Nutritional Status of Elderly in the Old Age Homes
Nutritional Status of Elderly in the Old Age Homes: A Study in Pune City
Health and well being depend of any individual on various factors like physical, social, psychological and nutritional factors. Nutrition plays an important role as a determinant in contributing to the well being and quality of life of an individual. It can be stated that health of the population at large is determined by the economic and human development of the place where they live in. Similarly the economic development is determined by the health of the individual proving it to have a cause and effect relationship. The Centres for Disease Control (CDC) and other groups have carried out substantial research for proving a significant relationship between nutritional choice (intake) and health ailments like hyperinsulinaemia, hypertension, dyslipidaemia, coronary heart disease and type 2 diabetes[i]. This proves that nutrition is now acknowledged as an important aspect in determining the health status of the individual.
According to the Population census carried out in 2011, the elderly in India comprises of about 103.9 million out of which 51.1 million and 52.8 million are males and females respectively. The elderly contribute of about 8.6 percent of the entire population, out of which 8.2 percent are males and 9 percent feamles.1 The number of elderly population in Maharashtra (Western region) constitutes to about 9.9 million, out of them 4.7 million are men and 5.2 million are women which is more than the national average of the country and majority of them live in rural areas. It is estimated that among every elderly in the country, 1 in 10 is from Maharashtra.2 With a steady increase in life expectancy there is trend in terms of a gradual shift in the disease pattern from infectious diseases to non communicable or chronic diseases, this is also called as epidemiological transition.3
Studies suggest ‘age’ as a powerful predictor of state of individual’s health and associated risks of mortality and morbidity, other factors include diversity in terms of health status/ health trajectories, life course, environment (pollution/ accessible infrastructure) and behaviors patterns and predictors like genetic factors, individual factors like occupation, income status, education cause variability in the health status. The World Health Organisation (WHO) states the mechanisms of ageing (elderly) and health status as complex.1
The elderly experiences an array of problems which can be categorised as social, economic, health and psychological. Some serious issues that have to be addressed include poverty, social insecurity, food insecurity and health problems including malnutrition which is seen at an alarming rate. Other problems faced by elderly are lack of income, irregularity in facilities providing any allowances causing absence of finances, causing illness, health deterioration causing inability to work and also loneliness (caused due to abandonment of the family members).2
Its important to understand the nutrition status of the elderly. Nowson (2007) enlisted some of the nutritional challenges faced by the elderly. They included vulnerability, unintentional weight loss, chronic illnesses, disabilities, increased protein, vitamin B6, calcium and vitamin D requirements and reduced energy requirements.3 A study was carried out in Chandigarh, Northern India wherein assessment of obesity was carried out among elderly participants (n=362) . The results concluded 33 percent elderly to be overweight, 8 percent to be obese and 14 percent to be underweight.4 Another study was carried out in South India to assess the prevalence of malnutrition among the rural elderly (n=227), about 14 percent were malnourished and 49 percent were at a risk of malnourishment.5 Taking into account social factor, caregiver/caregivng is one of the most important aspect of the elderly’s health. Jamuna (1999) cited that India has three types of caregivers; spouse, adult married children with their families and institutional care. The National Sample Survey Office (NSSO) reported about three-forth of the elderly are supported by their own children, 7 per cent and 11 per cent of women were supported by their spouses and 8 percent and 12 percent were supported by institutional care. Another study reported \ 71 per cent of the elderly live with their children (family care), 26.3 percent live by themselves and with spouse and about 2.73 percent live with institutional support.6 Living in a joint family system was associated with favorable outcome in elderly suffering from depression.7 The nuclearisation of the family due to pressure of modern and industralised lifestyle has caused delirious effects on the elderlys life. Thus old age homes is one of the alternative of the living arrangement for the elderly. The reasons for opting to live in an institutitional are varied. Bothra (2011) quoted Jamuna (1998) the majors reasons for opting for institutional caregiving is due to low economic status, widowhood, destitute conditions, abuse by family members and lack of support by social networks.8 Payette (2000) conducted study to assess the role of nutrition status on 288 elderly participants. Factors like anthropometric measurements, socio-demographic factors, social network variables, functional and health status were measured. It was observed that with the number of elderly living in any kind of ‘institutional setting’ had an impact on their nutrition status. The elderly faced weight loss, limited capacities and reduced functional capability which controls social network, health and functional status.9 In a study it was shown that the prevalence of malnutrition was higher in case of people who stayed in the old ages home as compared to the people who lived in their own houses. The tools used for this study included assessment using Mini Nutrition Assessment (MNA), Dietary assessment- questions related to number of meals, food and fluid intake, anthropometric assessment- Height (Ht), Weight (Wt), Mid-Upper Arm Circumference (MUAC), Calf Circumference (CC), triceps skin fold thickness, Body Mass Index (BMI) and general assessment- questions related to lifestyle, medication and mobility and subjective assessment- self perception of health and nutrition.10 A similar study was carried out in an OAH in Lucknow and it observed that 51.67 percent elderly were malnourished considering the anthropometric measurements alone with higher numbers in males.11 A similar study on assessment of nutritional status among the elderly living in the old age home was carried out in South Africa, it was reported that out of the 210 sample size, 6 per cent were identified as malnourished and 47 per cent were reported to have at risk of malnutrition (ibid). A number of important assumptions and policy objectives underpin the need for the present study. One of the objectives of the Millennium Development Goals (MDG) is to provide the minimum required amount of energy to the individual. In the context of the elderly and OAH, the role of the OAH is to provide not only shelter but also provide physical, psychological, nutrition and health care to the elderly. Nutrition plays an important role in determining the health and well being of the elderly. This study examines the nutrition status of the elderly residing in the Old Age Home in Pune, Maharashtra with respect to their nutrient intake.
- Genuis, S. J. (2005). Nutritional Transition: A Determinant of Global Health. Journal of Epidemiology and Community Health, 59 (8), 615-617
- Borah, H., Shukla, P., Jain, K., Kumar, S. P., Prakash, C., & Gajrana, K. R. (2016). Elderly in India.Ministry of Statistics and Programme Implementation, Government of India. New Delhi: Socail Statistics Division.
- Raju, S. S., Parasuraman, S., Mangal, D., & Bammidi, S. (2014). Building a Knowledge Base on Population Ageing in India.Institute for Social and Economic Change, Institute of Social Growth and Tata Institute of Social Sciences . UNFPA.
- McKeown, R. E. (2009). The Epidemiologic Transition: Changing Patterns of Mortalitiy and Population Dynamics. American Journal of Lifestyle Medicine, 3, 1-14.
- (2015). World Population Ageing.Population divison, Department of Economic and Social Affair. New York: United Nations
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- Nowson, C. (2007). Nutritional challenges for the elderly. Nutrition & Dietetics, 65 (4), 150-155.
- Swami, H. M., Bhatia, V., Gupta, A. K., & Bhatia, S. P. (2005). An Epidemiological Study of Obesity Among Elderly in Chandigarh. Indian Journal of Community Medicine, 30 (1), 11-13.
- Vedantam, A., Subramanian, V., Rao, N. V., & John, K. (2009). Malnutrition in free-living elderly in rural south India: prevalence and risk factors. Publich Health Nutrition, 13 (9), 1328-1332.
- Jamuna, D. (2008). Issues of Elder Care and Elder Abuse in the Indian Context. Journal of Aging & Social Policy, 15, 125-142.
- Jhingan, H. P. (2001). Prognosis of Late-onset Depression in Elderly: A Study in India. International Journal of Psychogeriatrics, 13 (1), 51-61.
- Bothra, N., & Dasgupta, M. (2011). A COMPARATIVE PSYCHOSOCIAL STUDY OF SELECTED ELDERLY GROUPS IN THE CANVAS OF SUCCESSFUL AGING. Ageing and SocietyThe Indian Journal of Gerontology, XXI (I & II).
- Payette, H. (2000). Nutrition Risk Factors for Institutionalisation in a Free-living Functionally Dependent Elderly Population. Journal of Clinical Epidemiology, 53 (6), 579-587.
- Pai, M. K. (2011). Comparative study of nutritional status of elderly population living in the home for aged vs those living in the community. Biomedical Research, 22 (I), 120-126.
- Singh, A., Sahai, D., & Mathur, N. (2014). A Study on Prevailing Malnourishment Among Elderly Population of Lucknow City. International Journal of Agriculture and Food Science Technology, 5 (2), 35-40.