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Nutritional Status of Older Persons Presenting in a Primary Care Clinic in Nigeria

Nutritional Status of Older Persons Presenting in a Primary Care Clinic in Nigeria. ADEBUSOYE Lawrence University College Hospital Ibadan, Nigeria. BACKGROUND.

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Nutritional Status of Older Persons Presenting in a Primary Care Clinic in Nigeria

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  1. Nutritional Status of Older Persons Presenting in a Primary Care Clinic in Nigeria ADEBUSOYE Lawrence University College Hospital Ibadan, Nigeria

  2. BACKGROUND • Good nutrition is especially important in older persons because of the physiological changes that occur in the body as people age.1 • Challenging experiences before 60 years • a life of continuing poverty • Deprivation • poor access to health care • a diet poor in quality and quantity.1, 2

  3. BACKGROUND- 2 ASSUMPTIONS • Undernutrition - a rare occurrence in old age • Overweight - invariable consequence of ageing.2, 3 • BMI is the most commonly available tool to assess nutrition in older persons.

  4. OBJECTIVES • Determine the prevalence of nutritional problems (undernutrition & overweight). • Describe the risk factors contributing to the development of nutritional problems. • Determine the association between nutritional problems and morbidities.

  5. THE STUDY SITEUniversity College Hospital, Ibadan, Nigeria. Largest and oldest Tertiary hospital in Nigeria.

  6. METHODS • Study design: Cross-sectional study (Family Medicine Department). • Study Population: 500newly registered male and female older persons (≥60 years) • Study period: September 1st to October 30th, 2009.

  7. METHODS- TOOLS • Mini-Nutritional Assessment (MNAR) tool.5 • 18 questions on dietary history, clinical evaluation and anthropometric measures. • Used to measure undernutrition • Sensitivity = 96% • Specificity = 98% • PPV = 97% • MNA score (10 – 30) • Undernutrition- 17.0 • At risk of undernutrition- 17.0 – 23.5 • Normal - 23.6 – 30.0

  8. METHODS- TOOLS contd • Body Mass Index (BMI) {weight (kg)/height (m)2}. • Used to measure overweight • BMI (WHO anthropometric classification) • Underweight < 18.5 kg/m2 • Normal 18.5 - 25.0 kg/m2 • Overweight >25.0 kg/m2

  9. RESULTS • 324 (64.8%) females and 176 (35.2%) males. Female : Male = 1.8 : 1 • Mean age (SD) = 66.7 (6.6) years; range = 60 to 90 years. • Median income = U.S. $1.56 daily; range = $0.22 to $24.44 • Average OPD hospital visits in the last one year = 3 (range 1 - 13)

  10. FIGURE 1: UNDERNUTRITION USING MNA TOOL

  11. Table 1: Significant risk factors for undernutrition

  12. Table 2: Prevalence of undernutrition and the morbidities

  13. Table 3: significant risk factors for overweight

  14. LOGISTIC REGRESSION ANALYSIS (Undernutrition): • Hospital admission after the age of 60 years • (OR=2.105, CI=1.479-2.996) • Having hypertension • (OR=8.197, CI=3.270-20.833). • Not being in marriage • (OR=1.355, CI=1.075–1.708) • CORRELATION ANALYSIS (PEARSON’S): Positive association between BMI and MNA scores (r=0.152, p <0.0001).

  15. MNA categories across care settings

  16. CONCLUSION • High prevalence of nutritional problems in this study underscores the need for intervention in the older population. • The MNAR tool is an easy, simple and fast tool that could assess the nutritional status of older persons especially in primary care setting at first-contact. • Older persons need to be comprehensively examined as most of the predisposing factors to nutritional problems can be easily identified and treated.

  17. THANK YOU

  18. REFERENCES • Charlton KE, Rose D. Nutrition among older adults in Africa: the situation at the beginning of the millennium. J Nutr. 2001; 131:2424S–8S. • Evans C. Malnutrition in the elderly: a multifactorial failure to thrive. The Permanente Journal. 2005; 9:3. • Hajjar RR, Karmel HK, Denson K. Malnutrition in aging. The Internet J Geriatr Gerontol. 2004; 1:1. • National Population Commission of Nigeria. National and states population and housing tables. 2006 population and housing census of the Federal Republic of Nigeria. 2009. Accessed at www.population.gov.ng on 14 February 2011.

  19. REFERENCES- 2 • Nestle nutrition institute. Mini Nutritional Assessment (MNA). Nestle´, 1994, Revision 2006. N67200 12=99 10M. Accessed at http://www.mna-elderly.com/ forms/MNA_english.pdf on 13 April 2009. • World Health Organization expert committee on physical status 1995: the use and interpretation of anthropometry physical status. Technical Report Series no. 854. Geneva: World Health Organization. • Vellas B, Sieber C. The MNA revisited : what does the data tell us? Scientific Symposium Proceeding XIXth IAGG World Congress of Gerontology and Geriatrics. Monday, 6 July 2009 Paris, France.

  20. TABLE 1: Demographic characteristics and undernutrition

  21. TABLE 2: Economic status and undernutrition

  22. TABLE 3: Social characteristics and undernutrition

  23. Table 4: Hospital care utilization and undernutrition

  24. Table 5: presenting complaints and undernutrition

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