Evaluation of mini nutrition assessment (MNA) tool among community dwelling elderly in urban community of Hawassa city, Southern Ethiopia

A Study of Factors Contributing to the Nutritional Status of Elderly People Receiving Home Care

(1) Background: Nutrition is a critical aspect of health and well-being in the elderly population, as physiological changes associated with aging can impact nutrient utilization and dietary needs. The aim of this study was the assessment of nutritional screening and associated factors among community-dwelling elderly people. (2) Methods: This study is the first phase of an intervention trial of people aged 65 years and over who received primary health services and resided in the municipality of Archanes Asterousia in Crete, Greece. Nutritional risk was assessed using the Mini Nutritional Assessment. Diet-related factors were analyzed, including health status (oral hygiene, depression, cognitive decline, impaired functioning, quality of life), social factors (educational attainment, marital status, type of work before 60 years), and lifestyle factors (smoking, drinking, diet). (3) Results: A total of 730 elderly people were evaluated (males, 31.5%), with an average age (±SD) of 76.83 (±6.68) years. MNA was found to have a statistically significant connection with assessment of oral hygiene, mental state, Charlson comorbidity, functional independence (assessed with the Barthel scale), and quality of life. The exception was geriatric depression (GDS), with which no statistically significant association was found (p > 0.05). Nutritional risk analysis revealed 379 participants (51.9%) to be adequately nourished, 205 (28.1%) to be at risk of malnutrition, and 146 (20.0%) to be malnourished. (4) Conclusions: These results clearly demonstrated the key factors that contribute to the nutritional screening of elderly people and need to be addressed by health authorities and social services.

Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice

Background

Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors.

Methods

A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit.

Results

Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%.

Conclusion

In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.

Magnitude of undernutrition and its association with dietary diversity among older persons in Ethiopia: a systematic review and meta-analysis, 2023

Undernutrition in elders remains under-detected, under-treated, and under-resourced and leads to further weight loss, increased infections, and delay in recovery from illness as well as increased hospital admissions and length of stay. The reports of the findings were fragmented and inconsistent in Ethiopia. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of undernutrition and its association with dietary diversity among older persons in Ethiopia. Online databases (Medline, PubMed, Scopus, and Science Direct), Google, Google Scholar, and other grey literature were used to search articles until the date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity using Stata version 14.0 software. Out of 522 studies accessed, 14 met our criteria and were included in the study. A total of 7218 older people (aged above 60 years old) were included in the study. The pooled proportion of undernutrition among older persons in Ethiopia was 20⋅6 % (95 % CI 17⋅3, 23⋅8). Elders who consumed low dietary diversity scores were strongly associated with undernutrition among older persons. Therefore, promoting appropriate intervention strategies for elders to improve dietary diversity practices and nutritional status is crucial.

Level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia

OBJECTIVES

Malnutrition is very common among older adults. In rural Ethiopia, around 25% of women and 34% of men ≥65 y of age are malnourished. However, the risk factors for malnutrition among older adults in rural areas are not well understood. The aim of this study was to assess the level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia.

MATERIALS

This was a community-based, cross-sectional study among randomly selected (N = 634) adults ≥65 y of age in Fogera Zuriya rural district. Participants were selected using a multistage sampling technique. A pretested full Mini-Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score <17), at risk for malnutrition (MNA score 17-23.5), or otherwise normal. A validated Geriatric Depression Scale form (15 items) was used to assess depression. Ordinal logistic regression was employed to identify factors of malnutrition and the PLUM procedure was used to produce an odds ratio (OR). P < 0.05 was considered statistically significant with the dependent variable. Both crude and adjusted ORs (COR and AOR, respectively) with a corresponding 95% confidence interval were computed.

RESULTS

This study included 634 older adults. According to the results of the study, the risk for malnutrition was 383 (60%), and being malnourished was 166 (268%). The following factors were significantly associated with the risk for malnutrition and malnutrition: • Age ≥85 y (AOR, 3.47; 95% CI, 1.270-9.465); • Skipping two meals daily (AOR, 6.36; 95% CI, 2.11-19.16); • Skipping 1 meal a day (AOR, 3.05; 95% CI, 1.82-5.12); • Having a poor appetite (AOR, 6.2; 95% CI, 2.50-15.36); • Being depressed (AOR, 4.04; 95% CI, 2.37-6.89); • Low physical activity (AOR, 3.81; 95% CI, 1.50-9.72); • Family size of three of less members (AOR, 1.9; 95% CI, 1.14-3.24); and • Low dietary diversity score (AOR, 1.91; 95% CI, 1.11-3.31) CONCLUSIONS: In this study, the prevalence of malnourished (26%) was almost higher than the national average in Ethiopia (21%). Older age, skipping a meal, poor appetite, depression, low physical activity, and low dietary diversity score were factors significantly associated with the risk for malnutrition and malnutrition. Along with this, improving diet and exercise should be a top priority. Maintaining continuing psychological support, social support, and a balanced family size within the community should be additional interventions.

Prevalence of undernutrition and its associated factors among older adults using Mini Nutritional Assessment tool in Womberma district, West Gojjam Zone, Amhara Region, North West Ethiopia, 2020

BACKGROUND

Undernutrition is a frequent and serious problem in the world's older adults. Even though life expectancy is increasing, they are more vulnerable and at risk for nutritional problems. However, not much is known about the nutritional status of this group of the population, and they are often neglected.

OBJECTIVE

This study was aimed at assessing undernutrition and associated factors among older adults in Womberma District, West Gojjam Zone, Amhara Region, Ethiopia, 2020.

METHODS

A community-based cross-sectional study design was used among randomly selected 594 older adults aged above 60 years with a multistage simple random sampling method and proportional sample size allocation was used to address study subjects at the village level. The collected data was entered into Epi-Data version 4.2 and analyzed by using SPSS version 25. All variables with a p-value<0.25 in the bivariable analysis were considered for multivariable logistic regression for further analysis and the level of statistical significance was declared at p-value<0. 05.

RESULTS

The prevalence of undernutrition among older adults was found to be 14.6% (95%CI: 11.9-17.7). A number of independent variables have a significant association with undernutrition, including gender, females [(AOR (95%CI): 3.14 (1.50-6.54)], age (Oldest Old [AOR (95%CI): 4.91 (2.44-6.08)] and Middle Old, [AOR (95%CI): 2.96 (1.44-6.08)], meal frequency [AOR (95%CI): 2.01 (1.12 (1.04-3.63)], dietary diversity score [AOR (95%CI): 2.92 (1.54-5.53)], depression [AOR (95%CI): 5.22 (3-9.07)], individuals with a sickness in the last 4 weeks [AOR (95%CI): 2.12 (1.02-4.41)] and individuals with a known hemorrhoid [AOR (95%CI): 3.51 (1.12-10.97)].

CONCLUSION

This study found that the prevalence of undernutrition in older adults is high and needs attention. Sex, age, meal frequency, dietary diversity, being sick in the last 4 weeks, having hemorrhoids, and depression were the associated risk factors. Therefore, the government, family members, and other stakeholders should give more attention to older individuals.

Assessing Nutritional Status and Functionality in Geriatric Population of Bangladesh: The Hidden Epidemic of Geriatric Malnutrition

The average life expectancy of the Bangladeshi population has risen over the last decade due to economic growth and improved medical care. Although the increased number of older adults and their health is a significant concern, there is scarce of data regarding that. A community-based cross-sectional study was conducted to analyze the association between nutritional status and functional ability among selected Bangladeshi geriatric populations living in their homes. Of 400 participants, the prevalence of malnutrition, and people at risk of malnutrition was 25.4% and 58.8%, respectively. Furthermore, almost 80% of participants are dependent in terms of activities of daily living. High risk of falling (OR = 10.82; 95% CI: 5.85-20.37; p ≤ .001), limited activities of daily living (IADL) (OR = 6.21; 95% CI: 4.02-9.58; p ≤ .001), along with dependency in performing IADL (OR = 4.48; 95% CI: 2.83-7.06; p ≤ .001) are significantly associated with malnutrition. Geriatric malnutrition can accelerate disability conditions, leading to early functional aging.

Prevalence of malnutrition among old people in Africa: systematic review and meta-analysis

OBJECTIVE

To summarise available evidence and estimate the pooled prevalence of malnutrition among old people in Africa.

DESIGN

Systematic review and meta-analysis.

SETTING

Any healthcare or community research reporting the prevalence or incidence of malnutrition in Africa from January 2000 to October 2021.

PARTICIPANTS

Old people, aged above 60 years.

OUTCOME MEASURES

Malnutrition, either undernutrition or overnutrition.

RESULTS

A total of 1442 studies were retrieved based on the search strategy, where only 36 studies (n=15 266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2% to 77.3% across the continent. Overall, the pooled prevalence rates of undernutrition and overnutrition were 18% (95% CI: 15% to 22%; I²=98.1; p<0.001) and 33% (95% CI: 22% to 44%; p<0. 001), respectively.

CONCLUSION

The prevalence of malnutrition in old African people is high and differs by setting, assessment tool and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable and simple screening tool should be thought of.

The Mini Nutritional Assessment tool's applicability for the elderly in Ethiopia: validation study

Background

The Mini Nutrition Assessment (MNA) is a widely used and valid tool for screening and assessment of malnutrition among the elderly population worldwide. However, MNA has not been validated among the Ethiopian elderly population and this study assessed the validity of the tool for the target population.

Methods

Cross-sectional validation study design employed to validate MNA in Meki town, East Ethiopia. This study included 176 randomly selected elders living in the community, whereas amputated, bedridden, visible deformity, known liver and/or renal disorders were excluded. The original MNA questionnaires were translated to local language and administered to each participant after doing the pretest. The anthropometric, self-perception of nutritional status and serum albumin concentrations were measured. Reliability, validity, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated. Receiver-operating characteristic (ROC) curve analysis was plotted to identify the area under the curve (AUC) and optimal cut-off value for the prediction of malnutrition.

Result

A total of one hundred and seventy-six elders participated in this study. Of the total participants, 78(44.3%) were males. The mean (SD) age of the participants was 67.6 (±5.8) years and ranged from 60 to 84 years. The prevalence of malnutrition based on the MNA criteria (MNA < 17 points) was 18.2%, and 13.1% based on serum albumin concentration (<3 g/dl).The MNA had an overall Internal consistency of Cronbach's alpha 0.61. The tool also demonstrated significant criterion-related validity (0.75, p < 0.001) and concurrent validity (0.51, p < 0.001) with serum albumin concentration and self-perception of nutritional status respectively. Using the original cut-off point, the sensitivity, specificity, PPV and NPV of the tool were 93.5%, 44.6%, 65.4% and 86.0%, respectively. By modifying, the cut-off point to a value of <20.5, the sensitivity and specificity of the tool increases to 97.6% and 82.8% respectively. The AUC (95%CI) showed an overall accuracy of 92.7% (88.5, 96.9).

Conclusion

The MNA tool can be used as a valid malnutrition screening tool for the Ethiopian elderly population by modifying the original cut-off point.

Prevalence of malnutrition among old age people in Africa

Background: Improved health care and rising life expectancy are creating a growing pool of old age people all over the world, including Africa. Malnutrition in the old age people is associated with both short- and long-term negative health outcomes. However, the reported burdens of malnutrition are fragmented and inconsistent, where more compiled evidence is warranted to aid decision-makers. Hence, this paper is aimed to estimate the pooled prevalence of malnutrition among old age people in Africa. Methods: A systematic search for research reporting the prevalence of malnutrition among old age people (aged above 60 years) was conducted from HINARI/PubMed and Google Scholar databases using combination keywords. Published articles in English language starting from January 2000 to October 2021 were screened. We presented the results based on the standard for reporting systematic review and meta-analysis of observational studies. A random-effect meta-analysis was done to estimate the prevalence of malnutrition along with the 95% confidence intervals. The publication bias was assessed using the funnel plot. Results: A total of 1,442 studies were retrieved based on the search strategy, where only 36 studies (n = 15,266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2 to 77.3% across Africa. Overall, the pooled prevalence of malnutrition was 18% (95% CI: 15-22; I2 = 98.1; p < 0.001). The prevalence is higher in the Central Africa (3.8%; 95% CI: 3.2-4.4), in the community (3.1%; 95% CI: 2.7-3.7), and among advanced age (3.5%; 95% CI: 2.3-5.4). Conclusion: The prevalence of malnutrition in African old age people is high and differs by setting, assessment tool, and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable, and simple screening tool should be thought of.

Calf Circumference Measurement Protocols for Sarcopenia Screening: Differences in Agreement, Convergent Validity and Diagnostic Performance

Background

Although recommended by the Asian Working Group for Sarcopenia 2019 consensus (AWGS’19) as a screening tool for sarcopenia, there remains no consensus regarding the position (sitting, standing) or laterality (right, left) for the measurement of calf circumference (CC). This study aimed to determine the agreement between CC measurements, correlations with muscle mass and function, and diagnostic performance for sarcopenia screening.

Methods

We studied 176 healthy community-dwelling older adults (mean age, 66.8±7.1 years) from the GERILABS-2 study. CC was measured using non-elastic tape in four ways: left and right sides in the sitting and standing positions. Sarcopenia was diagnosed using the AWGS’19 criteria. We produced Bland-Altman plots to assess the agreement, partial correlations for muscle mass and function to compare convergent validity, and area under the receiver operating characteristic curve (AUC) to compare diagnostic performance.

Results

The prevalence rate of sarcopenia was 17.4%. Sitting CC was larger than standing regardless of laterality (right 35.31±2.95 cm vs. 34.61±2.74 cm; left 35.37±2.96 cm vs. 34.70±2.83 cm; both p<0.001), consistent with the systematic bias on Bland-Altman plots showing the overestimation of sitting over standing measurements (right bias=0.70 cm; 95% confidence interval [CI], -0.48–1.88; left bias=0.67 cm, 95% CI, -0.35–1.68). After adjusting for age and sex, CC was significantly correlated with appendicular skeletal mass, hand grip strength, knee extension, gait speed, chair stand, and short physical performance battery. Although right-sided CC measurements had better diagnostic performance (AUC=0.817), the difference was not statistically significant compared to the other positions (p>0.05). The optimal cutoff was <34 cm for all measurements, except for the left standing position (cutoff <35 cm).

Conclusion

Standing CC measurements are recommended for sarcopenia screening in community-dwelling older adults because of their good agreement without systematic bias, convergent validity, and diagnostic performance.

Depression and associated factors among older adults in Bahir Dar city administration, Northwest Ethiopia, 2020: Cross-sectional study

Background

Depression is the most common psychiatric condition among older adults, and it goes unnoticed by individuals themselves and is under-diagnosed by clinicians due to the misconception that these are normal parts of aging. However, the problem is not properly addressed in Ethiopia. This study aimed to determine the prevalence and associated factors of depression among the older adults in Bahir Dar city.

Methods

A community-based cross-sectional survey was conducted among 423 older adults in Bahir Dar city. A simple random sampling technique was used to select the study participants. Depression was assessed using a 15-item Geriatric Depression Scale (GDS). A multivariable logistic regression analysis was used to explore the potential determinants of depression among the participants.

Results

The prevalence of depression among older adults was found to be 57.9% (95% CI: 53.2–62.6). This study showed that educational status with grades 5-8^th (AOR: 5.72, 95% CI: 2.87–11.34), and 9-12^th grade (AOR: 3.44, 95% CI: 1.59–7.41), income <2004 ETB (AOR = 1.89, 95% CI: 1.16–3.07), cognitive impairments (AOR: 3.54, 95% CI: 2.16–5.81), family history of mental illness (AOR:3.06, 95% CI: 1.03–9.04), and poor quality of life (AOR: 2.78, 95% CI: 1.74–4.46) were significantly associated with depression.

Conclusion

The prevalence of depression among older adults was found to be huge. Having low educational status, low monthly income, cognitive impairments, family history of mental illness, and poor quality of life were associated with depression. Therefore, raising community awareness of mental health, increasing social participation, providing supportive counseling and routine screening of depressive symptoms are essential in combating depression among Bahir-Dar city older adults.

Undernutrition and associated factors among elderly people served in Public Servants Social Security Agency in Harar, Eastern Ethiopia

Objective:

Undernutrition in the elderly has adverse effects on physiological functions and various clinical outcomes. In Ethiopia, similar to many developing countries, there is a dearth of epidemiological data on the nutritional status of the elderly. This study aimed to assess the magnitude of undernutrition and associated factors among the elderly population enrolled in the Public Servants Social Security Agency in Harar, eastern Ethiopia.

Method:

A cross-sectional study was carried out among 337 elderly adults from June to August 2020. The Mini Nutritional Assessment Tool Short Form assessed the nutritional status of the elderly. Data were entered in Epi Data software version 3.1 and transferred to SPSS version 20 for analysis. Ordinal logistic regression assessed factors associated with undernutrition, using variables with a p value less than 0.05 as statistically significant.

Result:

The magnitude of undernutrition was 16.6% and 45.1% were at risk of undernutrition. Being unable to read and write (odds ratio (OR) = 3.64; 95% confidence interval (CI), 1.98–6.72), elderly with morbidities (OR = 2.05; 95% CI, 1.15–3.64), low dietary diversity score (OR = 3.52; 95% CI, 1.63–7.60), and elderly who were food insecure (OR = 0.59; 95% CI, 0.37–0.95) were significantly associated with undernutrition.

Conclusion:

The magnitude of undernutrition among the elderly is a public health issue. Independent predictors include educational status, morbidity, dietary diversity, and food insecurity. Intervention programs need to focus on the elderly’s nutrition, access to healthy foods, and other health issues.

Neurocognitive Impairment and Associated Factors Among Elderly in the Bahir Dar City Administration, Northwest Ethiopia

Background

Neurocognitive impairment is a widely common problem in the elderly. It encompasses mild and major cognitive impairment, which will lead to disability and increase the risk of death. It also compromises the quality of life of the patient and poses a burden on the family and society as a whole. However, there is a paucity of information concerning neurocognitive impairment among the elderly in Ethiopia. This study aimed to assess the prevalence of neurocognitive impairment and associated factors among the elderly in Bahir Dar city, Ethiopia 2020.

Methods

A community-based cross-sectional study was conducted among 423 respondents using a simple random sampling technique from 1 June to 30 June 2020. Neurocognitive impairment was measured using the Mini-Mental State Exam adjusted cutoff point (presence or absence) by the level of education of the participants. Data were entered into EpiData version 4.62 and exported to SPSS version 23 for analysis: descriptive statistics were used for summarization and presentation and binary logistic regression for a measure of association between exposures and outcome variable.

Results

The prevalence of neurocognitive impairment was 42.1%. Factors such as having no spouse [AOR = 1.76, 95% confidence interval (CI): 1.08-2.86], having depression (AOR = 3.04, 95% CI: 1.80-5.14), lifetime alcohol use (AOR = 2.90, 95% CI: 1.19-7.07), and having low family support (AOR = 3.07, 95% CI: 1.35-6.96) and moderate family support (AOR = 1.83; 95% CI: 1.10-3.06) were significantly associated with neurocognitive impairment.

Conclusion and Recommendation

The prevalence of neurocognitive impairment was high in Bahir Dar city administration. Neurocognitive impairment has shown significant association with no spouse, depression, alcohol use, and low and moderate family social support. It is important to pay attention to old age with comorbid mental illness and also to strengthen social support systems to prevent and manage neurocognitive impairment.

Validity and Predictive Performance of Mini Nutritional Assessment Tool for Institutionalized Elders in Ethiopia

Background

Despite the high burden of malnutrition in the country, there is a lack of a simple and valid tool to screen elders in Ethiopia. The Mini Nutritional Assessment (MNA) tool has been validated for comprehensive geriatric assessment to identify malnutrition in other countries. However, there is a lack of evidence on the potential validity and reliability of the tool for institutionalized elders in Ethiopia. This study was aimed at determining the validity and predictive performance of MNA tool for malnutrition among Ethiopian institutionalized elderly.

Methods

A facility-based survey was conducted on randomly selected 164 elders in geriatric centers to evaluate the validity, reliability, and predictive performance of full MNA against hemoglobin (Hgb) and ideal body weight (IBW) measured under standard procedures. The data was presented in ROC graphs, and reliability was evaluated with Cronbach alpha. The receiver-operating characteristic curve (ROC) analysis was used to assess the predictive performance of the tool. The area under the curve (AUC) with its 95% CI was reported. The Youden index, at maximum sensitivity and specificity, was used to obtain optimal cutoff points.

Results

The internal consistency of the tool was good (α = 0.80). The full MNA score can better predict Hgb (AUC = 0.845; 0.783-0.899) and percentage of IBW (AUC = 0.90; 0.842-0.941) at specified cutoff points. A full MNA can predict malnutrition or risk of malnutrition based on percentage IBW at a sensitivity and specificity of 97.3% and 72.2%, respectively.

Conclusions

The full MNA has the potential to be a reliable and valid nutritional assessment tool for institutional elders.

Determinants of nutritional status among old age population in eastern Ethiopia: a general linear model approach

As the world's aging population grows, nutrition and health issues are becoming a major concern. The aim of the present study was to identify the factors associated with nutritional status among old age population. A community-based cross-sectional study was employed among randomly selected 739 elders over the age of 60 in Dire Dawa City administration, eastern Ethiopia. The validated full mini nutritional assessment tool and appetite test (SNAQ) was used to assess the nutritional status of the study population. Considering the ranked nature of the data, a bivariate and multivariable ordinal logistic regression model (under the generalised linear model) was conducted, with crude and adjusted odds ratios reported along with 95 % confidence intervals. Statistically significant associations are declared at P-value less than 0⋅05. In this study, 22 % (95 % CI: 19 %, 25 %) of elders were malnourished. Participants with >75 years old (AOR 4⋅95; 95 % CI 1⋅54, 8⋅4), being female (AOR 1⋅6; 95 % CI 1⋅1, 2⋅2), illiterate (AOR 1⋅5; 95 % CI 1⋅01, 2⋅2), severe depression (AOR 13⋅9; 95 % CI 8⋅2, 23⋅7) and with poor appetite (AOR 3⋅3; 95 % CI 2⋅3, 4⋅8) were important predictors of malnutrition among older age group. We found that the prevalence of malnutrition and the risk of malnutrition is a public health concern that warrants intervention in the area. Advanced age, illiteracy, depression and poor appetite were important risk factors for malnutrition among older age group. The identified risk factors will guide public health professionals and programmes in the design, implementation of interventions to improve the nutritional status of older age group.

Correlation Between Mini Nutritional Assessment and Anthropometric Measurements Among Community-Dwelling Elderly Individuals in Rural Southern Thailand

Purpose

The Mini Nutritional Assessment (MNA) can be applied to assess nutrition status among community-dwelling elderly individuals by health care professionals. This study aimed to evaluate the correlation of MNA score and anthropometric measurements, gait speed, and handgrip strength among elderly community members. The secondary outcome was to compare the performance of the MNA-SF with the full MNA.

Materials and Methods

The study was a cross-sectional study with 176 elderly individuals aged ≥60 years living in rural southern Thailand. The MNA-SF and full MNA scores were obtained by using the standard form in the Thai version of the MNA. We collected anthropometric measurements, gait speed, handgrip strength, and MNA data.

Results

There was a significant positive correlation between body weight, BMI, waist circumference, hip circumference, waist-to-height ratio, waist-to-hip ratio, mid-upper arm circumference, calf circumference, triceps skinfold thickness, handgrip strength and full MNA total score using the partial correlation coefficient after controlling for age and sex. The MNA-SF had sensitivity of 78.79%, specificity of 81.82%, PPV of 50%, NPV of 94.35%, LR+ of 4.33, LR- of 0.26, accuracy of 81.25% and AUC 0.901 when using the full MNA as a reference standard.

Conclusion

The MNA correlated with many anthropometric measurements. The MNA-SF had a high specificity, NPV and accuracy of more than 80% when compared with the full MNA.

A comparison of the different anthropometric indices for assessing malnutrition among older people in Turkey: a large population-based screening

OBJECTIVE

Due to an increase in aging worldwide, assessment of the nutritional status of older people becomes an important matter. Malnutrition in older people increases the risk of infections, disease period and hospitalization rates. This study aimed to compare the different anthropometric indices for detecting malnutrition among older people and comparing these indices among males and females to explain the possible differences.

METHODS

In this cross-sectional study, 2721 aged 65 years and older in Turkey were enrolled. Anthropometric measurements weight, height, hip circumference (HC), and waist circumference (WC), abdominal circumference (AC), mid-upper arm circumference (MUAC), triceps skinfold thickness (TST), calf circumference (CC)) were measured. Body mass index (BMI), abdominal volume index (AVI), body roundness index (BRI) and body adiposity index (BAI), and waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) indices were calculated using standardized formulas. The receiver operator characteristic curves (ROCs) were conducted in detecting the best anthropometric parameters. Adjusted odds ratios (OR) (stratified by sex) calculated for each anthropometric index.

RESULTS

Participants with both BMI < 18.5 (1.1%) and BMI > 25 (80%) defined as the malnourished group and BMI of 18.5-24.99 (18.9%) defined as the normal group. In both sexes, the area under the curve (AUC) was > 0.7 for all anthropometric indices except WHR in females (AUC 0.66). BRI, WHR, WHtR, and AVI indices strongly predict the risk of malnutrition among both sexes. In males, the ORs were for BRI (6.83, 95% CI 5.39-8.66), WHR (6.43, 95% CI 5.9-6.9), AVI (2.02, 95% CI 1.86-2.12). In females, the ORs were for BRI (3.72, 95% CI 3.09-4.48), WtHR (2.63, 95% CI 1.3-3.5), and WHR (2.45, 95% CI 1.9-3.06).

DISCUSSION

The presence of a large AUC in almost all anthropometric indices suggests that they can be used to assess the risk of malnutrition among older persons in both sexes.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.

Malnutrition and its determinants among older adults people in Addis Ababa, Ethiopia

BACKGROUND

In Ethiopia, malnutrition among older adults is under detected and, neglected area because the entire problem related with aging considered as fate of aging. Also, older adults are often omitted from public health research. Literatures are scarce in Ethiopia; there is limited information in the current study area among older adults using Min Nutritional Assessment (MNA). Therefore, this paper investigated the prevalence of malnutrition and its predictors among older adults people aged 65 years or above in Addis Ababa, Ethiopia.

METHODS

A community-based cross-sectional study was employed from January 1 to march 30, 2020 in Addis Ababa. Nutritional status of the older adults was measured by using Min nutritional assessment (MNA). Data from 662 older adults were collected through face to face interviews using a structured questionnaire. Bivariable and multivariable logistic regression analysis was done to identify factors associated with malnutrition.

RESULT

The prevalence of malnutrition among older adults was found to be 26.6%[95% Confidence interval (CI):22.8, 30.1]. Depression [Adjusted Odds Ratio (AOR) = 7.57 95%CI: 5.01, 11.45], being poor [AOR = 1.95 95% CI: 1.166, 3.25], occupation; daily laborer and guard [AOR = 2.78 95% CI: 1.12, 7.17] and being old old [AOR = 2.62 95% CI: 1.62, 4.25] were significantly associated with the higher odds of malnutrition.

CONCLUSION

This study illustrated that considerably high proportion of older adults were malnourished in Addis Ababa. Socio-economic characteristics and depression were significantly associated with malnutrition. Therefore, nutritional and social support activities are essential for older adults, particularly of those who are socio-economically disadvantaged and advanced age. In addition, regular nutritional screening and management as well as behavioral interventions should be strengthened as a pillar component of therapeutic interventions. Specific nutritional requirements, at later stages of life is changing, and with the population aged over 65 years increasing in low-income countries like Ethiopia, the research in this field is likely to increase further.

Predictors of malnutrition among older adults aged above 65 years in eastern Ethiopia: neglected public health concern

BACKGROUND

A nutritional problem, especially under nutrition is one of the common public health problems in older population causing greater mortality and economic loss in developing countries. However, evidences on the risk factors for increased nutritional risk among older population is not well stated in Ethiopia. This study aimed to assess the nutritional status and predictors of malnutrition among older adults (> = 65 years) in Eastern Ethiopia.

METHODS

A community-based analytical survey was conducted among randomly selected 592 older people aged above 65 years of age in Harari region. Subjects were selected using multistage sampling pretested Full Mini Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score < 17), at risk of malnutrition (MNA score of 17 to 23.5) and otherwise normal. Validated geriatric depression scale short form (15 items) was employed to screen for depression. Data were presented using statistical tables, frequency, percentage, and graphs. Ordinary logistic regression was employed to identify predictors of malnutrition and plum method was used to generate odds ratio. The level of statistical significance was declared at P-value less than 5%. Chi-square test, crude and adjusted odds ratio with 95% confidence was reported.

RESULTS

A total of 592 respondents (93.4%) were interviewed. About 306 (51.7%) and 93 (15.7%) were found to be at risk of malnutrition and malnourished respectively. The predicted log odds of being malnourished was higher among those from rural residents (AOR = 2.08: 1.25-3.45), not on working (AOR = 1.31: 95% CI: 0.87-1.95) and did not have health insurance (AOR = 1.58; 95% CI; 0.97-2.58). Those with chronic pain (AOR = 1.70; 95% CI: 1.15-2.51), previous hospitalization (AOR = 1.59: 95% CI: 1.27-2.38) and not able to cover their personal expense (AOR =1.61: 95% CI: 1.12-2.30) were predictors of malnutrition. The relationship between previous hospitalizations with malnutrition among older adults people is moderated significantly by the presence of chronic pain (β = 0.113, p = 0.015).

CONCLUSIONS

Malnutrition among old age is a public health concern that needs attention. Economical vulnerability, residence, depression, presence of chronic disease, and hospitalization were important risk factors for malnutrition among old age.

Handgrip Strength Cut-Off Values for the Undernutrition Risk Screening among Elderly Men and Women in Bosnia and Herzegovina

OBJECTIVES

To determine the optimal cut-off points of handgrip strength (HGS) to identify the undernutrition risk among individuals older than 65 years of age in Bosnia and Herzegovina.

DESIGN

Cross-sectional study.

SETTING

Towns of Sarajevo, Foca, Rogatica, and Pale in Bosnia and Herzegovina.

PARTICIPANTS

300 community-dwelling older adults and 146 nursing home residents. Comprehensive Geriatric multidimensional assessment (CGA) was carried out to evaluate general health, functional, and cognitive capabilities. Nutritional status and undernutrition risk were assessed by Mini Nutritional Assessment (MNA) and Seniors in the Community: risk evaluation for eating and nutrition, version II (SCREEN II). HGS was measured with a Smedley dynamometer.

RESULTS

According to the classification of nutritional status by MNA, 42% of community-dwelling men and 39% of community-dwelling women were at undernutrition risk. The undernutrition risk was significantly higher among nursing home residing men (89%) and women (78%) (p < 0.001). When nutritional status was assessed by SCREEN II, 100% on nursing home residents, 86% of community-dwelling men and 80% of women were identified as having a high risk for undernutrition. Per MNA, HGS cut-off thresholds were 23.50 kgF (65-74 years) and 19.50 kgF (≥75 years) for men; 15.50 kgF (65-74 years) and 13.50 kgF (≥75 years) for women. Per SCREEN II, cut-points were 28.50 kgF (65-74 years) and 24.50 kgF (≥75 years) for men; 24.50 kgF (65-74 years), 19.50 kgF (≥75 years for women).

CONCLUSION

HGS can be a useful instrument to identify undernutrition risk among the elderly patients. This study provides threshold for men and women older than 65 years of age in Bosnia and Herzegovina.

Chronic energy deficiency and associated factors among older population in Ethiopia: A community based study

Introduction

Chronic energy deficiency is an important public health problem among older (aged ≥ 65 years) population. Globally, one in seven older people has a medium to high risk of malnutrition. The situation of chronic energy deficiency among older people is quite poorly known in Ethiopia. Therefore, this study was aimed to determine the magnitude of chronic energy deficiency and associated factors among elders’ aged ≥ 65 years, in Aykel town administration, Amhara Regional State, Northwest Ethiopia.

Methods

A community based cross-sectional survey was carried out from March 28^th to April 20^th, 2018. Study participants were recruited by a census technique. Both bivariate and multivariate logistic regression analysis used to identify factors associated with chronic energy deficiency. All variables with p–values of < 0.2 in the bivariate analysis were remarked for the multivariable analysis. Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) were computed to determine the strength of association. In the multivariate analysis, all variables at p–values of < 0.05 were considered as statistically significant.

Results

A total of 892 participants recruited for the study. The prevalence of chronic energy deficiency was 17.6% (95%CI: 15.00, 20.20) among the study community. It was significantly associated with female sex (AOR: 1.58; 95%CI: 1.04, 2.41), age (AOR: 3.90; 95%CI: 1.85, 8.25), household food insecurity (AOR: 1.95; 95%CI: 1.16, 3.00), poor household wealth status (AOR: 1.77; 95%CI: 1.07, 2.94), loss of appetite due to illness (AOR: 2.93, 95%CI: 1.92, 4.48) and poor dietary diversity score (AOR: 5.51; 95%CI: 2.89, 10.52).

Conclusions

The magnitude of chronic energy deficiency was high in the study area. It was significantly associated with female sex, age, poor dietary diversity score, loss of appetite due to illness, household food insecurity and poor wealth status. Therefore, there is a need to design and implement programs and strategies to improve nutritional status particularly focusing on female older population in improving dietary practices and food security. In addition, improving household economic and living standards is an essential measure to address the burden of CED among the older community.

Executive Dysfunction Detected with the Frontal Assessment Battery in Alzheimer's Disease Versus Vascular Dementia

Alzheimer's disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect.