Nutritional Status in Elderly In A Selected Area of Lubuk Basung, Agam

Welly Oktaviani1, Dewi Kurniawati2, Wisnatul Izzati3

University of Mohammad Natsir Bukittinggi

Email correspondence : dewee.kurniawati@gmail.com

ABSTRACT

Background : Globally, the elderly population has increased of the entire population. The
increase in the elderly population causes changes in health problems and decreases the
productivity of organs as well as nutritional problems in the elderly. Most of the elderly
population is malnourished. There are many factors related to the nutritional status of the
elderly. However, there are limited data regarding factors related to the nutritional status of the
elderly.

Objective: This study aims to determine the nutritional status and factors related to nutritional
status in the elderly in Agam Regency. .

Methods: Respondent in this study were 338 elderly aged >60 years in Agam Regency. Using
the Mini Nutritional Assessment (MNA) to assess the nutritional status of the elderly. All data
were analyzed using the Statistical Package for Social Sciences (SPSS) version 24.0 with
spearman rank test and multinomial regression.

Results: 220 (65.1%) respondents at risk of malnutrition, and age is the most influential factor
on nutritional status in the elderly. The results of this study were (51.6%) elderly in the age range
71-75 years experiencing malnutrition with significant (p<0,05).

Conclusion: More than half (65.1%) of the study respondents were at risk of malnutrition. We
suggest that to reduce the incidence of malnutrition in the elderly, preventive efforts are needed
from the nearest health facility with nutrition education for the elderly.

Keywords: elderly; nutritional status factors; Mini Nutritional Assessment (MNA)

BACKGROUND of around 21 million (8.2%). In addition,

The number of people older than 60
is expected to increase from 901 million to
1.4 billion worldwide between 2015 and
2030, and reach nearly 2.1 billion by 2050
(Lorenzo-López et al., 2017). Indonesia is
home to the eighth largest elderly population
in the world and the fourth largest among
Asian countries, with an elderly population
Indonesia has the highest number of elderly
people in Southeast Asia (Setiati et al.,
2019). The elderly population continues to
increase, causing changes in health problems
and a decrease in body organ productivity as
well as nutritional problems in the elderly
(Yustisia, 2021).
 Based on research by Kai Wei et al,
the overall prevalence of MNA malnutrition
is 2.8%, and the risk of malnutrition is
27.6% (Hsieh et al., 2019). Basically,
nutritional problems that occur in the elderly
or malnutrition are nutritional status in the
form of deficiency, excess or imbalance of
nutrients in food which have an effect on
body function and decline in health.
Malnutrition can be in the form of excess
nutritional status (overnourished) and
undernourished status (Miriam, 2018).
According to research conducted by Fredy
Akbar et al, data obtained in Indonesia,
elderly with less nutrition (BMI <18) as
much as 31% and over nutrition as much as
1.8% (Akbar & Eatall, 2020).
Nutritional status has an important
role in the health status of the elderly
(Kurniawati & Dewi, 2018). Malnutrition,
which is affected by inadequate, excessive,
or unbalanced energy or nutritional
consumption is associated with physical and
cognitive impairment, poor quality of life,
morbidity, and mortality in older
individuals. (Jayanama et al., 2018).
However, there are limited
comprehensive data on factors related to the
nutritional status of the elderly in Agam
Regency. Therefore, this study aims to
determine the nutritional status of the elderly
in Agam Regency.
METHODOLOGY
Study Design and Population
This study is a cross sectional study
that examines nutritional status in Agam
Regency. In addition, the researchers also
looked at the factors that affect the
nutritional status of the elderly. The study
was conducted in July 2022 with 338
respondents in the Agam region. The
respondents studied met the inclusion
criteria, namely the elderly who were
willing to be respondents, the elderly >60
years, and the elderly who were at the
research site. With the exclusion criteria,
namely the elderly with cognitive
impairment, vision and hearing.
Data Collection Tool
Major Factors Measurements
The research instrument includes the
characteristics of the respondents consisting
of gender with male and female categories,
age with categories 61-65 years, 66-70
years, 71-75 years, 76-80 years, > 80 years.
The education in the low category is that the
respondent's last education is not in school
or elementary school, while the respondent's
last education is Junior High School, high
with the respondent's last education being
High School or College. Economic status in
the low category, namely income <Rp.
1,000,000, medium with income Rp.
1,000,000 - Rp. 2,000,000, high with income
> Rp. 2,000,000. Then the disease suffered,
oral dental health, sense of taste and
stomach acid.
Mini Nutritional Assessment (MNA)
The Mini Nutritional Assessment
(MNA) was designed and validated to
provide a single, rapid assessment of
nutritional status in elderly patients. The
MNA questionnaire consists of 19 questions
with the categories of screening and
assessment. MNA categories include a
score of <17 which is in the malnutrition
category, a score of 17-23.5 in the Table 1. The Characteristic of respondents
malnutrition risk category, and a score of 24 in elderly in Agam Regency 2022.
in the good nutrition category.
Characteristic Category F % p
s
Gender Male 9 27,8 .247
Statistical Analiysis 4
Female 244 72,2
All data were analyzed using the
Statistical Package for Social Sciences Age 61-65 year 6 19,5 .000
(SPSS) version 24.0. Statistical descriptions 6
of respondents including mean, range, 66-70 year 5 16,9
7
standard deviation and frequency are used to 71-75 year 154 45,6
present the demographics of respondents. 76-80 year 4 14,5
Spearman rank test was used to measure the 9
relationship between variables and > 80 year 1 3,
2 6
multinomial regression to measure which
characteristics are most related to nutritional Education Low 121 35,8 0,000
status in the elderly. Medium 7 23,4
9
Results High 138 40,8

The characteristics of the Occupational Merchant 3 9, 0,00

Status 2 5 0
respondents are shown in table 1. On the
Homemaker 178 52,7
gender characteristics, 94 males (27.8%) and Farmer 8 25,4
244 females (72.2%). The age of the 6
respondents was 154 (45.6%) in the range of Entrepreneu 2 7,
r 6 7
71-75 years. The education level of
Retired civil 1 4,
respondents is high 138 respondents servants 6 7
(40.8%). Medium economic status is 192
respondents (56.8%). Widow/widower Economic Low 6 18,3 0,000
Status Medium 2 56,8
marital status 191 respondents (56.5%).
192
Respondents who had disease were 298 High 8 24,9
respondents (88.3%). Dental and oral health 4
in 180 respondents (53.3%) in the good Marital Status Not married 2 6 0,00
8
category. With a good sense of taste as
Widow/ 191 56,5
many as 323 respondents (95.6%). And widower
most of the respondents have stomach acid Married 145 42,9
with a total of 293 respondents (86.7%).
Disease Yes 298 88,3 0,002
No 4 11,8
0
Oral dental There is 158 46,7 0,000
problem
 health
No problem 180 53,3

Sense of Deficient 1 4, 0,00

taste 5 4 0
Good 323 95,6

Stomach acid Yes 293 86,7 0,512

No 4 13,3
5

Fig.1 Nutritional Status of the

respondents

In Figure 1. The results obtained are

47 respondents (13.9%) with good nutrition,
220 respondents (65.1%) with malnutrition
risk and 71 respondents (21.0%) with
malnutrition.

Table 2. Analysis factors of Nutritional Status in elderly in Agam Regency.

Variable Malnourished p-value Risk of malnourished p-value

Adjust OR (95% CI) Adjust OR (95% CI)
Usia
61-65 year 2.2(1.012-4.797) 9.9(1.013-9.742)
66-70 year 1.9(1.145-3.415) .000 8.9(1.114-7.184) .000
71-75 year 8.5(8.043-9.073) 1.8(3.291-1.023)
76-80 year 7.1(1.537-3.294) 1.6(1.687)
> 80 year 0b 0b

In table 2. For the regression process, the Discussion

well-nourished category was taken as a
reference for comparing with at risk of
malnutrition and malnourished group. A
significantly higher odds of having
malnutrition was observed among the
respondents with 71-75 years (OR8.5; 95%
CI 8.043-9.073). The study also found that
the odds of being in the ‘at risk of
malnutrition’ group is higher among the
respondents with 61-65 years (OR 9.9; 95%
CI 1.013-9.742).
Based on the results of this study,
more than half (65.1%). respondents have a
risk category for malnutrition. The results
of this study are the same as those conducted
by Fredi (2020), where (52.6%) of
respondents were at risk of malnutrition.
Malnutrition in the elderly can be
influenced by several factors. One of them
is age. The results of this study were
(51.6%) elderly in the age range 71-75 years
experiencing malnutrition. This shows that
the age factor with the nutritional status of
the elderly in Agam Regency shows a
significant relationship with p value = .000.
As explained in Oktariyani's research
(2016), many elderly people are at risk of
malnutrition due to age. Increasing age will
cause some changes, especially physically
(Oktariyani., 2016). These changes will
affect a person's physical condition from
psychological, physiological and other
aspects. So that this condition also affects
the function of organs that play an important
role in maintaining and creating excellent
health, namely the function of organs related
to food and digestion (Nurfantri, 2016).
In Pindobilowo's research (2018), it
is said that the metabolism of the human
body begins to decline after the age of 50
and physical activity decreases. After the
age of 50 years, energy needs are reduced by
5% for every 10 years, while the need for
protein, vitamins, and minerals will remain
because they function as cell regeneration
and antioxidants to protect cells from free
radicals that can damage cells in the body
(Pindobilowo, 2018).
In addition to age, risk factors for
malnutrition can also be caused by disease.
The results of research on disease factors
with nutritional status of the elderly in
Agam Regency showed that there was a
significant relationship with p value = 0.002.
Nutritional status is directly related to health
status, especially the presence of diseases,
especially infectious diseases. This is
caused by the aging process as a result of
changes in the quality of basic needs as
humans who run less balanced.
Diseases or health disorders in the
elderly are generally in the form of chronic
and degenerative diseases, such as
hypertension, diabetes mellitus,
osteoporosis, heart disorders, digestive
disorders, respiratory disorders, balance
disorders, visual disturbances, chewing
disorders and so on (Gita, 2015). The
presence of disease shows a decrease in
physical activity as a result of increasing age
and changes in eating patterns that decrease
(Dewi, 2019).
The results of research on education,
economic status and employment with the
nutritional status of the elderly in Agam
Regency showed that there was a significant
relationship with p value = 0.000. The level
of education is included in the socio-
economic factors. Where increasing
education is likely to increase income
related to the type of work the elderly have,
thereby increasing the purchasing power of
food to meet the nutritional needs of the
family (Yustisia, 2021).
With a high level of education, a
person's knowledge of nutrition will affect
the fulfillment of nutritional needs.
Educated people are generally more aware
of life. Education affects the type of work,
jobs with different income levels can
certainly affect the fulfillment of good
nutritional needs for their families
(Nursilmi, 2017).
In terms of marital status, the results
showed that as many as (57.01%) elderly
with widow/widower marital status
experienced the risk of malnutrition. These
results indicate that there is a significant
relationship with p value = 0.008 between
marital status and nutritional status of the
elderly in Agam Regency. The number of
elderly people with widow/widower marital
status, where factors such as loss and
separation from the closest people will
greatly affect the food intake of the elderly
(Dewi, 2019).
In addition, togetherness during
meals and family support such as paying
attention to healthy eating patterns for the
elderly according to the history of the
disease they are suffering from is very
necessary for the elderly. This is because,
some of the elderly experience a decrease in
body function, many things can encourage
the elderly to maintain their nutritional
intake so that it affects their nutritional
status. One of them is the role of the family
in meeting the nutritional needs of the
elderly (Yustisia, 2021).
The next factor of malnutrition in the
elderly is dental and oral health. The elderly
are susceptible to a decrease in the number
of teeth and can result in a decrease in
chewing ability which causes a decrease in
appetite in the elderly. This is caused by a
decrease in opioid receptors and endogenous
opioids in the brain, so this reduces the
working capacity of these cells where the
performance of these cells plays a role in a
person's desire for food (Nurfantri, 2016).
Elderly who have lost a lot of teeth
often consume foods that are lacking in fiber
and often consume foods that contain high
saturated fat so that it affects the general
health of the elderly which greatly affects
the nutritional status of the elderly
(Pindobilowo, 2018).
With increasing age, the ability to
taste, digest and absorb food will decrease,
so that the elderly enjoy less food and lack
of food intake which can lead to a decrease
in appetite (Asmaniar, 2019.)
This can happen because there are
many taste buds on the tongue that provide
various taste sensations. As a result of
increasing age, the number of nerve
protrusions decreases, so that the elderly are
less able to feel the sensation of taste in food
which can result in a decrease in appetite
(Widiyawati, 2020).
In addition, stomach acid is also a
factor in malnutrition. Where the elderly
with several chronic conditions have a
higher risk of developing acid reflux
disease. Weight gain that often occurs in the
elderly can also cause stomach acid disease
to occur.
Conclusion
More than half of the respondents
have a risk category for malnutrition, where
age is the factor that has the most significant
relationship with nutritional status in the
elderly.
To reduce the number of
malnutrition in the elderly, it is necessary to
program efforts to prevent the risk of
malnutrition by providing nutrition
education from the nearest health facilities.
And the need to increase knowledge for the
elderly about the importance of good
nutrition for the elderly in order to reduce
the incidence of malnutrition in the elderly
population.
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