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LETTER TO THE EDITOR
Year : 2013  |  Volume : 12  |  Issue : 2  |  Page : 140-141  

Nutritional status of elderly people managed in a Nigerian tertiary hospital


Department of Medicine, University of Ilorin Teaching Hospital, Ilorin PMB 5314 Ilorin, Kwara State, Nigeria

Date of Web Publication22-May-2013

Correspondence Address:
E O Sanya
Department of Medicine, University of Ilorin Teaching Hospital, P.O. Box 5314 Ilorin
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.112416

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How to cite this article:
Sanya E O, Kolo P M, Adekeye A, Ameh O I, Olanrewaju T O. Nutritional status of elderly people managed in a Nigerian tertiary hospital. Ann Afr Med 2013;12:140-1

How to cite this URL:
Sanya E O, Kolo P M, Adekeye A, Ameh O I, Olanrewaju T O. Nutritional status of elderly people managed in a Nigerian tertiary hospital. Ann Afr Med [serial online] 2013 [cited 2019 Dec 9];12:140-1. Available from: http://www.annalsafrmed.org/text.asp?2013/12/2/140/112416

Sir,

The elderly people constitute significant proportions of hospital admission and accounted for a high number of mortality in medical wards. [1] Among the old people nutritional deficiency has been reported to be common in Europe and North America both from community and hospital based data. [2] Unfortunately, the diagnosis of undernutrition is often overlooked for the main diagnosis that brought patients to hospital. This has grave implication since the patient's nutritional status has some influence on outcome of hospital admission especially in the elderly. The frequency of nutritional deficiency among hospitalized older people varies between 23% and 62%, while in the community it is about 15%. The severity of undernutrition in the aged has a correlation with morbidity and mortality. Reasons why elderly people are at risk of developing malnutrition include poor nutritional intake, depression, low economic power, and presence of multiple diseases with use of polytherapy.

Prompt correction of undernutrition in the elderly people is one important step that will ensure better outcome during medical admission. Therefore, our study assessed nutritional status of old people (≥60 years) using anthropometric, hematological, and biochemical measurements within 24-48 hours of admission into medical ward at the University of Ilorin Teaching Hospital, Ilorin. Body weights were measured to the nearest 0.25 kg using a bathroom scale. Height was measured using tape measure to the nearest 0.1 cm with the subject barefoot. Body mass index (BMI) was determined for each subject as the ratio of body weight (kg) and squared height (meters). Energy malnutrition status was determined using BMI criteria proposed by Ferro-Luzzi and James. [3] Severe chronic energy deficiency (CED III) was graded as BMI <16; BMI of 16-16.9 as moderate (CED II); and BMI of 17-18.99 was considered mild CED (grade I). BMI between 19 and 29 were regarded as good energy stores and those above 29 were considered to reflect obesity. Patients too weak to stand erect, surgical cases, and individuals with clinically demonstrable ascites and edema were excluded from the study.

One hundred and twenty-nine patients participated in the study, of which 68 (53%) were men and 61 (47%) women. Their age ranged from 60 to 95 years with mean of 69.3 ± 8.3 years. Mean duration of hospital stay was 17.4 days and median of 14 days (range of 1-124 days).

Fourteen percent of the group had a BMI value below 19 which indicated undernourishment and chronic energy deficiency. Gender did not influence their nutritional status as equal proportions of males (14%) and females (13.2%) were undernourished. Three subjects (2.7%) had severe chronic energy deficiency (CED) - grade III; four (3.6%) had a moderate CED - grade II, and 8 (7.3%) had mild CED - grade I. Sixty-one patients (51.2%) had normal BMI with good energy store, of these, 32 (52.5%) were males and 29 (47.5%) females. Eighteen women and 15 men were classified as obese.

Close to 17% of our patients had a BMI value below 18.99 which is the cut-off point for undernutrition and chronic energy deficiency state. This corroborated the results of earlier study from Western countries and East Africa. This has important implication for our elderly patients on admission because BMI values of 19 and below have been associated with steady rise in mortality. [2] When the graph of body weight is plotted against mortality in advanced age group, a J-shaped curve is obtained which shows increased mortality with both low and high BMI values. Other documented adverse effects of undernutrition in older people include impaired immune function, decreased respiratory function, and poor quality of life. [2],[4] The mean duration of hospitalization in our study was higher in the undernourished group compared to healthy and obese people which is consistent with studies that have associated prolonged hospital stay with poor nutritional status. [4],[5]

Obesity was another form of nutritional disorder observed in 28% of our elderly patients. Although there are conflicting reports on implication of overweight and obesity in older people, some studies seems to suggest a protective effect of moderate overweight with reverse association existing between obesity and mortality. However, the further aged patient moves outside the normal reference range the more the increased risk of morbidity and mortality. [2],[5] The risk of death from higher BMI in the elderly is not as great as in younger people.

The conclusion from this study is that elderly people at admission have some form of malnutrition which could be associated with poor outcome. To reduce this risk the attending physician needs to be more proactive and be on the lookout for clinical evidence of undernutrition in older people at admission. This could ensure prompt correction, early discharge, and better hospital outcome.

 
   References Top

1.Sanya EO, Abiodun AA, Kolo P, Olanrewaju TO. Profile and causes of mortality among elderly patients seen in a tertiary care hospital in Nigeria. Ann Afr Med 2011;10:278-83.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Stevens J, Cai J, Pumuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body mass index and mortality. N Engl J Med 1998;338:1-7.  Back to cited text no. 2
    
3.Calle EF, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body mass index and mortality in a prospective cohort of US adults. N Engl J Med 1999;34:182-90.  Back to cited text no. 3
    
4.Ferro-Luzzi A. season energy deficiency in Ethiopian rural women. E J Clin Nutr 1990;44:7-18.  Back to cited text no. 4
    
5.Landi F, Onder G, Gambassi G, Pedone C, Carbonin P, Bernabei R. Body mass index and mortality among hospitalized patients. Arch Intern Med 2000;160:2641-4.  Back to cited text no. 5
    




 

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