrition and to support the development of preventive and treatment strategies.²⁰

Keeping all the above set facts in mind the present study was conducted to find the malnourished elderly in the community.

Aim and objectives

• • To evaluate the nutritional status of elderly using mini nutritional assessment (MNA) scale.
• • To evaluate the dietary consumption in terms of total calories and protein intake.
• • To assess the factors associated with the malnutrition.
• • To educate regarding nutritional importance in elderly.

METHODS

A community based cross-sectional study was conducted among the geriatric population (n=117) in rural Mangaluru using convenient sampling technique. The period of study was from April 2018 to June 2018.

Inclusion criteria

Person of 60 years of age and above and permanent resident of the area was taken as study subject.

Exclusion criteria

Person who is not willing to participate in the study was excluded.

Data collection

Oral consent was taken and validated questionnaire was used to conduct the study. The variables studied cover the profile of house hold in terms of gender, house hold size, social groups, APL/BPL, house hold structure, per capita monthly income, key variable, being the nutritional status of geriatric age group.

Questionnaire mainly focused on Mini Nutritional Assessment.⁷

Total screening score of 14 and assessment score of 16 were summed up to get the total assessment score on 30 to determine the person’s nutritional status (whether malnourished / at risk of malnutrition / normal).

Data analysis

Data collected were entered in Microsoft Excel and data analysis was done using SPSS version 25 and presented using descriptive statistics, mean and standard deviation. Association between two attributes were seen using chi-square statistics. The results with p<0.05 was taken as statistically significant.

RESULTS

A total of 117 participants were included in the study. According to Table 1 which shows Socio-economic characteristics of the study participants, 64.9% were between 60-65 years of age, 28.2% were between 66-75 years of age and 6.8% were above 75 years of age. 53% population were Muslims and 51% belonged to nuclear family. Majority 60.7% of the study population were females and 39.3% were males 35% belonged to Class 3 SES.

According to Table 2, 68.4% people does not avail any schemes, 25.6% avail old age pension, and 4.3% people are having health insurance.

According to the Table 3 and 4, MNA scale, 54 (46.7%) were at risk of malnutrition, 17 (14.5%) were suffering from malnutrition and rest 46 39.3%) had normal nutritional status.

The malnutrition screening score of elderly assessed in relation to their BMI as tabulated in Table 3 and MNA score in Table 4 depicts that with BMI less than 19 were at risk of malnutrition and is statistically significant (χ²=9.8655, p<0.00016). There was a significant correlation of MNA score with BMI.

According to this Table 5, 22.2% are hypertensive 15.4% are diabetic,10.3% are diabetic as well as hypertensive and 17.1% people does not have any illness.

DISCUSSION

In our study done according MNA classification, it was seen that out of 117 participants 54 (46.7%) were at risk of malnutrition, 17 (14.5%) were suffering from malnutrition and rest 46 (39.3%) had normal nutrition status. Our results revealed more elderly to be at risk of malnutrition than actually malnourished. This finding has been seen among the community dwelling elderly from India and other parts of world.^1,2,7,12

In study done by Anantesh et al, 2017 prevalence of malnutrition was found to be 18.6%, 42.6% were well nourished and 38.7% were at risk of malnutrition.¹

In the study done by Vedantam, et al out of 227 elderly subject 14% were malnourished and 49% at risk of malnourishment.¹²

There was significant correlation of MNA score with BMI as 47% of subjects had 23 or greater and 17.1% had BMI less than 19, 20.5% had BMI ranging between 19 to 21, 15.4% had BMI ranging between 21 to 23. In a study by Gandhi et al, in Rajasthan, 63.2% subjects were having BMI 23 or greater, 28.3% were having BMI ranging from 21 to 23, 7.2% were having BMI ranging from 19 to 21 and 13% were having BMI less than 19 according to MNA scale.²

Our analysis showed that lower MNA score were associated with those subjects who take less than 3 meals per day. A similar study showed that the elderly who were malnourished or at the risk of malnourishment consumed only two meals per day.¹²

CONCLUSION

In our study, out of total study participants, 54 (46.7%) were at the risk of malnutrition and 17 (14.5%) were malnourished as per MNA score. The results suggest that MNA is a useful tool in the identification of elderly at risk of malnutrition. Due to the high prevalence of elderly who were malnourished or at the risk of malnutrition, a more detailed evaluation, regular follow up and dietary intervention to reverse the situation is required. Research efforts and nutrition education strategies should be directed towards health of the elderly to develop nutritional guidelines promoting successful aging.

Recommendations

There is a pressing need to identify early those at risk and to develop targeted nutrition intervention programmes for prevention of the effects of untreated malnutrition that can lead to morbidity and to ensure healthy ageing.

Limitations

Convenient sampling was used.

ACKNOWLEDGEMENTS

This study was supported by Col (Dr.) K.G. Kiran, HOD, Dept. of Community Medicine, Kanachur Institute of Medical Sciences, Mangaluru. The authors are grateful to the MBBS students who helped in data collection.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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