INTRODUCTION:

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. This proves that nutrition is now acknowledged as an important aspect in determining the health status of the individual.¹

Aging is a biological process, not a disease or curse which is inevitable and irreversible. It is associated with many of physiological and biological changes which are progressive. As such there is no standard numerical criterion to define ‘old age’. However United Nations (UN) recommended a cut off of age 60 years and above+ when referring to elderly population.²

The process of ageing also affects other nutrient needs. For example, while requirements for some nutrients may be reduced, some data suggest that requirements for other essential nutrients may in fact rise in later life. There is thus an urgent need to review current recommended daily nutrient allowances for this group. There is also an increasing demand worldwide for WHO guidelines which competent national authorities can use to address the nutritional needs of their growing elderly populations.³

Another factor is the price of foods rich in micronutrients, which further discourages their consumption. Compounding this situation is the fact that the older people often suffer from decreased immune function, which contributes to this group’s increased morbidity and mortality³

Older persons are particularly vulnerable to malnutrition. Moreover, attempts to provide them with adequate nutrition encounter many practical problems. First, their nutritional requirements are not well defined. Since both lean body mass and basal metabolic rate decline with age, an older person’s energy requirement per kilogram of body weight is also reduced.³

Factors like feeding difficulty, reduced mobility, psychological distress, being widowed, illiteracy, caring for children, poverty, and poor access to health and social services make elderly more vulnerable for malnutrition.⁴Several studies have shown that malnutrition among elderly can cause increase in morbidity and mortality⁵. Old age has direct effect on required amounts of nutrients, their absorption and subsequent metabolism. Many of the diseases suffered by older persons are the result of dietary factors, some of which have been operating since infancy. These factors are then compounded by changes that naturally occur with the ageing process.⁵

Mini-nutritional assessment (MNA) tool is a simple and reliable tool for assessing elderly at risk of malnutrition and has been designed especially for primary care physicians and health care providers involved in taking care of frail and sick elderly patients, at home or hospitals.⁶

NEED FOR THE STUDY:

The World Health Organization (WHO) estimates that the total number of older or elderly people (≥60 years) worldwide would cross the figure of 1.2 billion by 2025, including around 840 million people from low-income countries.³ In India too, the number is escalating with about 7.7% of the total population being elderly. Hence, the health status of the elderly population has a significant impact on the well-being of the country⁸.

The world’s population is ageing: virtually all countries are experiencing growth in the number and proportion of older persons in their populations. Globally, the number of older persons is growing faster than the numbers of people in other age groups.⁷ Elderly or old age consists of ages nearing or surpassing the average life span of human beings. Government of India adopted ‘National Policy on Older Persons’ in January, 1999, and defined elderly as a person who is of age 60-years and over and the United Nations also consider the same age for reference of older population. The number of elderly in the developing countries has been growing at a phenomenal rate; where 67% of older persons are living in developing countries⁷ and the story of India is not an exceptions status of the elder population has a significant impact on the well-being of the country.⁸

According to census, 2011, elderly population (age 60-years and over) constitutes about 8% of total population.⁹According to the United Nations Population Division report, India’s older population will increase dramatically over the next four decades, constituting 19% of total population of India by 2050.⁵ 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 Karnataka Constitutes about 7.9%of the population. Karnataka also stands 7th in India in terms of percentage population in the age group 60 and above in the country. The urban proportion (8.4%) of aged population in Karnataka is more than the corresponding rural share (6.9). Also there is significant Male-Female differences in the distribution of aged population both in urban and rural Karnataka. Female population was about 0.6 percent more than males¹¹. The overall old-age dependency ratio also relatively higher in Karnataka, 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.¹⁰

In Karnataka, only few studies were conducted to assess the nutritional status of elderly by MNA tool. Hence an attempt was made to carry out the present study on nutritional status assessment of elderly by using MNA tool in rural area of Chamarajanagar district as the majority of elderly live in rural area and very limited information is available on nutritional status of elderly.

OBJECTIVES:

1. To assess the nutritional status of elderly by using mini nutritional assessment tool at selected rural area of Chamarajanagar District.

2. To find the association between mini nutritional assessment scores of elderly with their selected demographic variables.

MATERIALS AND METHODS:

Study Design:

An Exploratory Descriptive Survey approach was used

Study Location:

The study was undertaken in selected rural areas chamarajanagara district.

Study Population:

Elderly people >60 years of age and who agreed to participate in the study were included and those who are not available during the study were excluded

Sample Size:

A sample size of 60 was selected

Mini Nutritional Assessment Tool:

To assess the nutritional status of the individual following consideration are as follows:

1. Screening tools which include MNA: MNA tool is a total of screening score which includes 14 points and assessment which includes 16 points interpretation of scores was done as follows: Score <17: Malnourished, score 17–23.5: At risk of malnutrition, and score > 23.5: Well nourished.

RESULTS:

SECTION – I:

DEMOGRAPHIC CHARACTERISTICS:

Table: I- Frequency and Percentage distribution of Elderly people according to their personal variables N = 60

Sl. No	Variable	Frequency	Percentage%
1	Age in years
a	60-64 years	19	31.7
b	65-69 years	13	21.7
c	70-74 years	10	16.7
d	75-79 years	9	15.0
e	80-84 years	9	15.0
2	Gender
a	Male	47	78.3
b	Female	13	21.7
3	Weight in KGs
a	50-59	12	20.0
b	60-69	14	23.3
c	70-79	18	30.0
d	80-89	14	23.3
e	90-99	2	3.3
4	Height
a	140-149	33	55.0
b	150-159	6	10.0
c	160-169	11	18.3
d	170-179	9	15.0
e	180-189	1	1.7
5	Religion
a	Hindu	23	38.3
b	Muslim	17	28.3
c	Christian	6	10.0
d	Others	14	23.3
6	Education
a	Literate	22	36.7
b	Illiterate	38	63.3

The data presented in table 1 show that majority of elderly people are in the age group between 60-64 years. Majority of elderly peoples are males and their weight is in between 70-79 kg and height is in between 140-149cm. Also Most of the elderly people belong to Hindu religion and majority of elderly peoples are illiterate.

SECTION II: NUTRITIONAL STATUS OF ELDERLY PEOPLE AT SELECTED RURAL AREAS OF CHAMARAJANAGARA DISTRICT

Table: II - Frequency and Percentage distribution of nutritional status of the Elderly people N = 60

Sl. No	Nutrition status	Frequency	Percentage%
1	Malnourished	4	6.7
2	At risk malnutrition	20	33.3
3	Normal nutrition status	36	60
	Total	60	100

Table: III - Mean, Median and SD of MNA scores of the Elderly people N=60

Sl. No	MNA aspects	No. of Items	Max Score	Mean	Median	SD
1	Screening	6	14	11.32	12	2.296
2	Assessment	12	16	12.37	13	2.391
3	Overall	18	30	23.68	24.75	4.260

Table IV: Association of MNA Scores of Elderly People With Their Demographic Variables N=60

Sl. No	Variables	Below median	Median and above	Chi square	Df	P value (0.05)	Inference
1	Age in years
a	60-64 years	11	8	0.773	4	0.942	NS
b	65-69 years	6	7
c	70-74 years	5	5
d	75-79 years	4	5
e	80-89 years	4	5
2	Gender
a	Male	22	25	0.884	1	0.347	NS
b	Female	8	5	0.884	1	0.347	NS
3	Weight
a	50-59	6	6	0.508	4	0.973	NS
b	60-69	6	8
c	70-79	10	8
d	80-89	7	7
e	90-99	1	1
4	Height
a	140-149	20	13	4.081	4	0.395	NS
b	150-159	2	4
c	160-169	4	7
d	170-179	4	5
e	180-189	0	1
5	Religion
a	Hindu	12	11	1.055	3	0.788	NS
b	Muslim	8	9
c	Christian	2	4
d	Others	8	6
6	Education
a	Literate	12	10	0.287	1	0.592	NS
b	Illiterate	18	20	0.287	1	0.592	NS

The data presented in table II shows that Among 60 participant’s 36(60%) elderly people having normal nutritional status, 20(33.3%) elderly people are at risk for malnutrition and 04(6.7%) elderly people are malnourished

The data presented in table III shows that Among 60 participant’s out of 06 items, max score obtained for screening was 14 with the mean score of 11.32 whereas 16 was the max score and 12.37 was the mean scores for assessment with 12 items.

The data presented in table IV shows that association between MNA scores of elderly with their demographic variables and the results shows that none of the variables are significant.

CONCLUSION:

Present study reveals that 33.3% of elderly at risk for malnutrition and 6.7% of population are malnourished. Older people are at an increased risk of inadequate diet and malnutrition. Calcium, protein rich diet and early digestible diet should be provided to reduce malnutrition in elderly people.

RECOMMENDATIONS:

On the basis of present study, the following recommendations can be made.

1. A similar study can be taken for larger sample to generalise findings

2. Comparative study can be conducted among rural and urban population

3. Similar study can be adopted for experimental design by giving nutritional interventions

4. Study recommended for conduct nutritional programs for elderly

REFERENCE:

1. Genuis, S. J. (2005). Nutritional Transition: A Determinant of Global Health. Journal of Epidemiology and Community Health , 59 (8), 615-61

2. Registrar General of India office, Government of India. India: 2011.Census of India.

3. WHO Nutrition for older person’s available from: http://www.who.int/nutrition/topics/ageing/en/index1.html.

4. Kikafunda JK, FB. Nutritional status and functional ability of the elderly aged 60 to 90 years in the MPIGI district of central Uganda. Nutrition. 2005; 21:59–66.

5. Kalaiselvi S, Arjumand Y, Jayalakshmy R, Gomathi R, Pruthu T, Palanivel C. Prevalence of under-nutrition, associated factors and perceived nutritional status among elderly in a rural area of Puducherry, South Lukwago India. Arch Gerontol Geriatr. 2016; 65:156–60

6. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999; 15:116–22.

7. (2015) World Population Ageing 2015: Highlights. Department of Economic and Social Affairs, United, Nations, New York

8. https://openaccesspub.org/jarh/article/336#ridm1851102556.

9. Borah, H., Shukla, P., Jain, K., Kumar, S. P., Prakash, C., Gajrana, K. R. (2016). Elderly in India. Ministry of Statistics and Programme Implementation,

10. 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.

11. https://openaccesspub.org/jarh/article/336#redm1850958148

12. https://idd.karnataka.gov.in/storage/pdf-files/63_Geriatricproject.pdf

Received on 10.11.2020 Modified on 08.12.2020

Int. J. Nur. Edu. and Research. 2021; 9(1):61-64.

DOI: 10.5958/2454-2660.2021.00014.4