Malnutrition and its determinants among older adults people in Addis Ababa, Ethiopia

Toward a Self-Report Cumulative Deficits Frailty Scale (Sr-CDFS): Development and Clinimetric Properties of a Novel Frailty Scale

BACKGROUND AND PURPOSE

Frailty, a multidimensional syndrome, is linked with heightened risk of adverse outcomes. Targeted physical therapy interventions for individuals with frailty have proven beneficial, underscoring the value of routine frailty assessment in both clinical and research settings. This study aimed to: (1) describe development of a simple self-report cumulative deficits frailty scale (Sr-CDFS); (2) establish the criterion validity of Sr-CDFS against the commonly used Fried's frailty scale and Study of Osteoporotic Fracture criteria (SOF); and (3) assess other concurrent validity and internal consistency of the new Sr-CDFS.

METHODS

The study included 230 older adults (M age = 79.27 ± 7.42 years), with 76.5% being women. Outcome measures were: (1) validated frailty scales, including Fried's frailty phenotype, SOF, and Sr-CDFS; and (2) a battery of tests for impairment, activity limitations, and health status. Data analysis involved calculating frailty prevalence using the validated frailty scales. The clinimetric properties of the Sr-CDFS were assessed against validated frailty scales. Convergent and discriminative validity of the Sr-CDFS were examined. Internal consistency and structure were evaluated using Cronbach's alpha and exploratory factor analysis.

RESULTS AND DISCUSSION

No differences (P = .80) in frailty prevalence were found between Fried (26.1%) and SOF (25.2%) methods. The Sr-CDFS exhibited excellent internal consistency (Cronbach's alpha = .92), with reliability of questionnaire components (health, falls, physical, cognitive, socioemotional function) ranging from .73 (falls) to .90 (physical ability). Additionally, the Sr-CDFS demonstrated convergent and discriminative validity, with its total score and various parts correlating significantly with most outcomes (r = .25-.59, P < .05). Using K1-criterion and a scree plot, we identified a 5-factor solution that had a common variance of 63.9%.

CONCLUSION

The newly developed Sr-CDFS exhibits robust clinimetric properties with good-to-excellent reliability and validity. The newly developed Sr-CDFS has the potential to increase the feasibility of assessing frailty in clinical settings or large-scale epidemiological studies.

Diet and sociodemographic predictors of the double burden of malnutrition in urban Zimbabwe

BACKGROUND

 Rapid urbanisation in low- and middle-income countries (LMICs) has intensified the double burden of malnutrition, where undernutrition and overnutrition coexist in the same populationAim: This study aimed to examine the point prevalence rate and risk factors of the double burden of malnutrition among adults in urban Zimbabwe.

SETTING

 The study was conducted in Zimbabwe's two metropolitan provinces (Harare and Bulawayo).

METHODS

 A cross-sectional study of 348 urban adults explored associations between dietary intake, socio-demographics and anthropometrics using means, frequencies, and logistic regression.

RESULTS

 Obesity prevalence was 23.6%, and underweight prevalence was 8.6%. Men had higher odds of being underweight than women (Adjusted Odds Ratio 2.30, 95% CI 1.20-4.41), while high household income increased the odds of obesity (Adjusted Odds Ratio 2.90, 95% CI 1.47-5.60). A fruit and vegetable-rich diet reduced the odds of obesity by 47% (Adjusted Odds Ratio 0.53, 95% CI 0.26-0.89), whereas a diet dominated by staples and sugary foods increased the risk of obesity.

CONCLUSION

 Obesity and underweight were common among urban adults in Zimbabwe, where both undernutrition and overnutrition pose significant health risks. Public health interventions in LMICs should broaden their focus to address adult malnutrition and its contribution to diet-related non-communicable diseases (NCDs).Contribution: The double burden of malnutrition underscores an urgent need for comprehensive public health strategies in LMICs. Efforts should move beyond childhood undernutrition to address the entire spectrum of malnutrition. Tackling these challenges holistically will be key to mitigating undernutrition, curbing rising obesity rates, and, in turn, reversing the tide of diet-related NCDs.

Prevalence of Malnutrition and Associated Factors Among the Elderly With Type 2 Diabetes Using MNA Form

Objective: This study has been conducted to identify the frequency of malnutrition and different factors associated with it among elderly people with Type 2 diabetes. Methods: This cross-sectional study was conducted in the National Institute of Diabetes and Endocrinology (NIDE), DUHS, Karachi, between January 2023 and October 2023. A total of 325 elderly participants aged ≥ 60 years with Type 2 diabetes were included. Mini Nutritional Assessment (MNA) was used for data collection. Results: Nutritional assessment of older diabetic patients according to the MNA revealed that 226 (69.5%) patients were at risk of malnutrition whereas 53 (16.3%) were malnourished. A total of 325 Type 2 diabetic patients were included in the study with a mean age of 65.7 ± 5.5 years, where 135 (41.5%) were male and 190 (58.5%) were female. Older patients (mean age: 65 years) were significantly more malnourished compared to those with normal nutrition (mean age: 62 years; p=0.021). Employed patients were less likely to have the risk of malnutrition as compared to housewives (p=0.005). Patients who had low family income were eight times more likely to be malnourished as compared to those who had better family income (p=0.003). It was also found that patients with low BMI and calf circumference will be more prone to be malnourished as compared to those with high levels of BMI (p=0.003) and calf circumference (p=0.013). Conclusion: The majority of study participants were at risk of malnourishment, with associated factors such as rapid weight loss, poor health status, decline in physical activity, and food intake. Therefore, these findings highlight the importance of tailored interventions for at-risk individuals, including regular screening and nutritional support.

A randomized multi-arm open labelled comparative clinical trial report of Pankajakasthuri DiabetEaze powder, a novel polyherbal formulation on the nutritional management and glycemic control in type 2 diabetic and prediabetic patients

Background and aims

Recently Diabetes Mellitus (DM) has been associated with heightened susceptibility to malnutrition, suggesting that augmenting nutritional intake stands out as a potent therapeutic strategy for addressing malnutrition in individuals with DM. The aim of this clinical investigation was to evaluate the effect of DiabetEaze powder, a polyherbal nutritional formulation developed by us for nutritional management and glycaemic control, on patients with diabetic and prediabetic conditions.

Methods

A total of 143 type II diabetic (T2D) patients who were managing their diabetic condition through modern medicine, AYUSH medicine, lifestyle modification and 68 pre-diabetic patients, aged between 40 and 65 years, were randomly assigned into six groups: control, modern, AYUSH, lifestyle, prediabetic control and prediabetic trial. The treatment groups were administered 5 g of DiabetEaze powder two times a day after food for 6 months. Microminerals, vitamins, glycaemic parameters, Quality of Life (QoL), hematology, lipid profiles, Renal Function Test (RFT) and Liver Function Test (LFL) parameters, and electrolytes were evaluated at Day 0, Day 90, and Day 180.

Results

Out of 211 enrolled patients, 189 individuals successfully completed the entire 180-day duration of the study, indicating a retention rate of approximately 89.6 %. In our study, we observed a statistically significant elevation in the levels of vitamin D, B2, and B6 across all treatment groups. Besides, the treatment groups displayed a notable increase in zinc and manganese levels compared to the other minerals tested. Notably, the treatment groups demonstrated distinct mineral and vitamin profiles. In terms of metabolic markers, significant reductions in Fasting Blood Sugar (FBS)/Post Prandial Blood Sugar (PPBS) were observed across the modern, AYUSH, and lifestyle groups, while the modern group also showed a marked decrease in glycated haemoglobin (HbA1c) levels. Furthermore, overall QoL among the tested groups was also statistically significant. The consistent maintenance of normal LFT and RFT parameters and electrolyte levels across trial groups throughout the study duration indicates that the supplement does not induce liver toxicity or negatively impact hepatic function.

Conclusion

In conclusion, the nutrients present in the DiabetEaze powder contribute to the effective management of nutritional status in diabetic people and thus effectively reduce sugar spikes by regulating PPBS and HbA1c levels, which is a critical aspect of its role in diabetes management. These properties benefit in managing diabetes-related outcomes and overall quality of life.

Clinical trial registry of India under registration no

CTRI/2021/04/032956 on 20/04/2021.

Under-nutrition and its associated factors among adult second-line antiretroviral treatment users in Northern Ethiopia

BACKGROUND

Despite advancements in Human Immunodeficiency Virus (HIV) treatment and care, undernutrition remains a significant concern, accelerating disease progression and risk of Acquired Immune Deficiency Syndrome (AIDS)-related deaths. The nutritional status of second-line antiretroviral treatment (SLART) users in Ethiopia has not been thoroughly investigated. So, this study aimed to assess the nutritional status of HIV/AIDS patients who were on SLART and its associated factors in Northern Ethiopia.

METHODS

A retrospective cross-sectional study was conducted on 366 HIV-infected adults who had been on SLART for at least six months in northern Ethiopia. Clients who had documented Weight and height at six months of therapy were included. Data was entered and cleaned by using EpiDATA version 4.6.0.2 and statistical analysis was done by STATA version 17. Multiple imputation method was applied to manage variables having up to 25% missing values by using R-Version 3.6.2 software. Binary logistic regression was used with P < 0.05 as a significant predictor in the final analysis. Data was collected from February 01 to April 30, 2021.

RESULTS

The magnitude of undernutrition among adults who were on SLART in the study area was 38.52% (95%CI: 33.65-43.64). Those populations also had a baseline undernutrition status of 39.1% (95%CI: 34.11-44.15) during their transition to SLART. The risk of being malnourished at six months of SLART initiation was fifteen times higher among those who were undernourished at SLART start (AOR:15.099, 95%CI: 8.532, 26.720) reflecting the high burden of the problem in the advanced courses of HIV/AIDS treatment and care.

CONCLUSIONS

The proportion of undernutrition among SLART users in Northern Ethiopia is high. During HIV therapy, a client's overall nutritional health is predicted by their prior undernutrition condition. This highlights the need for comprehensive nutritional assessment, counseling, and monitoring of the nutritional status of SLART users in the area with emphasis on an early identification of possible barriers to the improvement of such conditions. Promoting the consumption of nutrient-dense local foods and appropriate food preparation methods in addition to nutritional support are vital in this setting.

Are Mobile Apps Effective at Targeting Physical Activity or Malnutrition in Community-Dwelling Older Adults? A Systematic Review and Meta-Analysis

This systematic review aims to identify the effectiveness of digital health applications (apps) to increase physical activity (PA) or prevent malnutrition in community-dwelling older adults. Searches were conducted in June 2023 across seven electronic databases (MEDLINE, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials), and grey literature were searched via google scholar. Data from studies that met the inclusion criteria were extracted. Risk of bias was assessed, and the quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were undertaken where appropriate using DerSimonian and Laird random-effects model (Stata version 16.1), or data were described narratively. Twenty-seven studies met the eligibility criteria, although 23 of these had low or unclear risk of bias. Twelve studies considered PA outcomes only, two studies considered nutritional outcomes only, and three studies considered both PA and nutritional components. A meta-analysis comprising six studies (818 participants) showed that those using a digital health app had a higher step count compared with participants in the control group (mean difference = 799, 95% CI [48.76, 1550.08]). Studies looking at nutritional outcomes aimed to increase protein intake or adherence to dietary patterns with mixed findings. Digital health apps have the potential to increase PA in community-dwelling older adults. Digital health app interventions that aim to reduce the risk of malnutrition in older adults is a relatively unexplored area with mixed findings, so more high-quality studies should be prioritized.

On the Relationship Between Frailty, Nutritional Status, Depression and Quality of Life Among Older People

BACKGROUND

Frailty is a multidimensional geriatric syndrome associated with physical, psychological and social changes. There is a paucity of research on frailty in Sub-Saharan African (SSA) countries, especially Ethiopia.

OBJECTIVES

To assess the initial correlations among frailty, nutritional status, depression and QOL (quality of life) in a group of older people in Ethiopia who are later enrolled in a study examining the effects of a nurse-led community intervention on frailty and related health outcomes.

METHODS

Data from 68 community-dwelling individuals 60 years of age, or over, were collected. Frailty was measured using the Amharic version of the Tilburg Frailty Indicator. The statistical analysis included Spearman's rank correlation coefficient for degrees of association, Mann-Whitney U-test for variables with two categories and Kruskal-Wallis for variables with three or more categories.

RESULTS

The mean frailty score for participants was 7.3 (±1.9). Participants with higher frailty scores had lower nutritional status (rs = -0.46, p < 0.01). There was a statistically significant relationship (positive) between frailty scores and depression (rs = 0.39, p < 0.01). Depressed (Md = 9, n = 23) and non-depressed frail older people (Md = 7, n = 45) showed a significant difference in their overall frailty score, U = 330.50, z = -2.49, p = 0.01, r = 0.30. There was an inverse significant association between the level of frailty across different domains in the QOL: physical (rs = -0.44, p < 0.01), psychological (rs = -0.45, p < 0.01), social relations (rs = -0.29, p < 0.05) and environmental (rs = -0.47, p < 0.01).

CONCLUSION

The findings from this study were consistent with those from across middle-income and high-income countries.

IMPLICATIONS FOR PRACTICE

This research indicates that older people living in communities who are identified as frail often suffer from a poor nutritional status, depression and reduced QOL. It suggests that healthcare professionals in Sub-Saharan countries would benefit from recognising the frailty in this population, and developing interventions aimed at enhancing nutrition, mental health and overall well-being.

Prevalence and Factors Associated With Healthy Aging in a Large Representative Community Sample of Older Ethiopians

Objectives: To examine the prevalence and predictors of healthy aging among community-dwelling older adults living in Bahir Dar, Ethiopia. Methods: A community-based cross-sectional study included older adults aged 60 and above (n = 845; Mage = 71 years; 56.4% females). Poisson regression estimated the Relative Risk (RR) of factors associated with healthy aging status. Results: 36.7% of respondents were classified as healthy agers. Factors associated with an increased likelihood of healthy aging included reporting not being lonely, adequate nutrition, no multimorbidity, good self-rated health, financial independence, and engaging in at least 1 hour of moderate physical activity per week. Discussion: The proportion of healthy agers in this study was substantially lower compared to developed countries but comparable to the prevalence reported in similar developing nations. Enhancing physical activity, ensuring proper nutrition, interventions to foster social participation engagement, and networking, and managing chronic diseases were identified as promising strategies to promote healthy aging.

Geriatric Nutritional Risk Index as a Possible Predictor of Decline in Kidney Function in Older People

BACKGROUND

The Geriatric Nutritional Risk Index (GNRI) is associated with morbidity and mortality in older individuals. Our study explored the relationship between GNRI, decline in kidney function, and all-cause mortality in older individuals.

METHODS

This retrospective cohort study analyzed data from participants aged ≥60 years who underwent a general health checkup between 2002 and 2018. The primary exposure was the GNRI, divided into quartiles. The primary and secondary outcomes were a decline in kidney function assessed using the 5-year estimated glomerular filtration rate (eGFR) and all-cause mortality, respectively.

RESULTS

The analysis included a total of 1,599 participants (median age, 63 years; interquartile range [IQR], 61-67; 54% males). The mean±standard deviation of GNRI was 114±7. Compared with the highest GNRI quartile, the lower GNRI quartiles were associated with steeper 5-year slopes in eGFR, with a fully adjusted beta coefficient and 95% confidence intervals (CIs) of -0.50 (-0.86, -0.14), -0.29 (-0.63, 0.05), and -0.19 (-0.53, 0.14) for the first, second, and third GNRI quartiles, respectively. The median follow-up duration was 7.4 years (IQR, 4.6-12.4). During this period, we identified 108 deaths (7.8 per 1,000 person-years). The first GNRI quartile was associated with all-cause mortality compared to the highest GNRI quartile (hazard ratio of 2.20; 95% CI 1.23, 3.95).

CONCLUSION

Nutritional status, as evaluated using the GNRI, was associated with 5-year changes in kidney function and all-cause mortality in older individuals.

The Association of Malnutrition and Health-Related Factors among 474,467 Older Community-Dwellers: A Population-Based Data Mining Study in Guangzhou, China

BACKGROUND

This study aimed to examine the prevalence and associated factors of malnutrition in older community-dwellers and explore the interaction between associated factors.

METHODS

A total of 474,467 older community-dwellers aged 65 or above were selected in Guangzhou, China. We used a two-step methodology to detect the associated factors of malnutrition and constructed logistic regression models to explore the influencing factors and interactive effects on three patterns of malnutrition.

RESULTS

The prevalence of malnutrition was 22.28%. Older adults with both hypertension and diabetes (RERI = 0.13), both meat or fish diet and hypertension (RERI = 0.79), and both meat or fish diet and diabetes (RERI = 0.81) had positive additive interaction effects on the risk of obesity, whereas those on a vegetarian diet with hypertension (RERI = -0.25) or diabetes (RERI = -0.19) had negative additive interaction effects. Moreover, the interactions of physical activity with a meat or fish diet (RERI = -0.84) or dyslipidemia (RERI = -0.09) could lower the risk of obesity.

CONCLUSIONS

Malnutrition was influenced by different health factors, and there were interactions between these influencing factors. Pertinent dietary instruction should be given according to different nutritional status indexes and the prevalence of metabolic diseases to avoid the occurrences of malnutrition among older adults.

Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study

BACKGROUND

The recent recognition of the multidimensional features of frailty has emphasised the need for individualised multicomponent interventions. In the context of sub-Saharan Africa, few studies have examined: a) the frailty status of the older population; b) the level of frailty and its health implications and; c) the impact of a nurse-led intervention to reduce frailty.

OBJECTIVES

This study aims to design, implement, and evaluate a nurse-led intervention to reduce frailty and associated health consequences among older people living in Ethiopia.

METHODS

The study will be conducted on 68 older persons using a pre-, post-, and follow-up single-group quasi-experimental design. Residents of Ethiopia, ≥60 years and living in the community will be invited to participate in a 24-week program designed to decrease frailty and associated health consequences. Data will be collected at three-time points: baseline, immediately after the intervention, and 12 weeks post-intervention. To determine the effect of the intervention, changes in frailty, nutritional status, activities of daily living, depression and quality of life scores will be measured. To measure the effect of a nurse-led intervention on the level of frailty among older people a generalised linear model (GLM) using repeated measures ANOVA will be used. Statistical significances will be set at p-values < 0.05.

DISCUSSION

The results of this study will determine the impact of a nurse-led intervention to reduce frailty amongst community-dwelling older people living in Ethiopia. The results of this study will inform the development of future interventions designed to reduce frailty in lower-income countries.

TRIAL REGISTRATION

The trial was registered in ClinicalTrials.gov with the identifier of NCT05754398.

Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice

Background

Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors.

Methods

A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit.

Results

Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%.

Conclusion

In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.

Magnitude of undernutrition and its association with dietary diversity among older persons in Ethiopia: a systematic review and meta-analysis, 2023

Undernutrition in elders remains under-detected, under-treated, and under-resourced and leads to further weight loss, increased infections, and delay in recovery from illness as well as increased hospital admissions and length of stay. The reports of the findings were fragmented and inconsistent in Ethiopia. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of undernutrition and its association with dietary diversity among older persons in Ethiopia. Online databases (Medline, PubMed, Scopus, and Science Direct), Google, Google Scholar, and other grey literature were used to search articles until the date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity using Stata version 14.0 software. Out of 522 studies accessed, 14 met our criteria and were included in the study. A total of 7218 older people (aged above 60 years old) were included in the study. The pooled proportion of undernutrition among older persons in Ethiopia was 20⋅6 % (95 % CI 17⋅3, 23⋅8). Elders who consumed low dietary diversity scores were strongly associated with undernutrition among older persons. Therefore, promoting appropriate intervention strategies for elders to improve dietary diversity practices and nutritional status is crucial.

Level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia

OBJECTIVES

Malnutrition is very common among older adults. In rural Ethiopia, around 25% of women and 34% of men ≥65 y of age are malnourished. However, the risk factors for malnutrition among older adults in rural areas are not well understood. The aim of this study was to assess the level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia.

MATERIALS

This was a community-based, cross-sectional study among randomly selected (N = 634) adults ≥65 y of age in Fogera Zuriya rural district. Participants were selected using a multistage sampling technique. A pretested full Mini-Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score <17), at risk for malnutrition (MNA score 17-23.5), or otherwise normal. A validated Geriatric Depression Scale form (15 items) was used to assess depression. Ordinal logistic regression was employed to identify factors of malnutrition and the PLUM procedure was used to produce an odds ratio (OR). P < 0.05 was considered statistically significant with the dependent variable. Both crude and adjusted ORs (COR and AOR, respectively) with a corresponding 95% confidence interval were computed.

RESULTS

This study included 634 older adults. According to the results of the study, the risk for malnutrition was 383 (60%), and being malnourished was 166 (268%). The following factors were significantly associated with the risk for malnutrition and malnutrition: • Age ≥85 y (AOR, 3.47; 95% CI, 1.270-9.465); • Skipping two meals daily (AOR, 6.36; 95% CI, 2.11-19.16); • Skipping 1 meal a day (AOR, 3.05; 95% CI, 1.82-5.12); • Having a poor appetite (AOR, 6.2; 95% CI, 2.50-15.36); • Being depressed (AOR, 4.04; 95% CI, 2.37-6.89); • Low physical activity (AOR, 3.81; 95% CI, 1.50-9.72); • Family size of three of less members (AOR, 1.9; 95% CI, 1.14-3.24); and • Low dietary diversity score (AOR, 1.91; 95% CI, 1.11-3.31) CONCLUSIONS: In this study, the prevalence of malnourished (26%) was almost higher than the national average in Ethiopia (21%). Older age, skipping a meal, poor appetite, depression, low physical activity, and low dietary diversity score were factors significantly associated with the risk for malnutrition and malnutrition. Along with this, improving diet and exercise should be a top priority. Maintaining continuing psychological support, social support, and a balanced family size within the community should be additional interventions.

Malnutrition in older adults

Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.

Nutritional status and its associated factors among elderly people in Ilu Aba Bor Zone, Southwest Ethiopia: a community-based cross-sectional study

OBJECTIVES

This study aimed to assess the nutritional status and its associated factors among elderly people.

DESIGN

A community-based cross-sectional study.

SETTING

The study was conducted in urban and semiurban areas.

PARTICIPANTS

The study included 620 elderly community dwellers in Southwest Ethiopia from 3 October 2021 to 10 November 2021. Those who were seriously ill, could not get around or were on special diets were excluded from the study.

OUTCOME MEASURE

The Mini Nutritional Assessment was used to evaluate nutritional status and the STEPwise approach was used to collect data on backgrounds and lifestyle. SPSS V.22.0 was used for data analysis. Logistic regression was computed. The level of significance was set at 0.05.

RESULTS

Elderly people who were malnourished or at risk of malnutrition were found to make up 48.1% (44.1%) and 17.4% (14.5%) of the population, respectively. Those aged 80 years and older had a chance of being at risk of malnutrition (adjusted OR (AOR)=22.555; 95% CI: 7.963 to 63.881), while the odds of being malnourished were 11.5 times higher (AOR=11.755; 95% CI: 4.825 to 28.638). Informal education was a significant predictor of being at risk of malnutrition (AOR=6.102; 95% CI: 2.684 to 13.871). Urban dwellers were 8.9 times more likely to be malnourished. Inadequate financial resources make people 3.7 times more likely to be malnourished. A lower wealth index was a significant predictor of being at risk of malnutrition (AOR=4.156; 95% CI: 1.361 to 12.692). Single elderly people had a 3.4-fold higher risk of malnutrition. Elderly people with chronic pain, who were smokers and alcoholics, and who had depression were all at risk of nutritional problems.

CONCLUSION

The risk of malnutrition and malnourishment was high. Age, urbanisation, finances, education, economics, being a woman, smoking and alcohol are associated factors. Interventional studies are warranted to minimise malnutrition challenges in the study population.

Undernutrition and associated factors among older adults in Ethiopia: systematic review and meta-analysis

OBJECTIVE

Undernutrition contributes to decreased physical and cognitive functional status, higher healthcare consumption, premature institutionalisation and increased mortality. So, the objective of this study was to determine the pooled prevalence and factors associated with undernutrition among older adults in Ethiopia.

DESIGN

Systematic review and meta-analysis was used. Articles that presented original data on undernutrition using body mass index (BMI) were included. We made an inclusive literature search from PubMed, Medline and Google Scholar. The I² test was used to examine the heterogeneity of the studies considered in this meta-analysis. Stata software V.14 and METANDI command were used.

SETTING

Studies conducted in Ethiopia were included.

PARTICIPANTS

Eight independent studies were eligible and enrolled for final analysis.

OUTCOME

Prevalence and determinants of undernutrition. A selection of publications, data extraction and reported results for the review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

A total of eight unique studies were enrolled for final analysis. The pooled prevalence of undernutrition was 20.53% (95% CI 17.39% to 23.67%). The study revealed that males had lesser odds of being undernutrition with AOR 0.17 (95% CI 0.15 to 0.20). Older adults in the age range of 65-74 years were less likely to be undernourished as compared with those whose age was above 85 years with Adjusted Odds Ratio (AOR) 022 (95% CI 0.22 to 0.25). Older adults who were depressed had higher odds of undernutrition as compared with their counterparts with AOR 1.27 (95% CI 1.19 to 1.37). However, older adults from households with poor wealth indexes were two times more likely to be undernourished as compared with those who were from rich households.

CONCLUSION

The burden of undernutrition in Ethiopia is significant. The limitation of the current study was that all included studies were observational, mainly cross-sectional.

Malnutrition, Frailty, and Health-Related Quality of Life Among Rural Older Adults in Vietnam: A Cross-Sectional Study

Purpose

Rural older adults are more likely to be malnourished than urban older adults, particularly those living in lower-middle-income countries like Vietnam. Therefore, this study aimed to address the prevalence of malnutrition and its association with frailty and health-related quality of life in older rural Vietnamese adults.

Participants and Methods

This cross-sectional study was conducted on community-dwelling older adults (aged ≥ 60 years) living in a rural province in Vietnam. Nutritional status was determined using the Mini Nutritional Assessment Short Form (MNA-SF), and frailty was evaluated using the FRAIL scale. The 36-Item Short Form Survey (SF-36) was used to evaluate health-related quality of life.

Results

Among the 627 participants, 46 (7.3%) were malnourished (MNA-SF score <8), and 315 (50.2%) were at risk of malnutrition (MNA-SF score: 8-11). Individuals with malnutrition had significantly higher rates of impairments in instrumental activities of daily living and activities of daily living than those without malnutrition (47.8% vs 27.4% and 26.1% vs 8.7%, respectively). The prevalence of frailty was 13.5%. Risk of malnutrition and malnutrition were associated with high risks of frailty, with odds ratios of 2.14 (95% confidence interval [CI]: 1.16-3.93) and 4.78 (1.86-12.32), respectively. Furthermore, the MNA-SF score was positively correlated with eight domains of the health-related quality of life among rural older adults.

Conclusion

The prevalence rates of malnutrition, risk of malnutrition, and frailty were high among older adults in Vietnam. A strong association was observed between nutritional status and frailty. Therefore, this study reinforces the importance of screening for malnutrition and risk of malnutrition among older rural individuals. Further studies should explore whether early nutritional intervention reduces the risk of frailty among older adults and increase their health-related quality of life in the Vietnamese population.

Malnutrition among the aged population in Africa: A systematic review, meta-analysis, and meta-regression of studies over the past 20 years

BACKGROUND

Nowadays, malnutrition among the advanced age (60 years and older) population is becoming a public health problem worldwide, especially in low-income countries including Africa. Hence, the prevalence in Africa is still not known. So, this review aimed to assess the pooled prevalence of under-nutrition among the advanced age population in Africa.

METHODS

A study search was carried out using databases (such as African Journals Online, Web of Science, Global Index Medicus, Embess, and PubMed) and gray literature following PRISMA guidelines from April 20, 2022, to May 30, 2022, with no restriction on date of publication. We used a standardized extraction format to compile eligible studies as per the inclusion criteria. Then, systematic review and meta-analysis were employed using a random effect model to obtain the pooled prevalence of malnutrition among aged population living in Africa. The counter-funnel plot and at the 5% significance level, Egger's test and Begg's test were used to check for publication bias. Furthermore, a meta-regression analysis was carried out to identify the relationship between the outcome of interest and different predictors.

RESULTS

A total of 731 studies were identified and 28 met the inclusion criteria, which were conducted in 17 African countries. The pooled prevalence of under-nutrition in Africa was 17% (95%CI; 13.5-20.6). The prevalence of malnutrition among the elderly varied significantly across countries, ranging from 1.8% (95% CI; 0.96-2.63) in South Africa to 39.47% (95% CI; 31.70-47.24) in Kenya. According to meta-regression analysis, the likelihood of a malnutrition problem would be reduced by a factor of 9.84 (β = -9.84, 95 percent CI; _-14.97, -4.70, P = 0.00) in upper-middle income countries. In addition, based on the publication year, malnutrition has decreased by a factor of 0.75 (β = -0.75, 95%CI:-1.49, -0.01, P = 0.04) from 1998 to 2021.

CONCLUSION

There is a high prevalence of malnutrition among the aged population. So, this underserved population should be targeted for intervention programs and/or integrated into maternal and child nutrition programs.

Malnutrition in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: A cross-sectional study

Introduction

The global population of the elderly with type 2 diabetes mellitus (T2DM) is growing due to improvement in DM care and increased life expectancy. Malnutrition is a recognized complication of DM especially in the elderly. However, despite the impact of malnutrition on the overall outcome of the elderly with DM, it has not received adequate attention.

Aim

To determine the prevalence of malnutrition and associated factors in the elderly with T2DM.

Methods

This was a cross-sectional study that involved 96 elderly with T2DM and 96 age and sex matched elderly without T2DM as controls. Malnutrition was assessed using mini-nutritional assessment-short form (MNA-SF), hypoalbuminemia and body mass index (BMI). The factors associated with some malnutrition indices were determined.

Results

The mean age of T2DM and non-T2DM groups were 66.73 ± 5.18 years and 66.78 ± 5.25 years respectively. The observed malnutrition indices among elderly with T2DM and controls were hypoalbuminemia (79.2% vs 25.0%; P ≤0.001); overweight and obesity (58.3% vs 24.0%); and underweight (16.7% vs 4.2%). According to MNA-SF, malnutrition (7.3% vs 0%) and at risk of malnutrition (42.7% vs 16.7%) were significantly more prevalent among elderly with T2DM compared to controls (P ≤0.001). On logistic regression, the significant predictors of malnutrition were male gender (AOR:2.70; CI:1.11-6.55; P = 0.028) and albuminuria (AOR:3.14; CI:1.18-8.35; P = 0.022) and poor glycemic control (AOR:7.05; CI:2.01-24.71; P = 0.002).

Conclusion

Malnutrition is highly prevalent in elderly with T2DM. Poor glycemic control, albuminuria and male gender were significant predictors of malnutrition in this study. Nutritional assessment should be included in the routine DM care especially among the elderly.

Prevalence of malnutrition among old age people in Africa

Background: Improved health care and rising life expectancy are creating a growing pool of old age people all over the world, including Africa. Malnutrition in the old age people is associated with both short- and long-term negative health outcomes. However, the reported burdens of malnutrition are fragmented and inconsistent, where more compiled evidence is warranted to aid decision-makers. Hence, this paper is aimed to estimate the pooled prevalence of malnutrition among old age people in Africa. Methods: A systematic search for research reporting the prevalence of malnutrition among old age people (aged above 60 years) was conducted from HINARI/PubMed and Google Scholar databases using combination keywords. Published articles in English language starting from January 2000 to October 2021 were screened. We presented the results based on the standard for reporting systematic review and meta-analysis of observational studies. A random-effect meta-analysis was done to estimate the prevalence of malnutrition along with the 95% confidence intervals. The publication bias was assessed using the funnel plot. Results: A total of 1,442 studies were retrieved based on the search strategy, where only 36 studies (n = 15,266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2 to 77.3% across Africa. Overall, the pooled prevalence of malnutrition was 18% (95% CI: 15-22; I2 = 98.1; p < 0.001). The prevalence is higher in the Central Africa (3.8%; 95% CI: 3.2-4.4), in the community (3.1%; 95% CI: 2.7-3.7), and among advanced age (3.5%; 95% CI: 2.3-5.4). Conclusion: The prevalence of malnutrition in African old age people is high and differs by setting, assessment tool, and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable, and simple screening tool should be thought of.

'Hunger would kill us instead of COVID-19': Elders' response to the pandemic in Debre Markos Town, Ethiopia

The COVID-19 pandemic has posed unpredictable challenges globally. Older adults are among the population groups most vulnerable to COVID-19. Poor urban elders in Ethiopia struggle to meet their basic needs due to waning traditional familial norms of providing care for elders as a result of urbanisation, poverty and migration. The aim of this study was to give voice to vulnerable elders during the COVID-19 lockdown in Ethiopia and to reveal their sources of support. Using a qualitative case study design, data were collected from 27 elders aged 60 and above in Debre Markos Town, Ethiopia via in-depth interviews conducted from March-May 2020. To determine the nature of support provided for destitute elders, data were also gathered from two local officials. Narrative data were analysed using thematic analysis. Four prominent themes were identified: 'Hunger would kill us instead of COVID-19,' 'Feeling hopeless and begging to die,' 'We prefer social support rather than food donations' and 'Gratitude.' Elders considered the practice of social distancing to fight COVID-19 as an unwelcome luxury for people whose livelihood depends on begging and petty trade. The physical distancing programme put elders in isolation, diminishing their capacity to maintain their livelihood. Due to the increasing disrespectful attitudes towards aged people, elders felt even less valued than usual. Interactions were described as undermining, embarrassing and abusive. A special emergency fund and organised social supports are needed to minimise the effect of the pandemic on vulnerable groups like destitute elders in Ethiopia. Moreover, an institutional welfare response is needed to ensure elders can live a dignified life.

Prevalence and factors associated with depression among older adults in the case of a low-income country, Ethiopia: a systematic review and meta-analysis

BACKGROUND

Depression is among the common mental health problems in late-life and an important public health problem. Studies from both middle- and high-income countries have shown that depression is more common among older people than in adolescents. Many older people with depression are overlooked, and fewer efforts are made to mitigate their suffering. Despite depression being a major public health problem among older adults, its overall magnitude, and its main predictors were not determined for the development of appropriate measures. Hence, the objective of this study was, therefore, to estimate the overall prevalence of depression and identify its predictors among older adults in Ethiopia.

METHODS

Available articles were searched by means of different databases using the PRISMA guideline. The quality of the included studies was assessed using a JBI quality appraisal tool. STATA version 14.0 (STATA Corporation, College Station, Texas, USA) statistical software was used to analyze the eligible studies. Subgroup and sensitivity analyses were performed. Cochran's Q and the I2 test were used to assess heterogeneity. The presence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots.

RESULT

In this meta-analysis, we included 11 articles that assessed 6521 older adults. The overall prevalence of depression among older adults in Ethiopia was 41.85 (33.52, 50.18). The finding was higher in the Oromia region with a prevalence of 48.07% (95% CI: 35.62, 60.51). The finding also demonstrated that being female (AOR = 1.76, 95% CI: 1.17, 2.63), no formal education (AOR = 1.82, 95% CI: 1.03, 3.19), with chronic diseases (AOR = 2.46, 95% CI: 1.00-6.06), and no social support (AOR = 2.01, 95% CI: 1.06, 3.83) were found to be independent predictors of depression in older Ethiopian adults.

CONCLUSION

Our systematic review and meta-analysis showed that almost two out of five older adults had depression. Female sex, no formal education, having chronic diseases, and no social support were the independent predictors of depression among older adults in Ethiopia. The study emphasizes that depression among older adults in Ethiopia calls for appropriate screening and interventions to reduce the occurrence and its overwhelming consequences.

An Individually Tailored Program to Increase Healthy Lifestyle Behaviors among the Elderly

A healthy lifestyle among the elderly is associated with improved health. However, many older adults are not engaging in such behavior. The purpose of the study was to develop an individually tailored online/telephone program to increase healthy lifestyle behaviors among community-dwelling elderly people. The program includes individually tailored healthy lifestyle recommendations based on participants' functional level. Community-dwelling elderly people aged 60+ years (n = 77; mean age: 72.98 ± 6.49) participated in the study. Significant associations were observed between health promotion activities and health status (r = 0.23, p = 0.04) and physical functional level (r = 0.44, p < 0.001). Twenty-seven percent of participants claimed that they learned "a lot" of new things about themselves, and 31% claimed that the recommendations received were new to them. Most participants engaged in the recommendations at least 1-2 times a week. Regression analyses showed that barriers significantly predicted reduced compliance with the health-related recommendations received (adjusted R² = 0.18). The main barrier for compliance was inaccessible information about services (32.46% of the participants). The most prevalent facilitator for compliance with the recommendation was health behavior motivation (59.74% of the participants). In conclusion, this study provided evidence on the effectiveness of a multicomponent tailored intervention program among the elderly in increasing health-related knowledge and behavior about the recommendations.

Determinants of nutritional status among old age population in eastern Ethiopia: a general linear model approach

As the world's aging population grows, nutrition and health issues are becoming a major concern. The aim of the present study was to identify the factors associated with nutritional status among old age population. A community-based cross-sectional study was employed among randomly selected 739 elders over the age of 60 in Dire Dawa City administration, eastern Ethiopia. The validated full mini nutritional assessment tool and appetite test (SNAQ) was used to assess the nutritional status of the study population. Considering the ranked nature of the data, a bivariate and multivariable ordinal logistic regression model (under the generalised linear model) was conducted, with crude and adjusted odds ratios reported along with 95 % confidence intervals. Statistically significant associations are declared at P-value less than 0⋅05. In this study, 22 % (95 % CI: 19 %, 25 %) of elders were malnourished. Participants with >75 years old (AOR 4⋅95; 95 % CI 1⋅54, 8⋅4), being female (AOR 1⋅6; 95 % CI 1⋅1, 2⋅2), illiterate (AOR 1⋅5; 95 % CI 1⋅01, 2⋅2), severe depression (AOR 13⋅9; 95 % CI 8⋅2, 23⋅7) and with poor appetite (AOR 3⋅3; 95 % CI 2⋅3, 4⋅8) were important predictors of malnutrition among older age group. We found that the prevalence of malnutrition and the risk of malnutrition is a public health concern that warrants intervention in the area. Advanced age, illiteracy, depression and poor appetite were important risk factors for malnutrition among older age group. The identified risk factors will guide public health professionals and programmes in the design, implementation of interventions to improve the nutritional status of older age group.