Assessment of Elderly’s Nutritional status in Geriatric Homes at Al-Furat Al-Awusat Governorates

Objective: Assess the elderly’s nutritional status through the dietary habits and anthropometric measures. Methodology : A descriptive (cross-sectional) study is carried out from Nov 1st,2014 to July9th-2015 to assess elderly’s nutritional status at geriatric homes in Al-Furat Al-Awusat governorates through a simple random sample of (120) elderly people aged 65 and above who live in geriatric homes. Data were collected through the use of the questionnaire and interview method, and analyzed through the application of descriptive and inferential statistical data analysis. Results


INTRODUCTION
Nutrition refers to the processes by which a living organism ingests digests, absorbs and excretes nutrients. Nutrition as a clinical area is primarily concerned with the properties of food that build sound bodies and promote health. a good nutrition for a person is essential to good healthy body and prevents diseases and other health problems, the individual should be provided with knowledge about nutrition and the body nutritional requirement through the life span. The person must take diet that contains carbohydrate, protein, fat, vitamins, minerals, water and fiber in sufficient amounts to meet optimal health . ( 1) Malnutrition in elderly people is associated with impaired activities and general physical conditions, the development of malnutrition is described as a continuum, starting with inadequate food intake followed by a decreases in the anthropometric measurement, The anthropometric measures have commonly been used to assess the nutritional status in the elderly, the nutritional assessment has been specifically developed to evaluate the risk of malnutrition in elderly people and identify those that could benefit from early intervention. (2) The elderly people are particularly prone to inadequate nutritional status because of factor related -age such as physiological changes, chronic diseases, use of medication and decrease mobility, the elder nutrition may not be easy to recognize or to distinguish from changes resulting from the aging process, if detected could result in more rapid deterioration of health and early death. (3) Nutritional status is defined as the outcome of the balance between intake and consumption of nutrients. Nutritional status is influenced by many factors, such as dentition, neuropsychological problem and mobility and may be related to other health concerns.The mini nutritional assessment remains the most useful screening instrument for use in nursing homes .Height is an important component to assess nutritional status, since accurate measurement of status is very important in determining the body mass index (BMI). Body Mass Index is an indicator for assessing the risk of chronic energy deficiency (CED) and obesity. However, measurement of stature in elderly people cannot be conducted perfectly due to kyphosis and scoliosis, with this population of elderly people, it may be more appropriate to estimate stature from the measurement of other skeletal segments such as knee height, and span and setting height. The ageing does process not influence the length of arm, leg (Knee). Arm span is less influenced by aging. Reduction of arm span is recommended as a parameter for stature prediction setting can also be used to predict the stature of elderly, but tend to decrease along with aging. The prediction of stature in elderly people is considered as quite vialed in developing anthropometric and taking an interpretation of the measurement of body compassion. (4) Some nutritional assessment measurements are inaccurate because the physical and metabolic changes that occur in elderly populations. Body mass index may be unreliable because the difficulty in height measurement in elderly results from vertebral compression and spinal deformities. (5) Measuring arm span and knee height may be more accurate and reliable for body mass index. Skin fold thickness is also in ineffective to detect changes in body fat and muscle mass due to a decrease in elasticity and an increase in compressibility of older skin. Mid-arm upper circumference gives a good indicator about weight changes and good sensitivity for any disorder in body weight in elderly. (6) Nutritional assessment involves studying the nutritional status in older adult people and identifying the cause of malnutrition through the use of anthropometric measures, dietary history intake and clinical appearance. The goal of nutritional assessment is to determine that an individual has diet containing all necessary substance amounts appropriate for that person and is accessible eland acceptable to the person (7) The elderly people are particularly prone to inadequate nutritional status because of factor related -age such as physiological changes, chronic diseases, use of medication and decrease mobility, the elder nutrition may not be easy to recognize or to distinguish from changes resulting from the aging process, if detected could result in more rapid deterioration of health and early death. (8) Nutrition needs changes through elderly. These changes may be related to the normal aging process, medical condition or life style. Assessment of nutrition status is essential for preventing health problems in older adults and identifying the causes of nutrition disorder and understands the person nutritional status Nutritional assessment as a clinical study is used to determine the nutritional status, risk factor and food related to older adults. The assessment can be useful to evaluate the status of the elder individual and identify the prevalence of certain health and nutrition risks among old adults. (9) METHODOLOGY A descriptive (cross-sectional) study is carried out between Nov 1st,2014 to July9th-2015 to assess elderly's nutritional status ingeriatric homes at Al-Furat Al-Awusatgovernorates through random sample of (120) elderly people aged 65 and above who live in geriatric homes through permission from Written official permissions were obtained from the Ministry of Planning (Central Council of Statistical System) for the acceptance of the study questionnaire draft (Appendix D). As well as a formal permission was obtained from Ministry of Labor and Social affairs prior to the initiation of the study.
An assessment tool was constructed in a form of questionnaire after reviewing the relevant literature and studies for the purpose of assessing the nutritional status of older adults. Data collection was conducted through interview with every person included in the present study that includes Dietary patterns. Dietary patterns was composed of ( 7) items; rated on (3) Point Likert Rating Scale whereas (always, some times and never). Measurements were taken by using the Electronic Scale (Seca-Australia) for recording weight per kg and the height was taken by knee height tape measure with a sitting position and the knee and ankle of one leg at a 90 degree with sitting on a table. (11) RESULTS:   (1) shows that the study sample is distributed equally between the provinces (25%) for each one. With regard to the age groups for the study sample, (28.3%) of them at(76-80) years old. Concerning the gender more than half of the study sample (58.3%) is males Furthermore, the study results indicated that the high percent of the study sample (34.1%) is highly educated.  This table shows the study results concerning dietary habits. It was found that more than half of the study sample passed the testit with regard to (4,5,6,7)items others where as they failed in(1,2,3) items. Table (4) depicts the results of the study that which are concerned with overall anthropometric measures assessment includes (Body Mass Index and Mid upper Arm Circumference)) for the study sample. The results showed that more than half of the study sample (53.3% and 55.8%) respectively is overweight.
With regard to the age group of the study sample (76-80) years old, this result agrees With a previous study who studied the anthropometric measures with the age group (75-85) years old. (12) Concerning gender, more than half of the study sample is male (58.3%). This result is supported by a study conducted by Another study to assess the Anthropometric indicators inthe nutritional assessment of the elderly in Palestine, their results indicate that most of the elderly residents are male. (13) Regarding the level of education, it was found that the majority of the study sample (34.1%) is between middle and high level of education with previous study their result contradicted this study result in that they found most of the elderly residents are illiterate.

(14)
Concerning the use of dentures, the study results indicate that most of the study subjects do not use of dentures.
In addition, the study results indicate that more than half of the study subjects take medications. These results come along with previous study, their results indicate that most of the residents are do not use dentures, and they take medications. (15) In addition, the study results indicate that the study subjects are suffering from(Easy hair loss and bleaching nails) and other signs and symptoms of mal-nutrition including (hair loss, bleaching nails, & pallor). These results agree with previous study whose resultsindicate that the old residents are suffering from signs and symptoms of malnutrition including easy hair loss and bleaching nails. (16) Regarding the residents' dietary habits, the study results indicate that more than half of the residents have good dietary habits. In addition, the study results indicate that the majority of the study subjects have a good nutrients intake during 24 hours, that means their nutrients intake involve the 4 basic nutritional elements. As for the nutritional assessment by using the anthropometric measures (BMI & MUAC) Mid Upper Arm Circumference, the study results show that more than half of the residents are overweight (53.4%) and (55.8%)respectively. Many studies which discussed the nutritional status for nursing home residents (7) , and showed high agreement with these results, they found that the majority of the residents are overweight, due to the lack of a physical activity. In addition,The same study found that the residents mostly have a gooddietary habit and a good dietary intake during the 24 hours.

CONCLUSIONS
Majority of sample health problems of the study were including easy hair loss and bleaching nails. Most of the old residents do not customarily take vitamins and Minerals intake.