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Introduction

Assessment of adults and older people in emergencies: Approaches, Issues and priorities , Recommendations By Dolline Busolo HelpAge International. HelpAge International is a global network of over 70 NGOs Mission to work with and for older people world-wide Improve quality of their lives.

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Introduction

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  1. Assessment of adults and older people in emergencies:Approaches, Issues and priorities , RecommendationsBy Dolline Busolo HelpAge International

  2. HelpAge International is a global network of over 70 NGOsMission to work with and for older people world-wideImprove quality of their lives. Introduction

  3. Body Changes that occur with Ageing Age affects body size, shape and composition Adults tend to loose fat free mass Increase fat mass with age. The changes may alter the functional significance of conventional nutritional assessment indices at different ages.

  4. Current Assessment and Intervention Practices Body Mass Index requiring weight and height measurement Mid-Upper Arm Circumference (MUAC) (clinical and social indicator) Oedema But there is no agreement about cut off points Options for assessing older people and adults are limited Currently similar indices are used for adults and older people Based on resource availability and context

  5. Issues Widely differing approaches and criteria Inclusion /exclusion criteria undefined (deaf and dumb and bedridden) Sampling procedure not defined The respondents (role of caregivers especially for those with impairments) Admission into selective feeding programmes Discharge from selective feedingprogramme Research Support

  6. Body Mass Index (BMI) BMI, defined as weight/(height)2 , developed in non-famine situations A measure of chronic energy deficiency. Studies have shown that lower BMIs are correlated to higher risks of mortality Higher number of sick events, days in bed Capacity for physical activity.

  7. Adult BMI Varies according to shape, gender and age Height and weight difficult to assess during peak famine Calculation unfamiliar with field workers Oedema is common during famine therefore increases weight Pregnant women cannot be included BMI not designed for emergencies Correction required

  8. Challenges of measuring older people • Measuring height due to spinal curvature common in older people • Cultural issues; anthropometry regarded as “invasive” • Determining the age of on older person • The process may take a longer time • Religion or cultural issues may be stronger (necessary to have respect for similar sex measurement) • Necessary to treat older people with dignity, e.g. not rushing, listening

  9. Issues with BMI • Using a proxy for height • Adjust for different body shapes • Gather baseline information • Additional information needed for interpretation

  10. Findings are interpreted in the context of: • CMRS • Prevalence of malnutrition among 5 year olds • Adjusting for Cormic Index in emergencies is impractical. • The adjustment calculation is complicated and perhaps impractical • The recommendations to use Cormic Index not endorsed by WHO.

  11. Mid-Upper Arm Circumference (MUAC) Advantages • · Easier to perform • · Correlated with mortality in children/ TFCs • · Not confounded by oedema • · Independent of height • · Correlation with BMI: linear and robust • · More sensitive to acute weight loss

  12. Limitations The measurement error (intra- and inter-observer error), Mortality correlation with MUAC are not described for adults and older people No consensus on cut-offs. Tentative proposal for emergency assessment needs further research

  13. Fig. 1: Nutritional Risk Factors for Older People at an individual level

  14. Key question for discussions • a) Which methodologies should be used to assess the nutritional status of adults and older people in emergencies (Prevalence, monitoring, evaluation, programming?) • b) What sampling approach should be used to arrive at the required representative sample size for older persons • c) What cut-off points that should be used to categorise the nutritional status of adults and older people.

  15. Follow up activities for assessment and intervention Definition of protocol Definition of key indicators

  16. Who • All stakeholders but especially HAI USAID, FANTA and research and institutions involved in emergency work

  17. Recommendations

  18. Acknowledgement Food and Nutrition Technical Assistance (FANTA

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