A Study On Nutritional Status, Health Characteristics, And Psychosocial Aspects of The Elderly Living With Their Family And Of Those Living In Nursing Home

Abstract

One of the indicators of development success in a country is increased life expectancy of the citizens. The increased life expectancy of the citizens causes number of elderly increase from year to year. Up to now, Indonesia is ranked as the fourth country with the largest number of elderly after China, India, and United States. BPS estimated that this will continue to raise, shown by percentage of elderly in year 2010 reached 9.58% and will reach 11.20% in 2020 (Mariana & Kadir 2007). Furthermore, the number of senior citizens in Bandung City reached 360,000 people or 15% of the total population in Bandung which was 2.4 million people (Berita Indonesia 2009:1). The objectives of the study were: (1) to analyze socioeconomic characteristics of the elderly, (2) to analyze food consumption and nutrient intake of the elderly, (3) to analyze nutritional status (anthropometry, Hb level and nutritional risk assessment) of the elderly, (4) to analyze health characteristics (health status, health care, living environment) of the elderly, (5) to analyze psychosocial aspects (perceived happiness, stress, family strength) of the elderly, (6) to describe government and non-government programs for the elderly, (7) to analyze factors affecting nutritional and health status of the elderly, and (8) to analyze the differences among factors affecting nutritional and health status and psychosocial aspect of the elderly living in nursing home and those living with their family. The design of the research was cross sectional study. The research was taken place in Bandung, West Java, Indonesia. The whole research activity was conducted in 12 months. This study was carried out to the elderly (aged > 55 years old) as sampling unit. Eighty two elderly living in nursing home were selected as samples. Another 336 elderly living outside nursing home were chosen purposively. The primary data included data on socioeconomic characteristics, nutritional status, health status and psychological aspects of the elderly. The secondary data included programs of local government and NGO for the elderly (type of programs, duration, source of fund, implementation, etc). The methods used to collect data consisted of interview, physical assessment, and Hb analysis depending on the variable measured. Prior to data collection, a set of questionnaires was formulated and tried out. Data analysis included descriptive statistics, t-test analysis, and regression to analyze factors affecting nutritional and health status and psychosocial condition of the elderly. The data analysis was done by using the Statistical Analysis System (SAS). The present study shows that sex proportion of elderly was dominated by female (80.9% female vs 19.1% male). Most of the elderly in nursing home were widowers (78.0%). The average of length of education among elderly in non nursing home, which was 7.7 ± 4.6 years, was higher than that among elderly in nursing home (6.8 ± 4.8 years). However, no statistical difference was found in length of education between elderly in nursing home and in non nursing home. The average income of the elderly in nursing home was IDR 408 111. On the other hand, the elderly in non nursing home had higher income with monthly average of IDR 1 298 003. As side dish, the elderly usually consumed tempeh and tofu with relatively high frequency. For elderly, tempeh/tofu is relatively easy to consume due to their soft texture. Pure water was the type of drink that was most consumed by elderly in nursing home (7,503.7 ml/week) and also by elderly in non nursing home (3,097.0 ml/week). Other type of water that usually consumed by the elderly is tea and coffee. Tea consumption among elderly in nursing home (990.2 ml/week) was higher than among elderly outside nursing home (650.0 ml/week). This condition was similar to coffee consumption (548.8 ml/week in nursing home and 264.9 ml/week in non nursing home). Other beverage which usually consumed by the elderly was milk with quantity of 522.0 ml/week for elderly in nursing home and 271.6 ml/week for elderly in non nursing home. his number was relatively small compared to milk consumption of people in developed countries. The calculation of daily water consumption showed that elderly in nursing home consumed water as much as 1,441.6 ml/day and elderly in non nursing home consumed 659.0 ml/day. Besides, consumption of water for healthy person is 2000 ml/day so that it can be said that generally elderly consumed less than the adequacy. Energy adequacy level among elderly was generally low, which was 49.0% for elderly in nursing home and 54.9% for elderly in non nursing home. This low energy adequacy level might relate to the declining appetite among elderly. The impact of lack of appetite among elderly was low nutrient adequacy level, including protein, mineral, and vitamin. The energy, mineral, and vitamin adequacy level among elderly in nursing home were lower than those in non nursing home (p<0.05), except for vitamin C. The phenomenon of low energy, protein, mineral, and vitamin intake level among elderly in nursing home as well as in non nursing home indicated that group of elderly was susceptible to nutrition problem, which further reduced capacity of the body to prevent various diseases. In this study, overnutrition was more prevalent than undernutrition in elderly in both groups, and the prevalence was higher in elderly living in family. The prevalence of central obesity in both groups were higher than the normal (59.8% and 75% in elderly in nursing home and in non nursing home, respectively), and the waist circumference was significantly higher in those in non nursing home. Based on WHO criteria, the prevalence of anaemia of elderly living in nursing home and in non nursing home were 45.1% and 28.9%, respectively. The prevalence of anaemia in this study was much higher than other previous reports in Indonesia as well as other countries. The prevalence of diseases in elderly showed that hypertension and arthritis were the most common diseases found in both groups, followed by dyspepsia syndrome, dyslipidemia and heart disease. The trend of the diseases was similar in both groups, except that the prevalence of cataract was much higher in elderly in nursing home. The cause of this higher prevalence of cataract might have correlation with age, which the age of elderly in nursing home was older than it of other group. The efforts done by elderly to keep healthy were vary. Most elderly performed worship as their way to keep healthy. Maintaining healthy diet, exercise and avoiding stress were also common in both groups. In general, the awareness of elderly to keep their physical healthy was good, but still needed to be improved. Sanitation condition among elderly in non nursing home was categorized as good. Almost all elderly had bathroom, family latrine, and garbage disposal facilities in their houses. Generally, place to defecate among elderly was family latrine and only few who defecated in public latrine, river or ditch. In nursing home, the sanitation facilities were considered as good. The general result on perceived happiness among elderly showed that the highest factor which made elderly feel happy was always grateful with their lives (96.9%). Physical indicator of stress among elderly in the past six months which the most “often” was frequent urination, while the most “rarely” was coughing and the most “never” was excessive sweating. Psychological indicator of stress among elderly in the past six months which the most “often” suffered by elderly was sleepless (insomnia), while the most “rarely” was feeling weak and sluggish and the most “never” was not confident. There was more than half (51.2%) of elderly in nursing home was in category of light depression, less than half (45.1%) of them in category of no depression, a little proportion (3.7%) of them in category of medium depression, and none (0%) of them in category of severe depression. The percentage was almost similar to the elderly in non nursing home. The elderly in nursing home was better in aspect of psychological strength, while elderly in non nursing home was better in aspect of physical and social strength. The study result showed that the most potential factor causing low psychological welfare of elderly was feeling worry about the future. When compared, this was suffered more by elderly in non nursing home. Government programs related to welfare of the elderly was under Ministry of Social Affairs of Republic of Indonesia. During period of 2009-2014, services which were given to the elderly in nursing home included: regular service, daily service, day care service, and crosssubsidy service which all was conducted in 237 nursing homes (2 nursing homes own by Ministry of Social Affairs, 70 nursing homes own by local government, and 165 nursing homes own by private/community). Beside Ministry of Social Affairs, Ministry of Health also had service for elderly program, which was Integrated Development Post (Posbindu). Type of services which are given in Posbindu include: nutritional status examination through measuring body weight and height, blood pressure measurement, hemoglobin examination using, examination on glucose in urine as early detection of diabetes etc. Regression analysis result showed that factors significantly influenced nutritional status assessed with MNA score were age of elderly (=-0.104; p=0.030), protein adequacy level (=0.147;p=0.041) and education level (=4.316; p=0.000), with adjusted R square 0.128. As elderly age increased, MNA score decreased. Protein adequacy level had significant positive effect on MNA score, as protein adequacy was fulfilled, malnutrition risk in elderly would decrease. Among influencing variables, education had the strongest influence. As education level became higher, risk of elderly becoming malnourished would be lower. Factor that significantly positive influenced Hb was sex (=0.091;p=0.086), with adjusted R square 0.015. This means that men had Hb level significantly higher than women. Eventhough the correlation was weak as shown by low adjusted R square, and was in 10% level of significance, it was in accordance with physiologic fact and confirmed many previous researches. For elderly who lived in nursing home, there was no factor that significantly influence nutritional status assessed with MNA score. Different result was obtained in elderly who lived in non-nursing home, in which age and length of education had significant effect to MNA score. Among elderly who lived in non nursing home, individual characteristics and nutrient intake did not affect Hb level, probably due to subjects’ characters that was relatively homogenous.