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ASSESSMENT OF THE NUTRITIONAL STATUS OF THE ELDERLY ATTENDING VARIOUS PUBLIC POLYCLINICS IN BENGHAZI CITY *Mohamed H Buzgeia, *Diwa Pandey, **Safaa A.E Badr, * Faiza Ghaith El Fakhry , * Azza Emraja El Baddry, *Najwa Dhakeel El Agori

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ASSESSMENT OF THE NUTRITIONAL STATUS OF THE ELDERLY ATTENDING VARIOUS PUBLIC POLYCLINICS IN BENGHAZI CITY

*Mohamed H Buzgeia, *Diwa Pandey, **Safaa A.E Badr, * Faiza Ghaith El Fakhry, * Azza Emraja El Baddry, *Najwa Dhakeel El Agori

*Nutrition Department, Faculty of Public Health, Al Arab Medical Science University, Benghazi (Libya),

** Community Medicine Department, Faculty of Medicine, Menoufiya University, Egypt

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SUMMARY

Objective:To assess thenutritional status of the elderly attending various Benghazi

public polyclinics using the Mini Nutritional Assessment (MNA) & identify the

Physiological& non-physiological factors associated or related to malnutrition or its risk.

Design and setting:A cross sectional study using the MNA to assess the nutritional

status of the elderly (> 60 years) attending various Public polyclinics between 10th

December, 2007 & 13th February, 2008.

Subjects:A total of 508 (221 males and 287 females) out of 566 (90 %) eligible

patients who participated & completed the study.

Major outcome methods:Interviewer administered structured questionnaire, MNA

questionnaire& a 24 hours diet recall.

Results:As per the MNA, 6.5 % & 36.8 % of the outpatient elderly were malnourished

or at its risk respectively. Age group, sex, occupation, self perceived income inadequacy

to purchase nutritious food, self perceived oral problems, dentition problems, dysphagia,

constipation, dehydration, activity level, presences of chronic disease & the number of

systems involved in it and the presence & type of food intolerances were the studied

factors associated with (p< 0.05) the nutritional status of the subjects. BMI alone is

an insensitive means of assessment of outpatient elderly nutritional status. Both the

mean total & domain MNA scores were different (p< 0.05) among the normal, at risk &

The malnourished groups. All the MNA questions except for daily fluid intake & living

independently had a significant (p < 0.05) positive correlation (r = 0.23-0.65) with

the final MNA score.

Conclusion:There is a considerable prevalence of malnutrition & its risk among the

elderly in public polyclinics in Benghazi. The MNA is a useful tool to help the

government identify the beneficiaries of early intervention & work towards optimal,

timely & cost effective nutritional intervention.

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INTRODUCTION

  • Elderly:
  • Defined as those 60 years & more by the World Health Organisation (WHO).
  • Estimated to grow from 605 million (20 %) in 2002to 1.2 billion (29 %)2025 1,2.

Demographic change in Libyan Arab Jamahiriya: Projected increase [2008- 2025] in for the elderly3.

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Changes during ageing

  • Individualised degenerative changes like lowering of lean body mass, altered gastrointestinal, sensory, nervous, immune renal function etc and changes in the oral cavity, fluid regulation.
  • Additional contributors are socio-psychological, physical and socio-economic factors.
  • All these predispose the elderly towards malnutrition, which is common (1-11 % are malnourished and 8-48 % at risk of malnutrition 4) and frequently overlooked resulting in various negative health outcomes.
  • Early detection of the risk of malnutrition and it’s diagnosis therefore becomes important.
  • The Mini Nutritional Assessment (MNA) 4which very simple, inexpensive, quick and patient friendly Nutritional screening tool with minimal opportunity for bias can quickly & cost effectively identifies persons who are at a risk, before they become malnourished.
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AIM OF THE STUDY

  • To study the nutritional status of the elderly attending various public polyclinics in Benghazi:
  • To assess the nutritional status of the elderly using the MNA by identification & assessment of the elderly in terms of normal, at risk of malnutrition and malnourished.
  • To find out if the three groups of the elderly based on their nutritional status, differed among themselves in the four domains of the MNA.
  • To find out the relationship of the questions within each of the four MNA domains with the nutritional status of the elderly.
  • To identify the various physiological & non physiological factors including select socio-economical factors that are associated with malnutrition within this age group.
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SUBJECTS AND METHODS

  • Study population and design:
  • A cross-sectional study (1st December 2007 to 15th April 2008) carried out
  • in public polyclinics in Benghazi city.
  • Inclusion criterion: All patients > 60 years of age of both sexes.
  • 508 patients were finally enrolled in the study giving a response rate of 90 %.
  • Methodology:
  • A detailed structured interviewer administered questionnaire to collect information about:
  • Select socio-economic characteristics
  • Self perceived physiological or food related problems, food intolerances
  • ,nutritional supplements and medical information related to chronic disease and surgery
  • Nutritional assessment using the two step scored MNA to classify subjects as
  • well nourished, at risk of malnutrition or malnourished.
  • Anthropometric measurements were taken per standard techniques for the elderly
  • ambulatory & non-ambulatory and/or amputees 5-6 using WHO reference values
  • for 60-69 years & > 70 years5
  • Statistical analysis done using SPSS with level of significance set at p < 0.05
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RESULTS

Distribution of subjects according to their nutritional status

based on the cumulative interpretation of the MNA (n = 508)

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FACTORS ASSOCIATED WITH NUTRITIONAL

STATUS

  • Socio-economic characteristics
  • Age group, sex, occupation & self perceived income inadequacy to purchase nutritious food were the socio-economic factors associated (p< 0.05) with the nutritional status of the subjects as assessed by the MNA.
  • The nutritional status:
  • Lowered with increased age group
  • Was better among females, in those currently employed and those with
  • self perception of adequacy of their income to purchase nutritious food.
  • Self perceived physiological & food related characteristics
  • Oral problems, dentition problems, dysphagia, constipation and dehydration were associated (p< 0.05) with lower nutritional status of the subjects.
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Among the self reported physical activity characteristics, activity level was associated

  • (p< 0.05) with the nutritional status of the subjects.

The immobile were at the greatest risk of malnourishment & of actual malnourishment

  • and among those who were mobile, a lower activity level was associated with a lower
  • nutritional status.
  • The presence of chronic disease & a greater number of systems involved because of
  • the chronic disease were the medical characteristics associated (p < 0.05) with
  • nutritional status.
  • Both the presence & the type of food intolerances (dairy foods, meat or egg) was
  • associated (p< 0.05) with a lower nutritional status of the elderly in this study.
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BMI although associated with the nutritional status, is insensitive

  • as the sole means of assessment of nutritional status of outpatient elderly.
  • This finding is supported by previous studies4,7.
  • The total MNA score of the three groups differed (p< 0.05)
  • from each other.
  • The three groups also differed (p< 0.05) in their mean
  • score for each of the four individual domains of the MNA
  • All the individual questions within the four domains of the MNA
  • (except for daily fluid intake & living independently) were positively
  • correlated (r = 0.14-0.65 at p < 0.05) to the nutritional status of the subjects.
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CONCLUSION

  • The mean prevalence of malnutrition at 6.5 % and 36.8 % at risk of malnourishment was highlights the need for an earlier preventive approach
  • through identification of specific risk factors followed by
  • appropriate intervention.
  • The factors associated with malnutrition among the elderly outpatients help the government identify the subgroups within the outpatient
  • elderly who are at greater nutritional risk, who may benefit from early
  • intervention and to guide it towards optimal, timely and cost effective
  • nutritional intervention.
  • This study justify the use of multifaceted nutritional assessment methods like the MNA.
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RECOMMENDATIONS

  • The findings of this study suggest the following recommendations
  • All outpatient elderly in Benghazi should be routinely screened and assessed if needed, for malnutrition or its risk using the MNA.
  • Multi faceted & tailor made strategies to counteract specific malnutrition need to be planned, implemented, monitored and evaluated among the malnourished and at nutritional risk.
  • Special geriatrics units should be set up as a part of the national health care system to manage the nutritional problems related to age related physiological changes, chronic diseases and/ or nutrition related illnesses.
  • Nutritional intervention programmes planned for the elderly in general should have a focus on those belonging to a higher age group and the immobile.
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Nutrition education must form a part of geriatric care especially in context to the

  • dual problem of overweight & underweight among the elderly; & unhealthy eating practices among them.
  • 6 Acceptable exercise programmes need to be developed & integrated into the social life of the outpatient elderly.
  • 7 Special programmes should be launched to provide supplementary monetary aid & subsidy on nutritious food to the financially vulnerable sections of elderly receiving outpatient care.
  • 8 Additional studies need to be carried out among the elderly in different settings as well as other regions of Libyan Arab Jamahiriya to identify the specific prevalence of malnutrition & factors associated with it.
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MAJOR REFERENCES

  • 1 World Health Organisation. Keeping fit for life: Meeting the nutritional
  • needs of older persons. Geneva: World Health Organisation; 2002.
  • 2 Kennedy ET. Evidence for nutritional benefits in prolonging wellness.
  • Am J Clin Nutr.2006;83(suppl):410s-414s.
  • 3 U. S. Bureau of Census, International Data base, Washington [Online]
  • 2006 [Cited 2007 December 3] Available from:
  • URL: http://www.census.gov/cgi-bin/ipc/idbsprd
  • 4 Guigoz Y. The Mini Nutritional Assessment (MNA). Review of
  • literature- What does it tell us? J Nutr Health Aging.2006;10(6): 466- 485.
  • World Health Organisation. Physical status: the use and interpretation of
  • anthropometry report of WHO expert committee. Geneva: WHO Technical
  • Report Series No. 854, 1995.
  • Lee RD, Nieman DC. Assessment of the hospitalised patient. In: Nutritional
  • Assessment. 4th edition. New York: McGraw Hill Higher Education. 2007; 222-260.
  • Vellas B, Anthony P. The MNA (Mini Nutritional Assessment): 20 years of research
  • and practice in the field of malnutrition and intervention in the elderly. J Nutr Health
  • Ageing.2006;10(6):455.