Malnutrition is very common in elderly, and as average life expectancy is increasing with correlate decrease in fertility and mortality rates worldwide, this change will shift the epidemiology towards more geriatric populations (>60 yrs old). There are different tools to evaluate nutritional status; however, the most widely used and adapted tool is the Mini Nutritional Assessment (MNA) Tool.
The aim of this report study is to draw a random sample from elderly patients and evaluate their nutritional status retrospectively 3 months before their admission. It aims to link malnutrition with coexistence of relevant diseases and a literature review will be conducted accordingly. It also aims at increasing awareness amongst elderly people and youth about successful aging, and conducting a field study to an Elderly Care Centre to investigate its roles and duties in helping the geriatric community in Riyadh.
Abstract:
Introduction:
Malnutrition is very common in elderly, and as average life expectancy is increasing with correlate decrease in fertility and mortality rates worldwide, this change will shift the epidemiology towards more geriatric populations (>60 yrs old). There are different tools to evaluate nutritional status; however, the most widely used and adapted tool is the Mini Nutritional Assessment (MNA) Tool.
Goal:
The aim of this report study is to draw a random sample from elderly patients and evaluate their nutritional status retrospectively 3 months before their admission. It aims to link malnutrition with coexistence of relevant diseases and a literature review will be conducted accordingly. It also aims at increasing awareness amongst elderly people and youth about successful aging, and conducting a field study to an Elderly Care Centre to investigate its roles and duties in helping the geriatric community in Riyadh.
Methods:
This study was carried out on elderly patients (17 cases; > 60 yrs old), residing at in-patients wards in KFSH & RC in Riyadh, Saudi Arabia. In this study, data for 17 elderly patients was collected using a structured Mini Nutritional Assessment (MNA) Tool. Literature review from different international journals was conducted using Pubmed, Science Direct, and other research engines. To increase awareness, a pamphlet is intended to be emailed through Alfaisal University Electronic Email Service to educate youths and their relatives about the importance of successful aging. A field-study to an Elderly Care Centre in Nakheel District, Riyadh, was carried out by interviewing several personnel working for the house.
Results:
A total of 20 patients (male/female: 1:1) were included in the study. MNA showed poor nutritional status in 85% of patients (30% at risk (MNA score <=23), 55% malnutrition (MNA score<17)).The prevalence of malnutrition in females is significantly higher than that in males (P<0.05).
Conclusion:
The study confirms that there is co-existence between malnutrition and other diseases, and that malnutrition is a common problem among elderly. Though, due to the small sample size, this cannot be generalized for all population. We also encourage awareness campaigns on how to age successfully and have better health to lessen the burdens and economical costs that can be prevented by sheer knowledge and practice.
Introduction:
Malnutrition, which is the deficiency of energy, protein, and/or other nutrients such as vitamins, occurs with a high prevalence in the elderly and leads to significant increase in morbidity and mortality in a growing segment of the population of the world that’s becoming a burden on the health care system.
Reported prevalence of malnutrition across the world varies greatly from 0-65% due to differences in methodologies employed and the heterogeneity of the aging population. In a multinational study spanning 12 countries and using 24 data sets, the prevalence of malnutrition was found to be 22.8% on average, with the setting being a source of variation (50.5% in rehabilitation, 38.7% in hospitalization, 13.8% in nursing homes, 5.8% in community). 46.2% were found to be “at risk” of malnutrition1. In the UK, the prevalence is reported to be 25%-35% in age groups between 60 and 80 yrs and 35% in adults over 802. In a study in China, prevalence was found to be 1.71% and 19.6% were “at risk” of malnutrition3. In the Czech Republic, malnutrition is reported to affect 20-70% of elderly patients in a hospital setting4. In Belgium, malnutrition among the elderly population is estimated to be 33% with 43% at risk28.
Malnutrition contributes significantly to morbidity and mortality rates in elderly patients. A 10 year longitudinal study, in which 26.5% became weak or sick and 19.1% died, showed an increase in morbidity in malnourished patients. Subjects on a lower or higher calorie diet than the recommended (RDA) and those with a low protein intake were exposed to more weakness, sickness, or death than their counterparts5. Studies on elderly surgical patients suggest that malnourished patients are 2 or 3 times more likely to experience post surgical complications, increased mortality, and prolonged hospital stay that can be 90% longer than their counterparts with an estimated 35%-75% increase in cost [6,7]. In one study, weight loss and a low BMI (Body Mass Index), FFM (Fat-Free Body Mass), or SMM (Skeletal Muscle Mass) alone was found to increase the risk of mortality by 1.45, 2.42, and 3.2 times respectively8. In another study on hospitalized patients, a group of 21% of patients who had a daily intake of <50% of recommended, were exposed to a risk of mortality 8 times higher than their counterparts9 - For more information on Nutrition in Geriatrics and associated common diseases visit Appendices A & B.
In order to maintain a high standard level of optimum health in our aging population, the notion of healthy nutritional status must be assessed in elderly population so as to address the problems and needs of elderly people. Presently in Riyadh, there are little known cohort studies that address our geriatric community, and elderly care centres are fighting the exhausting turmoils of aging on their own with no common collaborations. It is seen as normal, whilst literature review has shown that successful aging can be one of life’s wondrous gifts to one's body, spirit, mind and family which will ultimately decrease costs and economical burden in hospitals. Thus, this study is designed to determine three main key points. Firstly, a sample assessment size of nutritional status in elderly patients. Secondly, reviewing literature to establish the co-existence of nutritional status with common diseases of aging, and thirdly, addressing geriatric community at large, by a) increasing awareness about successful aging and b) addressing the Elderly Care Centre in Riyadh, and discussing its roles and duties in helping our geriatric community.
Methods:
Subjects: This study was carried out on elderly people, residing in in-patients ward at KFSH & RC, Riyadh, Saudi Arabia. Subjects who were over 60 years of age were selected in the study, and were picked up randomly in Cardiac and GI wards. Subjects have been residing in the hospital for at least a day, and some were about to be discharged. The analysis was heavily retrospective on their nutritional status and food intake before their admission to the hospital for at least 3 months, without addressing the current nutritional status at the hospital now. A total of 17 patients (male/female: 1.43) were included in the study.
Methods: in this study, data of 17 elderly patients were collected using Mini Nutritional Assessment (MNA) Questionnaire.
The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminate analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most importantly, it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention1 29.
Abbildung in dieser Leseprobe nicht enthalten30
For this study, the MNA questionnaire was interpreted promptly into Arabic by a researcher and filled up as he questioned patients. It took on average 7 minutes for each patient. Note, certain criteria were not met, such as BMI, Mid Arm/Calf Diameter, because it was not reliable in a retrospective scenario like this, and a limiting factor was: most patients were unable to get out of bed or were medically unsuitable to conduct to be measured.
Field Study:
A visit was conducted to Riyadh Elderly Care Centre for Males, where we interviewed several people there. It was under the supervision of the Ministry of Social affairs. We have found out that it was first established around 60 years ago, and they had a lot of goal enhancements over the past relatively 20 years. They focused on several domains of CARE, in Summary:
1) A social care domain which focuses on establishing a steady social residency state for the elderly and helping them in the phase they are going through.
2) A health care domain which focuses on the optimization of the well-being of the resident, and aims to prevent him or her from the common geriatric diseases and thus any health deterioration thereof.
3) A Cultural and Religious domain which aims on strengthening the beliefs of the resident by arranging discussion groups, and encouragement to do the spiritual activities mandated by their religious beliefs, i.e., Islamic Beliefs.
4) Professional & Handcrafts domain which aims to provide residents with training courses on certain hobbies dependent on their preference and acceptance.
5) Psychological domain that aims to monitor residential cases with regular routine follow-ups so as to ascertain their psychological soundness and sensibility and lessen their worries in order to help them better accept themselves, others, and surroundings. Regular discussion activities are arranged and encouraged among residents.
Pamphlet:
A pamphlet was created using various resources, mentioned in bibliography, which focuses on successful aging and identifying common findings about age disease. Its goal is to increase awareness and encourage optimizing our lives.
Results:
A total of 20 patients (male/female: 1:1) were included in the study. Mean age of the patients was 69.6 (SD 9.19 , R 60-87 ). According to different age groups, 65% (n=13) were youngest old (60-70 yrs), 20% (n=4) were middle old (70-80), and 15% (n=3) were oldest old (>80). MNA showed poor nutritional status in 85% of patients (30% at risk (MNA score <=23), 55% malnutrition (MNA score<17)) When different age groups were taken into consideration, 84.6% of youngest old had poor nutrition (30.8% at risk, 53.8% malnutrition), all middle old had poor nutrition (25% at risk, 75% malnutrition), and 75% of oldest old had poor nutrition (33.3% at risk, 66.7% malnutrition). The difference in the prevalence of malnutrition between age groups is not statistically significant. When gender was taken into consideration, 80% of males were found to have poor nutrition (60% at risk, 20% malnutrition) and 90% of females were found to have malnutrition with none in the “at risk” category. The prevalence of malnutrition in females is significantly higher than that in males (P<0.05). [For Data Tabulation visit Appendix C]
[...]
1- Kaiser M, Bauer J, Sieber C, et al. Frequency of Malnutrition in Older Adults: A Multinational Perspective Using the Mini Nutritional Assessment. Journal Of The American Geriatrics Society [serial online]. September 2010;58(9):1734-1738. Available from: Academic Search Premier, Ipswich, MA. Accessed January 3, 2012
2-Russell CA, Elia M, on behalf of BAPEN and collaborators: Nutrition screening survey in the UK in 2007. Nutrition screening survey and audit of adults on admission to hospitals, care homes and mental health units. <http://www.bapen.org.uk/pdfs/nsw/nsw07_report.pdf> BAPEN 2007.
3-Gang Wang, Ying Wan, Qi Cheng, et al. Malnutrition and associated factors in Chinese patients with Parkinson’s disease: Results from a pilot investigation. Parkinsonism and Related Disorders 16 (2010) 119-123
4- D. Hrnciarikova, Z. Zadak, Malnutrition in seniors in the Czech Republic, European Geriatric Medicine, Volume 2, Issue 2, April 2011, Pages 111-114, ISSN 1878-7649, 10.1016/j.eurger.2011.01.014. (http://www.sciencedirect.com/science/article/pii/S1878764911000234)
5- Bruno J. Vellas, William C. Hunt, Linda J. Romero, Kathleen M. Koehler, Richard N. Baumgartner, Philip J. Garry. Changes in nutritional status and patterns of morbidity among free-living elderly persons: A 10-year longitudinal study. Nutrition - June 1997 (Vol. 13, Issue 6, Pages 515-519)
- REGULA MÜHLETHALER, ANDREAS E. STUCK, CHRISTOPH E. MINDER, and BRIGITTE M. FREY. The Prognostic Significance of Protein-energy Malnutrition in Geriatric Patients Age Ageing (1995) 24(3): 193-197 doi:10.1093/ageing/24.3.193
7- Norman DC. Nutrition and failure to thrive. In: Osterweil D, Reuben DB, Rozzini R, Rubenstain LZ, Trabucchi M editor. New frontiers in geriatric medicine. Brescia: Kendal; 1992
8- Simcha Kimyagarov, Raisa Klid, Shalom Levenkrohn, Yudit Fleissig, Bella Kopel, Marina Arad, Abraham Adunsky, Body mass index (BMI), body composition and mortality of nursing home elderly residents, Archives of Gerontology and Geriatrics, Volume 51, Issue 2, September-October 2010, Pages 227-230, ISSN 0167-4943, 10.1016/j.archger.2009.10.013. (http://www.sciencedirect.com/science/article/pii/S0167494309002684)
9- D.H. Sullivan, S. Sun and R.C. Walls, Protein-energy undernutrition among previous termelderlynext term hospitalized patients: a prospective study. JAMA, 281 (1999), pp. 2013–2019.
29 - Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15:116.)
Frequently asked questions
What is the primary focus of this document?
This document focuses on malnutrition in elderly patients, its prevalence, associated diseases, and strategies for improving nutritional status and promoting successful aging. It includes a retrospective study on elderly patients in Riyadh, Saudi Arabia, a literature review, and a description of a field study conducted at an Elderly Care Centre.
What is the Mini Nutritional Assessment (MNA) Tool?
The MNA is a tool designed to quickly assess the nutritional status of elderly patients in various settings. It uses simple measurements and questions to categorize patients as having adequate nutritional status, being at risk of malnutrition, or experiencing protein-calorie malnutrition.
What were the key findings of the study in Riyadh?
The study found that 85% of the elderly patients assessed showed poor nutritional status, with 30% at risk of malnutrition and 55% experiencing malnutrition. The prevalence of malnutrition was also significantly higher in females than in males.
What is the purpose of the literature review included in the document?
The literature review aims to establish the connection between malnutrition and common diseases in elderly populations, drawing on various international studies and reports.
What are the key goals of the Elderly Care Centre mentioned in the field study?
The Elderly Care Centre focuses on several domains: social care, health care, cultural and religious support, professional & handcraft training, and psychological well-being. Their goal is to provide comprehensive care and support to elderly residents.
What is the purpose of the pamphlet described in the document?
The pamphlet is designed to increase awareness about successful aging and common age-related diseases, encouraging individuals to optimize their lives and health as they age.
What are some of the reasons for Malnutrition reported in this paper?
According to various articles included in the paper, multiple factors contribute to malnutrition. These include variations in methodologies and the heterogeneity of the aging population, poor diets, morbid conditions and old age.
How prevalent is malnutrition in elderly populations worldwide according to this report?
The reported prevalence of malnutrition varies greatly (0-65%) due to differences in methodologies and the heterogeneity of the aging population. A multinational study found an average prevalence of 22.8%.
What does the study suggest about the relationship between malnutrition and mortality?
The study suggests that malnutrition significantly contributes to morbidity and mortality rates in elderly patients. Malnourished patients are more likely to experience post-surgical complications, increased mortality, and prolonged hospital stays.
- Arbeit zitieren
- A. Al-Ahaideb (Autor:in), N. Arain (Autor:in), S. Hashish (Autor:in), M. Dahlawi (Autor:in), Am. Elhossainy (Autor:in), As. Elhossainy (Autor:in), Y. Al Najashi (Autor:in), Y. Al Doghaither (Autor:in), 2012, Aging with Grace. Malnutrition in Elderly, München, GRIN Verlag, https://www.hausarbeiten.de/document/303726
