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Title: Influence of the nutritional status on the health condition of elderly people staying in medical and care institutions

Abstract:

One of the significant factors influencing both the Polish and the global health situation is the process of demographic and epidemiological transition of societies. An ageing society poses a major challenge to health care systems as it is integrally connected with increased demand for medical and care services.In view of the fact that older people are often afflicted by multiple diseases and disabilities, the priority of geriatric care should be to take action towards maintaining independent living amongst this population. Appropriate nutritional monitoring of elderly people, in particular those hospitalised in medical or i care institutions can significantly improve their health status.The objective of this study is to assess the influence of nutritional status on the health condition of elderly people staying in medical and care institutions.The research was conducted between November 2008 and July 2010. The institutions selected for the study included one hospital and five care institutions located within the Bielsko Poviat. The research proposal was accepted by the Ethical Committee of the Regional Medical Chamber in Bielsko-Biała.The study involved people who were at least 65 years old on the day of the examination. Initially, the overall number of people hospitalised on medical ward and residing in care institutions, fulfilling the age criterion was 308. Eligibility for participation in the study was assessed based on the initial interviews and analysis of medical documentation. The following non-inclusion criteria were implemented:• lack of subject’s consent to participate in all stages of the study;• active phase of neoplastic disease on course of chemo- or radiotherapy;• patient’s mental state hindering the interview or conscious consent to the study (diagnosed with dementia);• physical condition hindering anthropometric examination (such as immobile patients, contraindication to lifting or amputation of both lower extremities); • period of hospitalisation on the medical ward longer than 10 days.Ultimately, 202 (100%) people were assessed as eligible for the study, including 104 (51.50%) pe ople on medical ward and 98 (48.50%) people in care institutions.The study was conducted using the diagnostic poll method and the Paper and Pen Personal Interview technique. The questionnaire contained questions on lifestyle, socio-economic status, diet, functional capability and health status. The study also comprised standard research tools including the Mini Nutritional Assessment - full version (MNA-FV®); The malnutrition risk scale (SCALES), abbreviated test assessing the risk of falling (Tinetti) and the Geriatric ; Depression Scale (Yesavage). Each subject was also given anthropometric measurement and a blood test for selected biochemical tests. The results were recorded on an Excel Microsoft Office 2007 database and statistical analysis was conducted using the Statistica PL 9.0. The study population was described using numbers and percentages of subjects. Quantitative features have been presented with the arithmetic mean and standard deviation. In the assessment of differences between the groups, the Mann-Whitney non-parametric U test was used for independent variables. In order to measure the statistical dependence between variables the Spearman’s rank correlation test was performed. In order to study the connection between 2 sets of variables among 3 sets of variables (I – social status; II – health status and functional capability; III – nutritional status) canonical correlation analysis was undertaken. The majority of the study population were women (73.76%). The average age of study participants was 77.59±7.35 years (65-100 years). Hospital patients were admitted for an average of 3.16±2.48 days (1-8 days) and people staying in care institutions were resident for an average of 66.17±55.64 months (0.5-216 months). A significant majority of the study population suffered from multiple diseases (86.63%). By far the most frequent diseases diagnosed in the subjects were those of the circulatory system (80.20%) and among these the largest percentage suffered from hypertension.Study participants did not vary significantly from each other in the number of meals taken daily and had an average of 2.92±0.31 meals per day. The most frequent meals, taken by almost 100% of subjects, were the main meals (breakfast, lunch and dinner), whereas additional meals (brunch and tea) were taken by only 10% of subjects. Over half of all subjects (61.88%) declared they also snacked between meals. Almost half of all subjects (47.52%) stated that they had not always eaten regular meals. A significant majority of subjects (71.78%) confirmed they ate homemade meals.The subjects scored an average of 22.23±3.66 points (10-29 points) in the MNA-FV® questionnaire. Their place of residence at the time of the examination significantly influenced the results. Subjects residing in care institutions scored significantly more points in the MNA-FV® (22.74±3.69 points) compared to the hospitalised subjects (21.73±3.59 points). Based on the results of the MNA-FV®, almost half the subjects (49.01%) were classified as at risk of malnutrition (23.5-17 points), almost 40% of subjects proved to be well-nourished (>23.5 points) and 11.39% were classified as malnourished (<17 points). A significant positive correlations between MNA-FV® scores, functional capability, nutritional status, BMI scores and the serum albumin’s level were confirmed. The results of study pointed also at negative correlation with results of Yesavage test and the fact of having pulmonary or hematology diseases. The average point value scored by the subjects in the SCALES test was 2.67±1.79 points (0-8 points). Based on their scores, just over half of the subjects (51.98%) were classified as potentially at risk of malnutrition, whereas just under half of the subjects (48.02%) were classified as well-nourished. The assessment of this test’s correlation with other variables assessing a nutritional status confirmed its significant negative correlation with BMI stores, serum albumin level, ; serum cholesterol level, MNA-FV® stores and TLC.The results of the Tinetti test proved that in four out of five actions performed by the subjects: changing position from sitting to standing up; standing still for 5 seconds; walking 3 meters on a level surface and turning 180˚, the residents of care institutions displayed significantly less independence and greater risk of falling in comparison with hospitalised subjects. However, the significant positive correlation of Tinetti test with MNA-FV® scores and negative correlations with Yesavage test scores and SCALES test scores were confirmed.The average score on the Yesavage test for the overall study population was 11.73±6.48 points (0-29 points) and findings show that these results were dependent on the subjects’ sex. Lack of depression was confirmed in 45.55% of subjects and a similar percentage were classified as having mild depression (43.56%). Severe depression was identified in 10.89% of subjects, based on Yesavage’s scale.The average BMI value of the subjects was 27.76±5.34 kg/m2 (15-48 kg/m2). Having analysed the BMI results in accordance with the criteria proposed by WHO, it was found that only a quarter of the subjects fell within the “normal” BMI range, whereas a significant majority (71.29%) exceeded this range to varying degrees: 36.14% of subjects were found to be overweight; I˚ obesity was confirmed in 25.74% of the population, II˚ obesity in 8.42% of subjects and III˚ obesity was confirmed in 2 subjects (0.99%). The hospitalised patients’ BMI was significantly highier than that of care institution residents. It was a significant correlation between high BMI scores and the fact of having metabolic and endocrine diseases and low BMI scores and the fact of having hematology diseases. The BMI scores in subjects participating in the study were positive correlated with MNA-FV® scores and MMC values.The levels of albumin and cholesterol in the serum and total lymphocyte count (TLC) are sometimes referred to as the so-called „malnutrition ratios”. A significant majority of subjects participating in the study (87.62%) had normal levels of albumin (average 4.01±0.51g/dl). There was a significant correlation of serum albumin with the variables assessing a functional capability of study participants, their emotional and nutritional status. The negative correlation with the fact of having gastrointestinal disorders was confirmed.Above-average levels of cholesterol were found in only 26.42% of male subjects, yet among female subjects the percentage was higher (47.65%). The level of serum cholesterol in subjects participated in the study was found positive correlated with the serum albumin and with the fact of being smoker.TLC values were found to be below the recommended norm in half of all subjects; its average value was assessed as 2062±653/mm3. Based on the study conducted on the population of subjects over 65 years of age, hospitalised in selected medical institutions and care institutions, the following conclusions can be drawn:1. Amongst over 65 year olds, overweight and obesity are more significant and more frequent problems than malnutrition.2. A definite majority of the population of older people are ; diagnosed with two or more diseases, i.e. are suffering from polypathology and diseases of the circulatory system are among the most frequent diseases occurring in this population. 3. Sex, place of residence, number and kind of diseases diagnosed in elderly people are the most important variables which significantly influence their nutritional state.4. There is a positive correlation between nutritional status of elderly people, their morbidity and functional status.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

geriatria ; nauki o żywieniu

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Nauk o Zdrowiu.

Promoter:

Małgorzata Schlegel-Zawadzka

Date issued:

2012

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3473

Call number:

ZB-117403

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

Feb 13, 2020

In our library since:

Mar 8, 2013

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