Social and health factors influencing poor nutritional status among rural elderly Malays

BACKGROUND

Older people especially those residing in rural areas are at a greater risk of malnutrition.

OBJECTIVE

To assess nutritional status and social and health factors influencing poor nutritional status among rural elderly Malays.

DESIGN AND METHODS

Cross-sectional study on 350 elderly Malays, aged 60 years and above selected from 11 traditional villages in a rural area of Malaysia. Nutritional status was assessed using anthropometric measurements such as body weight, height, demispan and mid-upper arm circumference (MUAC). A questionnaire was administered to obtain information on social and health aspects. Multiple regression analysis was used to determine social and health predictors of poor nutritional status as assessed by Body Mass Index (BMI) and mid-upper arm circumference (MUAC).

RESULTS

In this sample, 38% of the subjects were underweight according to BMI < 18.5 kg/m2, particularly women. Women were also found to be four and three times more likely to be peripherally wasted, as assessed respectively by MUAC (p<0.05), and by corrected arm muscle area (p<0.005). It was found that 12% of subjects were overweight, the majority of whom were women. The predictors of BMI were unable to cook, reported insufficient money to buy food, smokers and perceived weight loss. The predictors of MUAC were: unable to cook, single, reported insufficient money to buy food, smokers, loss of appetite, depended on others for main economic resources, and perceived weight loss.

CONCLUSION

The nutritional status of the elderly is rather unsatisfactory. Recognition of social and health factors associated with the poor nutritional status will allow appropriate intervention to enhance the quality of life of the elderly.

Social and health profiles of rural elderly Malays

AIM

To evaluate the social and health functions of rural elderly Malays.

METHOD

A survey was carried out on 350 elderly Malays aged 60 and above using a set of socio and health questionnaires.

RESULTS

The majority of elderly people in the study were married (64%), unemployed with no pension (76%), relied on children for their main economic resources (62%) and perceived that they have sufficient money to buy the food they require (61%). Most of the subjects felt healthy, contented and satisfied with their everyday life, were able to do most of the Activities of Daily Living (ADL) tasks and were actively involved in community activities. However, most of the subjects (60%) had either one or two diagnosed chronic diseases. Thus, only 15% of the subjects had not taken any type of medicines during the previous 12 months.

CONCLUSION

Although the majority of the elderly in this study were able to perform all the ADL tasks and perceived their health as good, physical impairments (eg. sight, hearing and chewing difficulties) are prevalent and the use of medicines is widespread. It is expected that in future a greater proportion of rural elderly Malays will live alone and will face economic and health problems because of the lack of sufficient and satisfactory programmes for this age group.

Validation of a Dietary History Questionnaire against a 7-D Weighed Record for Estimating Nutrient Intake among Rural Elderly Malays

Energy and nutrient intake estimated using a pre-coded dietary history questionnaire (DHQ) was compared with results obtained from a 7-d weighed intake record (WI) in a group of 37 elderly Malays residing in rural areas of Mersing District, Johor, Malaysia to determine the validity of the DHQ. The DHQ consists of a pre-coded dietary history with a qualitative food frequency questionnaire which was developed to obtain information on food intake and usual dietary habits. The 7-d WI requires subjects to weigh each food immediately before eating and to weigh any leftovers. The medians of intake from the two methods were rather similar and varied by less than 30% for every nutrient, except for vitamin C (114%). For most of the nutrients, analysis of group means using the Wilcoxon matched pairs signed rank sum test showed no significant difference between the estimation of intake from the DHQ and from the WI, with the exceptions of vitamin C and niacin. The DHQ significantly overestimated the intake of vitamin C compared to the WI (p<0.05), whilst, the intake of niacin was significantly underestimated (p<0.05). The consistency of ranking as assessed using the Spearman's rank correlation coefficient (r) was satisfactory since there were positive correlations between all of the investigated nutrients estimated using the DHQ with those assessed using the WI, except for niacin. Furthermore, both the DHQ and the WI classified approximately 38 to 62% of the subjects into the same tertile for all nutrients, except vitamin C. Therefore, the DHQ was modified by adding a checklist of foods rich in vitamin C and niacin. In conclusion, the DHQ was fairly valid for obtaining the usual intake of most nutrients, particularly on a group basis. These findings indicate that in an elderly population with a high prevalence of illiteracy, a specially designed DHQ can provide very similar estimations to that obtained from 7-d WI.

Development of a screening tool for detecting undernutrition and dietary inadequacy among rural elderly in Malaysia: simple indices to identify individuals at high risk

Undernutrition and the consumption of poor diets are prevalent among elderly people in developing countries. Recognising the importance of the early identification of individuals at high nutritional risk, this study aimed to develop a simple tool for screening. A cross-sectional study was conducted on 11 randomly selected villages among the 62 in Mersing District, Malaysia. Undernutrition was assessed using body mass index, plasma albumin and haemoglobin on 285 subjects. Dietary inadequacy (a count of nutrients falling below two-thirds of the Recommended Dietary Allowances) was examined for 337 subjects. Logistic regression analysis was performed to identify significant predictors of undernutrition and dietary inadequacy from social and health factors, and to derive appropriate indices based on these predictions. The multivariate predictors of undernutrition were 'no joint disease', 'smoker', 'no hypertension', 'depended on others for economic resource', 'respiratory disease', 'perceived weight loss' and 'chewing difficulty', with a joint sensitivity of 56% and specificity of 84%. The equivalent predictors of dietary inadequacy were 'unable to take public transport', 'loss of appetite', 'chewing difficulty', 'no regular fruit intake' and 'regularly taking less than three meals per day', with a joint sensitivity of 77% and specificity of 47%. These predictions, with minor modification to simplify operational use, led to the production of a simple screening tool. The tool can be used by public health professionals or community workers or leaders as a simple and rapid instrument to screen individual at high risk of undernutrition and/or dietary inadequacy.

Nutritional status of rural elderly Malays: dietary and biochemical findings

A cross-sectional nutritional survey was carried out on 350 elderly Malays aged 60 and above from 11 randomly selected villages in a rural area on the East Coast of Malaysia. The findings indicated that the mean intakes of energy and all of the nutrients investigated were below the Malaysian Recommended Dietary Allowances, excepts for protein and vitamin C. Nutrients most likely to be inadequate were vitamin A, thiamine, riboflavin, niacin and calcium, with more than 50% of the subjects having estimated intakes of below 2/3 of the recommendations. However, vitamin A status was adequate, with only 2 subjects being biochemically deficient (plasma retinol < or = 0.7 mmol/l). Approximately a third of the subjects had hypoalbuminaemia (plasma albumin < 3.3 g/dl) and anaemia (Haemoglobin < 12 g/dl for men; < 13 g/dl for women). Riboflavin deficiency, as assessed by an erythrocyte glutathione reductase activation coefficient (EGRAC) of more than 1.35 was identified in 77% of the subjects. The prevalence of vitamin E deficiency (plasma a-tocopherol < or = 12 mmol/l) was 27%, with men being at a greater risk. In conclusion, the dietary intakes of these rural elderly Malays was inadequate. Over three quarters of the sample were biochemically deficient in riboflavin, the functional consequences of which need to be further investigated.

Measurement of haemoglobin using single drops of skin puncture blood: is precision acceptable?

The study aimed to investigate local concerns about clinically important discrepancies between repeat HemoCue haemoglobin measurements from single drops of blood. Two biomedical scientists and two health visitors each obtained a series of paired haemoglobin values by fingerprick sampling from healthy volunteers. Seven of 20 paired values obtained by health visitors and three of 20 obtained by scientists from the first drop of blood forming at the puncture site differed by > or = 10 g/l; 11 of 20 paired values obtained by health visitors and one of 20 by the scientists from the fourth drop of blood differed by > or = 10 g/l. After collecting and mixing a number of drops in EDTA tubes before analysis, seven of 40 paired values differed by > 5 g/l, and none by > 10 g/l. Pooling drops of blood before analysis improves precision of HemoCue haemoglobin measurement and allows users to achieve results comparable to those obtained by experienced laboratory staff. Measurement of haemoglobin from single drops of skin puncture blood should be discontinued.

Community nutrition survey in an urban settlement in Papua New Guinea

Results of a small nutrition survey carried out in an urban settlement in Port Moresby are presented. Anthropometric, dietary and socioeconomic data were collected on 90 children under five years old and 78 adults. 30% of the children under five years old were below 80% weight for age. Of the 31% of adults found to be undernourished, the majority were females aged less than 30 years. With respect to dietary information, most families appear to eat a variety of foods though no attempt was made to measure quantity of foods consumed. Rice is the single most popular food, with 69% of adults having consumed it the previous day. Despite the high reliance on purchased foods, income appears to be low with the majority of people relying on money from relatives and the sale of home produce. The recommendations made for appropriate health and nutrition education may be applicable for other growing settlement populations in and around Port Moresby and other urban centres of Papua New Guinea.