2Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
Methods: A community based cross-sectional study was conducted. Two stage cluster sampling technique was used to select study participants. A total of 757 subjects were included in this study for nutritional status assessment. The predictive value of the variable to Undernutrition was identified by bivariate and multiple logistic regression analysis.
Results: The prevalence of undernutrition was approximately 21.9% in elderly people included in this study. Multiple analysis found that unable to read and write [AOR 2.7 95% CI (1.7-5.2)], being female [AOR 3.0 95% CI (1.6-5.4)], being older [AOR 38.1 95% CI (15.0-96.9)], being poor [AOR 1.8 95% CI (1.0-3.2)] and have poor dietary diversity score [AOR 3.7 95% CI (1.8-7.6)] are independently and negatively associated with nutritional status of elderly people.
Conclusion and recommendation: This study indicated high prevalence of undernutrition among elderly people in Northwest Ethiopia. Old age range, gender, educational status, dietary diversity score and wealth index were found to be the factors affecting under nutrition of elderly people. Nutrition intervention and educations focusing on very old and female elderly people in improving health care and dietary practice are highly recommended in this study area.
Keywords: Undernutrition; Elderly people; Prevalence; Northwest Ethiopia
Old age people are more susceptible for malnutrition and infection. The cost of health expenditure associated with treating the infection and/or malnutrition is also high [3,4]. Older people are highly neglected from different health and social interventions carried out by different stake holders [5]. Nutrient needs of older people are different due to natural aging process, dental problems and psychosocial issues. This makes them different and demands critical nutritional evaluation and follow up [6].
In Ethiopia the elderly population is growing rapidly which could increase burden of malnutrition and other non communicable diseases in the future [7]. Most studies on malnutrition in Ethiopia are focusing in children and adults. The increasing number of elderly people with less effort to combat their health and nutritional needs seek great attention in Ethiopia. However, there are no studies which assess the determinants of malnutrition in elderly people in Ethiopia.
Therefore, the aim of this study is to determine the prevalence of undernutrition and to identify risk factors associated with undernutrition in elderly people. Data obtained from this study will be useful for raising awareness of the nutrition needs of elderly people and will be a base for policy makers and planners.
Socio demographic (age range, family size and marital status) and economic characteristics (educational status of participants and partner, occupation of care taker, with whom participants are living and income status) were evaluated in our study participants. The questionnaire also contained health (illness for the last 3 months, yes/no; visit health facility, yes/no; taking medication, yes/no; most common diseases) and dietary habits questions (decline food intake yes/no; reasons for declined food intake, meal timing). Dietary Diversity Score (DDS) was considered low for respondents eaten < 3 food items, middle when eaten 4-5 food items and high when eaten > 5 major food items per day.
Socio-demographic characteristics |
Number (n) |
Percent (%) |
Age group in years |
||
65-74 |
554 |
73.2 |
75-84 |
163 |
21.5 |
≥85 |
40 |
5.3 |
Family size |
||
<4 |
485 |
64.2 |
≥4 |
272 |
35.8 |
Marital status |
|
|
Widowed |
467 |
61.7 |
Married |
236 |
31.2 |
Single/Divorced/separate |
54 |
7.1 |
Educational status of respondents |
||
Unable to read and write |
440 |
58 |
Read and write |
244 |
32.2 |
Primary education |
51 |
6.7 |
Secondary and above |
22 |
2.9 |
Educational status of partner (n=236) |
||
Unable to read and write |
132 |
56 |
Read and write |
69 |
29.2 |
Primary education |
23 |
9.3 |
Secondary & above |
13 |
5.5 |
Occupation of care taker (n=272) |
||
Government employee |
122 |
44.8 |
Farmer |
3 |
14.3 |
Merchant |
108 |
39.7 |
Others |
39 |
1.1 |
With whom respondents are living |
||
With partner |
236 |
31.2 |
With children |
446 |
58.9 |
Alone |
65 |
8.6 |
Others |
13 |
1.7 |
Wealth index |
|
|
Poor |
294 |
38.8 |
Middle income |
218 |
28.8 |
Rich |
245 |
32.4 |
Age is found to be associated with undernutrition in elderly people. Oldest old and middle old were more likely to be undernourished than young old people [AOR 38.1 95% CI (15.0-96.9)]. Females were three times more likely to be undernourished as compared to males [AOR 3.0 95% CI (1.6- 5.4)]. Elderly people who cannot read and write were 2.7 times more likely to be undernourished [AOR 2.7 95% CI (1.7- 5.2)]. The risk in low income elderly to be undernourished was 1.8 higher than in rich elderly [AOR 1.8 95% CI (1.0-3.2)]. With regard to wealth index, middle income elderly were 2.5 times more likely to be undernourished as compared to rich [AOR 2.5 95% CI (1.4-4.7)]. Dietary diversity score is found to be significantly and positively associated with under nutrition. According to this study, elderly people with poor DDS were 3.7 times more likely to be undernourished when compared to those with high DDS[AOR 3.7 95% CI (1.8-7.6)] (Table 3).
Variable |
Number (n) |
Percent (%) |
Illness for the last 3 months |
||
Yes |
285 |
37.6 |
No |
472 |
62.4 |
Visit health facility (n=285) |
||
Yes |
199 |
70 |
No |
86 |
30 |
Taking medication (n=285) |
||
Yes |
191 |
67 |
No |
94 |
33 |
Most common diseases mentioned (n=285) |
||
Joint pain |
83 |
29 |
Hypertension |
72 |
25.3 |
Diabetic mellitus |
39 |
13.7 |
Hearing problem |
31 |
10.9 |
Indigestion problem |
27 |
9.5 |
Visual problem |
24 |
8.4 |
I don’t know |
9 |
3.1 |
Decline food intake |
||
Yes |
163 |
21.5 |
No |
594 |
78.5 |
Reasons for declined food intake (n=163) |
||
Digestive system problem |
74 |
45.4 |
Loss of appetite |
35 |
21.4 |
Chewing problem |
39 |
23.9 |
Swallowing problem |
15 |
9.2 |
Dietary diversity score |
||
Low |
51 |
6.6 |
Middle |
273 |
36.1 |
High |
433 |
57.2 |
Meal timing |
||
Regular |
566 |
74.8 |
Irregular |
191 |
25.2 |
Age, sex, educational status, wealth index and dietary diversity score of respondents found to be associated with undernutrition in elderly people. Females were three times more likely to be undernourished as compared to males. This finding is similar with the study done in Malaysia [14] but contradicts with study done in Kenya [13]. This could be due to the fact that female elderly still remain the care takers of the young children but given low care needed to themselves. Females are also exposed to many comorbid illnesses with no pension paid as compared to male elderly.
Variables |
Undernutrition(n) |
COR (95%CI) |
#AOR(95%CI) |
|
Yes |
No |
|||
Education status of respondents |
||||
Unable to read & write |
108 |
331 |
2.1 (1.3-3.3) |
2.686 (1.5-5.2) |
Able to Read & write |
58 |
259 |
1 |
1 |
Wealth index |
|
|
||
Poor |
73 |
221 |
1.6 (1.1-2.5) |
1.8 (1.0-3.2) |
Medium |
52 |
166 |
1.6 (1.0-2.5) |
2.5 (1.4- 4.7) |
Rich |
41 |
204 |
1 |
1 |
Sex |
||||
Female |
141 |
422 |
2.3 (1.4-3.6) |
3.0 (1.6-5.4) |
Male |
25 |
169 |
1 |
1 |
Age group in years |
||||
65-74 |
30 |
10 |
33.1(15.2-71.3) |
38.1(15.0-96.9) |
75-84 |
90 |
73 |
13.4(8.7-20.2) |
14.6(8.9-24.0) |
≥85 |
46 |
508 |
1 |
1 |
Dietary diversity score |
||||
Low DDS |
23 |
27 |
3.7 (2.0-6.7) |
3.7(1.8-7.6) |
Middle DDS |
61 |
212 |
1.2 (0.9-1.8) |
1.1 (0.7-1.8) |
High DDS |
82 |
351 |
1 |
1 |
Educational status was also one of the factors which had showed significant association with undernutrition. Elderly people who cannot read and write were 2.7 times more likely to be undernourished. This finding is comparable with studies done in Iran and Kenya [10,16]. This might be due to educated people have good feeding practice and have better life style.
With regard to wealth index, middle income elderly were 2.5 times more likely to be undernourished as compared to rich. Low income subjects were also 1.8 times more likely to be undernourished than rich. This result is supported by the study done in Russia which states wealthiest individuals have high BMI as compared to poor individuals and at the same time poor elderly are more likely to be undernourished as compared to wealthier [17]. This might be due to wealthiest individuals have enough food to eat and have relatively better life style as compared to poor who are always in trouble to secure their daily food intake.
Dietary diversity score is found to be significantly and positively associated with under nutrition. According to this study, elderly people with poor DDS were 3.7 times more likely to be undernourished when compared to those with high DDS. This result is the same as the study done in Dadab refugee camp in Kenya [16]. This might be due to low calories and protein content of less diversified foods as compared to high diversified foods.
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