Malnutrition in older adults on financial assistance in an urban Asian country: a mixed methods study

Abstract

Objective: The objectives of the present study were to assess the nutritional status, identify factors for malnutrition risk and evaluate barriers to adequate nutrition among recipients of the Public Assistance (PA) scheme for socio-economically disadvantaged Singaporeans. Design: Using a cross-sectional study design, we assessed PA recipients' malnutrition risk using the DETERMINE Nutritional Health checklist and the full Mini-Nutritional Assessment (MNA), as well as their nutritional knowledge, co-morbidity burden, depression risk, instrumental and basic activities of daily living (IADL and BADL), and awareness and utilization of available food services. In-depth interviews were also conducted on malnourished individuals (MNA score , 17) to understand barriers to adequate nutrition. Setting: Homes of community-living older adults and nursing homes of institutionalized older adults. Subjects: All PA recipients aged $55 years in Central Singapore District. Results: Four hundred and sixty-five of 511 (91?0 %) eligible PA recipients participated in the study. The prevalence of malnutrition in the study population was 2?8 %. However, 50?3 % were at risk of malnutrition. Among community-dwelling respondents, the risk of malnutrition was independently associated with age .75 years, currently unmarried, BADL impairment, depression risk and BMI , 19?0 kg/m 2 . Qualitative analysis revealed that financial, social and physical barriers and lack of knowledge were the main contributors to poor nutritional status. Only half were aware of subsidized food services and education increased interest in utilizing food services. Among nursing home respondents, those who were BADL impaired were more likely to be at risk of malnutrition. Conclusions: Among PA recipients, the prevalence of malnutrition is low but the risk of malnutrition is high. Education on adequate nutrition and food services are recommended.

The unhealthy lifestyle factors associated with an increased risk of poor nutrition among the elderly population in China

“…Not surprisingly, our values were similar to the findings of several other studies (13,20,30) using the same assessment tool (MNA), cut-off score (≤23.5 points), and research subjects (community-dwelling elderly adults). Specifically, the incidence of malnutrition and RM in our study were similar to findings from Shanghai (1.7% and 19.1%, respectively), Guangzhou (1.0% and 29.2%, respectively), and Beijing (0.2% and 32.3%, respectively) in China, as well as in Japan (0.2% and 20.6%, respectively) and Singapore (2.8% and 50.3%, respectively) [6,14,16,17,31]. Conversely, a study by Han and colleagues in Wuhan,…”

“…Meanwhile, mixed findings have been reported regarding the prevalence of malnutrition and the risk of malnutrition (RM). Based on the Mini Nutritional Assessment (MNA) scale, the incidence of malnutrition in community-dwelling elderly adults varies between 0.2% and 13.7%, as well as 8% to 50.3% of elderly individuals have RM (10,(13)(14)(15)(16)(17)(18). Differences in sample size, age distribution, diversified social environment, and geographical differences may all contribute to the variations between studies (14).…”

“…Several health-related factors such as chronic diseases, physical and social barriers, risk of depression, and a lack of health-related knowledge are also related to malnutrition (16,20). However, the associations between malnutrition and other factors, such as hospitalization in the last year and various unhealthy lifestyle factors, remain unclear.…”

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

“…Furthermore, the present meta-analysis also established an association between lowest income levels and a higher risk of developing malnutrition in the elderly. One explanation is based on the fact that the healthiest or freshest food is the most expensive, so are not accessible for the elderly with few economic resources [64]. Thus, all of these low income-associated aspects could increase the risk of malnutrition and could be a determinant of malnutrition in the elderly.…”

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling older adults in Singapore: Findings from the SHIELD study

“…An individual's competency in obtaining, understanding nutrition information, and knowing how to access nutrition health services have an impact on the nutrition knowledge of the individual. Studies have reported that the lack of aforementioned skills may contribute to poor nutrition health (10,18). Nutrition attitudes is centered on the perceptions and beliefs influencing food choices (13,14), mediating the link between nutrition knowledge and dietary habits (19).…”