|Year : 2020 | Volume
| Issue : 4 | Page : 145-150
Prevalence and disparity of malnutrition among elderly: A cross-sectional study
Md Taj Uddin1, Momduha Akter2, Md Shah Noor3, Md Kamal Hussain4, Iqbal Ahmed Chowdhury5
1 Professor, Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh, India
2 Graduate Student, Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh, India
3 Professor, Department of Mathematics, Shahjalal University of Science and Technology, Sylhet, Bangladesh, India
4 Assistant Professor, Department of Statistics, Bangabandu Sheik Mujubur Rahman Science and Technology University, Gopalgonj, Bangladesh, India
5 Assistant Professor, Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh, India
|Date of Submission||08-Oct-2020|
|Date of Decision||11-Nov-2020|
|Date of Acceptance||30-Nov-2020|
|Date of Web Publication||23-Feb-2021|
Dr. Md Taj Uddin
Professor, Department of Statistics, Shahjalal University of Science and Technology, Sylhet
Source of Support: None, Conflict of Interest: None
Objective: This study attempts to assess the prevalence and disparity of the nutritional status of the elderly with their socioeconomic characteristics. Materials and Methods: A total of four hundred elderly in Sunamgonj district of Bangladesh have been interviewed through a structured questionnaire from July to September 2019. Descriptive statistical tools and mini nutrition assessment short Form, t-test, and F-test have been applied for data analysis. Results: The analysis reveals that 40% of elderly suffer from malnutrition, 59% are at risk of malnutrition, and 1% are normal nutrition. The findings show that the nutrition status of elderly is significantly varied with their occupation, place of residence, marital status, religion, age, family type, living arrangement, take care, and sleeping disorder. It is observed that more proportion of the elderly is at risk of malnutrition. Conclusion: Therefore, measures should be taken to improve the nutrition status of the elderly.
Keywords: Elderly, family type, living arrangement, malnutrition
|How to cite this article:|
Uddin MT, Akter M, Noor MS, Hussain MK, Chowdhury IA. Prevalence and disparity of malnutrition among elderly: A cross-sectional study. J Indian Acad Geriatr 2020;16:145-50
|How to cite this URL:|
Uddin MT, Akter M, Noor MS, Hussain MK, Chowdhury IA. Prevalence and disparity of malnutrition among elderly: A cross-sectional study. J Indian Acad Geriatr [serial online] 2020 [cited 2023 Jun 6];16:145-50. Available from: http://www.jiag.com/text.asp?2020/16/4/145/309997
| Introduction|| |
Malnutrition is a state of nutrition, in which a deficiency or excess of energy, protein, and other nutrients causes measurable adverse effects on tissue or body form (body shape, size, and composition) and function. Nutrition is one of the most critical factors related to an individual's health, especially among the elderly. The occurrence of malnutrition among the elderly is developing fast. The prevalence of risk of malnutrition increases with age.,
The elderly are more likely to suffer from undernutrition, as age increases the functions of the vital body organs decreases. Sociodemographic factor also affects the body function. The consequences of malnutrition are severe and a long-lasting situation among the elderly. Malnutrition has a substantial impact on mortality, morbidity, and the quality of life. It increases the risk for infection, pressure sores, and delayed wound healing and reduces rates of drug metabolism, physical performance such as less physical activity or working capacity.,
Depression is a significant cause of weight loss and one of the risk factors of malnutrition in older persons. Social isolation, eating alone, and not having enough social interaction often influence food intake. When the elderly lose their spouse, they become socially isolated and suffer consequences of loneliness, affecting their nutritional status.,, The overall nutritional status and health status were not good and satisfactory in Bangladesh. Most elderly were suffering from malnutrition and arthritis, as well as diabetes was prevalent. Dietary pattern was not good. Intervention programs related to health and nutritional status may be arranged.
Elderly have knowledge, experience, and wisdom which society can use these resources of the elderly in the national reconstruction. They are the asset of the nation. It is a matter of concern that takes care of the elderly and utilize this respected asset. The elderly are the last stage of our life cycle and a reality. Everybody has to pass through this stage. Hence, it is the responsibility of all citizens of Bangladesh to come forward for the well-being of our elderly.
Since aged people are the senior citizens of the country, they deserve love and respect from others. Their wisdoms and experiences play a very important role to lead a nation successfully. A couple of research works has been done regarding the health and nutrition of the elderly. However, the study on level and differential of malnutrition of the elderly is minimal. A comprehensive study is needed to explore the exact level of nutrition of the elderly, their needs, and proper recommendation for their well-being. Therefore, the present study's objective is to know whether there are any differences in the elderly's malnutrition with their socioeconomic and demographic characteristics. It is also tried to see the relationship between malnutrition and socioeconomic factors of the elderly.
| Materials and Methods|| |
The present study's empirical data are collected from 400 randomly selected respondents in both rural and urban areas of Sunamgonj district in Bangladesh from June to August 2019. The respondents are persons aged 60 years and above. A structured questionnaire is administered to collecting the required information from the respondents. The respondents are the persons' age 60 years and above. The respondents are interviewed after they gave informed consent. Descriptive statistical tools and mini nutrition assessment (MNA) Short Form, t-test, and F-test have been applied for data analysis.
The MNA tool is a well-validated tool for assessing malnutrition in the elderly. The tool was shown to have an accuracy of 92% when it was compared with the clinical evaluation by two physician's specialists in nutrition, and 98% when it was compared with a comprehensive nutritional assessment including biochemical tests, anthropometric measurements, and dietary assessment.
| Results and Discussion|| |
A total of 400 respondents have been considered in this study from Sunamgonj district of Bangladesh. [Table 1] shows the socioeconomic and demographic characteristics of the Elderly. About 59% of the elderly are female, and 41% are male. Most (60%) of the elderly belonged to 60–69 years old. About half of the elderly are from the urban area. A very few (0.8%) elderly are unmarried, and the rest (99.2%) are married and widow and divorce. About 83.2% of the elderly are Muslim, and the rest are Hindu. The majority (61%) elderly are illiterate, and the rest are literate. About 75% elderly belongs to below middle income, and a few (8%) belongs to above middle income. Most (59.8%) of the elderly are engaged in agriculture profession, and a very few (1%) are in active service. Among the elderly, 32% lives in the nuclear family, 41.2% lives in the joint family, and 26.8% lives in the extended family. It is observed that 19.8% elderly have single living arrangement, followed by 48.7% % double and 31.5% extended living arrangement [Table 1].
|Table 1: Distribution of socioeconomic and demographic characteristics of the elderly|
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According to the MNA-SF score, only 1% of elderly belong to normal nutritional status. About 59% of the elderly are at risk of being malnourished, and 40% are malnourished [Figure 1]. Hence, more elderly are at risk of being malnourished than the elderly who are malnourished.
|Figure 1: Nutrition status of elderly according to mini nutrition assessment-short form|
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A study among the elderly population has shown that the prevalence of malnutrition among the elderly was 17.9%, and malnutrition was 58.8%. Another study reveals that about 30% of elderly participants were malnourished, and 63% were at risk of being malnourished. This study is very close to the present study. Because the present study reveals that 40% of the elderly are malnourished, and 59% are actually at risk of being malnourished.
In India, more proportion of rural elderly was malnourished (28.4%) and at risk of malnutrition (40.2%) compared to urban elderly where 8.8% were malnourished, and 37.3% were at risk of malnutrition.
The differential of nutritional status of the elderly with their socioeconomic characteristics
Nutritional status of elderly may be differed by their socioeconomic factors. For this, a set of socioeconomic variables such as income, education, marital status, gender, religion, residence, and occupation are considered in the study. It is observed that the nutritional status of the elderly is significantly (P < 0.03) differed with their place of residence. The mean score of MNA in rural elderly is higher than the urban elderly. This may be because of the availability of a fresh source of nutrition. The nutrition level of male and female elderly is not equal. The condition of female elderly is lower than male elderly. The mean score of MNA of Muslim elderly is significantly (P < 0.04) higher than non-Muslim elderly. The mean score of literate elderly is not significantly differed with illiterate elderly. The nutrition status of the richest elderly is better than the rich and poor elderly through their variation is not significant. The analysis shows that aged persons' nutrition has significantly fluctuated with their place of residence, religion, marital status, and occupation [Table 2]. Hence, it is clear from the analysis that the nutrition of the elderly is varied according to their socioeconomic characteristics.
|Table 2: Differential of nutritional status of the elderly with socioeconomic characteristics|
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In India, more rural elderly were malnourished (28.4%) and at risk of malnutrition (40.2%) compared to urban elderly where 8.8% were malnourished, and 37.3% were at risk malnutrition. However, this study is not similar to the present study. Because the present study shows that the level of nutrition of rural elderly is higher than urban.
The mean score of MNA of married elderly is significantly (P < 0.00) higher than the mean score of unmarried elderly [Table 2]. Similarly, the mean score of divorce and widow elderly is higher than the available elderly [Figure 2]. The nutrition condition of the elderly is differed according to their marital status.
A significant (P < 0.01) variation of the mean score of MNA has been observed among different profession of elderly [Table 2]. The mean's plot shows that the nutrition of retired elderly is far better than another profession [Figure 3]. Hence, there exists a variety of nutrition in different professions of the elderly.
The differential of nutritional status of the elderly with their demographic characteristics
Nutritional status of elderly may be differed by their demographic characteristics. For this, a set of demographic variables such as age, family type, blood pressure, health condition, diabetes, physical exercise, take care, living arrangement, water source, sleeping disorder, and treatment-seeking behavior have been considered in the study.
It is observed that the mean score of MNA of the elderly is significantly (P < 0.03) fluctuated with their sleep disorder. The elderly people who are not suffering from sleep disorder have better nutrition status than those elderly who are suffering from sleep problems.
It is depicted that the nutrition level of the elderly is varied with their water source. The older adults who are used tube well water; their nutrition level is higher than those elderly who are used water from other source such as supply, pond, and river water.
It is examined that mean score of MNA of the elderly is significantly (P < 0.00) changed with their living arrangement. The elderly people live with jointly, and their nutrition level is better than those elderly who are living with single and another arrangement.
It is found that nutrition status the elderly who are taken treatment by allopathic, homeopathic, and both, their nutrition situation is not better than the elderly who are taken treatment by other methods. However, the differences in mean scores of MNA among these treatment methods are not significant.
It is noted that the mean score of nutrition of the elderly is significantly (P < 0.00) varied with their health condition. The older adults whose physical condition are good and average; their nutrition level is higher than the elderly whose physical conditions are not good.
The mean score of MNA of elderly who performing physical exercise is higher than the elderly who do not perform physical exercise. However, the difference of mean scores is not significant. It is observed that the malnutrition of the elderly is significantly (P < 0.00) varied with psychological stress. The analysis shows that the nutrition of the elderly has oscillated considerably with their age, family type, take care, living arrangement, psychological stress, and sleeping disorder [Table 3]. Hence, it is clear from the analysis that the nutrition of the elderly is varied according to their demographic characteristics.
|Table 3: Differential of nutritional status of the elderly with demographic characteristics|
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It is observed that mean scores of MNA of the elderly are significantly (P < 0.03) differed with their age [Table 3]. The mean scores of MNA of youngest old and old–old elderly are higher than the mean score of the oldest old elderly [Figure 4]. A study in Norway shows that the prevalence of risk of malnutrition of elderly increases with age. The present study is similar to the present study because the present study indicates that the level of nutrition of the elderly is decreased as their age increases.
|Figure 4: Mean's plot of mini nutrition assessment with the age of elderly|
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It is found that the nutrition of the elderly is significantly (P < 0.00) varied with their family type [Table 3]. The mean score of MNA of elderly living in the nuclear family is higher than those elderly living in joint and extended family [Figure 5].
|Figure 5: Mean's plot of mini nutrition assessment of elderly according to family type|
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It is noted that the mean score of MNA of the elderly is significantly (P < 0.02) varied with respect to taking care [Table 3]. The elderly people who are being taken care of by their spouse; their nutrition status is much better than those elderly who are being taken care of by their son, daughter, and others [Figure 6].
Relationship between mini nutrition assessment sores and Socioeconomic characteristic of the elderly
Nutritional status of elderly may be related to their socioeconomic characteristics. For this, a set of variables such as income, age, height, weight, and mid arm circumference (MAC) of elderly have been considered. It is observed that age is significantly negatively correlated with MNA of the elderly, which implies that when age increases, the MNA score decreases. It is found that weight and MNA are significantly positively correlated with the MNA score. It means that if weight and MAC increase, the scores of MNA also increase. It is clear from the correlation matrix that age, weight, and MAC cause the nutrition level of the elderly through the relationship is not strong [Table 4].
|Table 4: Relationship between mini nutrition assessment sores and socioeconomic characteristic of the elderly|
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A study conducted in Nigeria recommended that age is an essential factor of elderly, influencing nutritional status. For instance, the age of the respondents of the study correlated negatively with BMI in both males (r = −0.23; P < 0.05) and female (r = −0.29; <0.05) elderly, respectively. A positive relationship (r = 0.31, P < 0.05) was observed between nutrition status and income.
| Conclusion|| |
In this study, most of the elderly are found at risk of malnutrition by MNA measurement. A significant difference of malnutrition level of elderly is observed with their age, occupation, place of residence, religion, marital status, family type, take care, psychological stress, and sleeping disorder. The findings of the study also indicate a negative relationship between MNA score and age of the elderly. The risk of malnutrition increases with age. Since the study is conducted in some Sunamgonj district areas with small sample size, the study's findings may not represent the country's actual malnutrition level. Further large-scale in-depth studies with the appropriate design are strongly recommended to get a complete picture of the malnutrition of the elderly in the country.
We are grateful to the Research Centre, Shahjalal University of Science and Technology, and Sylhet, Bangladesh, to support this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lu WJ, Liu YJ, Zhu HQ, Shang WJ, Yang JR, Hu XP. Verticillium wilt of redbud in china caused by Verticillium dahliae
. Plant Dis 2013;97:1513.
Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 2010;5:207-16.
Soderhamn U, Dale B, Sunday K, Söderhamn O. Nutritional screening of older home-dwelling norwegians: A comparison between two instruments. Clin Interv Aging 2012;7:383-91.
Das SK, Faruque AS, Ahmed S, Mamun AA. Nutritional and micronutrient status of older adults living in a rural community of Bangladesh. J Gerontol Geriatr Res 2015;01.
Schroeder DG. Malnutrition. In: Semba R, Bloem M, editors. Nutrition and Health in Developing Countries. Totowa, NJ: Humana Press; 2001.
Simon RA. Virtual clinical nutrition university: Malnutrition in the elderly, Epidemiology and consequences. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2009;4:e86-e89.
But S. Late-life depression: A literature review of late-life depression and contributing factors. Anales de Psicología 2009;25:25-6.
Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract 2006;12:110-8.
Chen C, Schilling LS, Lyder CA. Concept analysis of malnutrition in the elderly. J Adv Nurs 2001;36:131-42.
Mostafa A, Hoque R, Mostafa M, Rana MM, Mostafa F. Empathy in undergraduate medical students of Bangladesh: Psychometric analysis and differences by gender, academic year, and specialty preferences. ISRN Psychiatry 2014;2014:375439.
Barikdar A, Ahmed T, Lasker SP. The situation of elderly in Bangladesh. Bangladesh J Bioeth 2016;7:27-36.
Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, et al
. Overview of the MNA--Its history and challenges. J Nutr Health Aging 2006;10:456-63.
Krishnamoorthy Y, Vijayageetha M, Kumar SG, Rajaa S, Rehman T. Prevalence of malnutrition and its associated factors among elderly population in rural Puducherry using mini-nutritional assessment questionnaire. J Family Med Prim Care 2018;7:1429-33.
] [Full text]
Thomas D, Zdrowski C, Wilson M, Conright K, Lewis C, Tariq S, et al
. Malnutrition in subacute care. Am J Clin Nutr 2002;75:308-13.
Ananthesh B, Geeta V, Dattatraya D. A community-based cross-sectional study to assess malnutrition among elderly population residing in urban and rural areas of a district Karnataka, India. Int J Community Med Public Health 2017;4:53-6.
Olayiwola IO, Ketiku AO. Socio-demographic and nutritional assessment of the elderly Yorubas in Nigeria. Asia Pac J Clin Nutr 2006;15:95-101.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4]