NUTRITIONAL STATUS OF THE ELDERLY IN MALAYSIA: PAST, CURRENT AND - - PowerPoint PPT Presentation

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NUTRITIONAL STATUS OF THE ELDERLY IN MALAYSIA: PAST, CURRENT AND - - PowerPoint PPT Presentation

Feb 09, 2024 375 likes •588 views

NUTRITIONAL STATUS OF THE ELDERLY IN MALAYSIA: PAST, CURRENT AND FUTURE Hanis Mastura Yahya 1 , Suzana Shahar 2 1 Nutritional Sciences Program, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia 2

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SLIDE 1

NUTRITIONAL STATUS OF THE ELDERLY IN MALAYSIA: PAST, CURRENT AND FUTURE

Hanis Mastura Yahya1, Suzana Shahar2

1Nutritional Sciences Program, Centre for Healthy Ageing and

Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia

2Dietetics Program, Centre for Healthy Ageing and Wellness, Faculty

  • f Health Sciences, Universiti Kebangsaan Malaysia
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SLIDE 2

Ageing population

  • Malaysia is moving towards becoming an ageing

country with 14 % of elderly population in the year 2035

  • 2010:

27.4%

  • 2040:

18.6%

0-14 yo

  • 2010:

67.6%

  • 2040:

66.9%

15-64 yo

  • 2010:

5.0%

  • 2040:

14.5%

65 yo

Source: Department of Statistics Malaysia, Population Projection (Revised), Malaysia, 2010-2040

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SLIDE 3

Introduction

  • Increase of age increase of life expectancy
  • DOSM:
  • 65th birthday plus the expected year to live

increase the octogenarian population

Year Male Female 2016 14.8 years 16.9 years 2017 15.0 years 17.1 years

Source: Department of Statistics Malaysia, Selected Demographic Estimates Malaysia 2016

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SLIDE 4

Nutritional status of the elderly

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SLIDE 5

The past

  • In the early 90’s: reports on health and nutritional
  • bservation among elderly in rural populations Malaysia

Zaitun & Terry (1991) Suriah et al. (1996) Shahar et

  • al. (2000)
  • Underweight and
  • besity appear to be

prevalent

  • WHR: excess body

fat deposited in the abdominal region

  • Mean energy intake

was less than the recommendation by Malaysian RDA.

  • Total mean energy

intake decline with age increment for both sexes.

  • Mean intake of energy

& other studied nutrients were below Malaysian RDA except for protein & vitamin C

  • Despite meal intakes,

the dietary intake was inadequate.

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SLIDE 6

The past

  • Study among elderly from in 9 publicly funded

shelter homes in Peninsular Malaysia (N=1081):

Visvanathan et al. (2005)

Parameters:

  • Survey using

questionnaires: demographics, nutritional & cognitive status, physical function & psychological well- being.

Findings:

  • BMI <18.5 kg/m2: 14.3%
  • BMI 18.5 to 20 kg/m2:

18.2 %

  • 26.6% were at high risk
  • f undernutrition

according to the Nutritional Health Checklist

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SLIDE 7

The past: summary

  • Increase in mean BMI over time
  • Majority of Malaysian elderly were still in their

normal range of BMI, however, overweight and

  • besity had preceded underweight
  • Overweight & obesity at the rise, but reduced with

advancing age

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SLIDE 8

Prevalence of overweight increased by two folds from 15.6 % (1996)  29.8% (2006) Prevalence of obesity increased by three folds from 3.1% (1996)10.8% (2006) Prevalence of underweight & normal was reduced within 10 years period. (NHMS)

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SLIDE 9

The present

Author(s) Study population Parameters Findings Suzana et al. (2012) N=4746, elderly (NHMS III) BMI & WC

  • In men, prevalence of overweight

& obesity were 29.2% & 7.4% decreased with age

  • In women, prevalence of
  • verweight & obesity were 30.3%

& 13.8%

  • Prevalence of abdominal obesity

was 21.4% (7.7%: men & 33.4% in women) Chen et al. (2012) N=236, elderly resided in government- funded shelter home Weight, height, BMI, MUAC, WC

  • Underweight: 17.4%
  • Overweight: 28.4%
  • A significant decline

anthropometric measurements elderly at 60-69 years & ≥80 years.

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SLIDE 10

The present

Author(s) Study population Parameters Findings Shahar et al. (2013) N=160, elderly Malays in an agricultural settlement, i.e. FELDA Sungai Tengi, Selangor Malnutrition risk & appetite (MNA-SF & SNAQ), functional status (IADL, EMS & handgrip strength), MMSE, GDS & De Jong Gierveld Loneliness Scale

  • 42.5%: at risk of

malnutrition

  • 61.2%: poor appetite
  • Lower mean scores of

IADL and EMS among subjects at risk of malnutrition Singh et al. (2014) N=47, undernourished elderly from 2 residential institutions A battery of physical performance tests, biochemical profiles, falls risk, functional test & GDS

  • Elderly scored poorly on

the physical performance tests, had depression & at high risk of falls.

  • 10.9 % were anemic &

21.7 % were at risk of PEM

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SLIDE 11

NHMS (2015)

Risk of malnutrition

  • Muscle wasting measured by calf circumference
  • Prevalence: 20%

Normal weight*

  • Prevalence: 40.4 to 55.9 % (increase with age)
  • Highest among elderly (≥75 years old)

Overweight*

  • Prevalence: 27.1 to 35.7%
  • Highest: 70-74 years old

Obese*

  • Prevalence: 6.1 to 20.5 %
  • Highest: 60-64 years old

*Classification by WHO (1998)

60- 64 yo 65- 69 yo 70- 74 yo 75+

Physically active: 30-60.9 % (reduce with age)

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SLIDE 12

Author(s) Study population Parameters Findings Vanoh et al. (2016) N=1993, elderly from 4 states in Malaysia (Perak, Selangor, Kelantan, Johor) Socio-demographic, cognitive function, functional status, dietary intake, lifestyle & psychosocial status

  • Underweight: 4.7 %
  • Normal: 45.9 %
  • Overweight: 35 %
  • Obese: 14.4 %

Saleh Hudin et al. (2017) N=289, elderly from (FELDA) at Lubuk Merbau, Kedah Weight, height, food insecurity, depressive symptoms, stress, social support & functional status

  • Underweight: 7.6 %
  • Normal: 40.8 %
  • Overweight: 36.7 %
  • Obese: 14.9 %

Zainuddin et

  • al. (2017)

N=72, elderly in Klang Valley Anthropometrics parameters, socio- demographic, health status, food insecurity, cognitive status & frailty assessments

  • Underweight: 15.3%
  • Normal: 43.0%
  • Overweight: 41.7%
  • Abdominal obesity: 75.0%
  • Pre-frail (58.3%), frail

(27.8%) & non-frail (13.9%)

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SLIDE 13

Consequences of obesity

1Houston et al. (2009); 2Davison et al. (2002); 3Lee et al. (2012); 4Won et al. (2015)

Physical dysfunction and are predictive of a decline in functional status and future disability2 Increased the risk of chronic diseases, immobility & frailty1 TUA study: risk factors of cognitive decline, especially among women4 Low & middle cost housing area in Cheras: obesity was the risk factors of mild cognitive impairment (MCI) among women3

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SLIDE 14

Malnutrition

  • Malnutrition is still a concern: sarcopenia, frailty

& pre-frailty

Norshafarina et al. (2013)

  • Study in Cheras
  • Almost half of the

respondents were sarcopenic lean sarcopenia (36.3%) & obese sarcopenia (23.5%). Sathasivam et al. (2015)

  • Study in urban

areas

  • Frailty: 5.7 %; pre-

frailty: 67.7%

  • Cognitive function,

physical disability and history of falls were the risk factors Badrasawi, Shahar, & Singh (2016)

  • Study in Klang

Valley

  • Frailty: 8.9%; pre-

frailty: 61.7%

  • Obesity and

physical disability were the risk factors

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SLIDE 15

Nutrient intake

  • Nutrients of concern:

Energy, vitamin A, B1, B2, B3, calcium, iron (Azirah & Suriah, 1992) Energy, B2, B3, calcium (Zainorni 1992) Energy, vitamin A, B1, B2, B3, calcium, iron (Shahar et al. 2000) Vitamin B1, B2 & calcium (Shahar et

  • al. (2007)

Vitamin B1, B3, folic acid, vitamin E & calcium (Fakhruddin et al., 2016)

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SLIDE 16

The future: challenges

  • Coexistent of chronic diseases have effect on

nutritional status

  • Underdeveloped geriatric care: could not meet

the rapidly increasing demand

  • Provision of adequate social protection

financial support, depression & loneliness

  • Planning & implementation of intervention for the

elderly: data on health, nutrition, social, functional, cognitive, physical fitness

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SLIDE 17

Moving forward

  • The need to change our perspective on elderly

Elderly: aged but not helpless

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SLIDE 18

Take home messages

  • Overweight & obesity is prevalent among elderly.
  • We need a collaborative effort among

multidisciplinary experts to plan and implement sustainable intervention program to improve the health and well-being of the elderly.

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SLIDE 19

References

  • Badrasawi, M, Shahar, S. & Singh, D., 2016. Risk factors of frailty among a multi-ethnic Malaysian older adults. International Journal of Gerontology, In

Press.

  • Chen et al. 2012. Prevalence of Malnutrition among Institutionalized Elderly People in Northern Peninsular Malaysia: Gender, Ethnicity and Age-specific.

Sains Malaysiana 41(1):141-148.

  • Department of Statistics Malaysia.
  • IPH., 1996, 2006, 2011, 2015. National Health Morbidity Survey. Non-Communicable Diseases. Kuala Lumpur: Institute of Public Health.
  • Houston et l. 2009. Weighty concerns: the growing prevalence of obesity among older adults. Journal of the American Dietetic Association, 109(11),

pp.1886–1895.

  • Lee, L.K., Shahar, S., Chin, A.V., Mohd Yusoff, N.A. & Aziz, S.A., 2012. Prevalence of gender disparities and predictors affecting the occurrence of mild

cognitive impairment (MCI). Archives of Gerontology and Geriatrics, 54(1), pp.185–191.

  • Loo, W.H., Abdul Manaf, Z., Mat Ludin, A.F. & Shahar, S., 2015. A wide range of body composition measures are associated with cognitive function in

community dwelling older adults.

  • Singh et al. 2014. Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in

residential institutions. Clin Interv Aging. 25;9:1415-23. doi: 10.2147/CIA.S64997.

  • Norshafarina, S.K., Noor Ibrahim, M.S., Suzana, S., Hasnan, M., Zahara, M. Zaitun, Y., 2013. Sarcopenia and its impact on health: Do they have significant

associations? Sains Malaysiana, 42(9), pp.1345–1355.

  • Suzana et al. 2012. The Third National Health and Morbidity Survey: prevalence of obesity, and abdominal obesity among the Malaysian elderly population.

Asia Pac J Public Health. 2012 Mar;24(2):318-29.

  • Saleh Hudin et al. 2017. Influence of socio-economic and psychosocial factors on food insecurity and nutritional status of older adults in FELDA settlement

in Malaysia. Journal of Clinical Gerontology & Geriatrics 2017;8(1):35-40.

  • Shahar, S., Earland, J. & Rahman, S.A., 2000. Food intakes and habits of rural elderly Malays. Asia Pacific Journal of Clinical Nutrition, 9(2), pp.122–129.
  • Sathasivam, J. Kamaruzzaman, S.B., Hairi, F., Ng, C.W. & Chinna, K., 2015. Frail elders in an urban district setting in Malaysia: multidimensional frailty and

its correlates. Asia-Pacific Journal of Public Health, 27(8),pp.52-61.

  • Suzana et al. 2013. Malnutrition Risk and its Association with Appetite, Functional and Psychosocial Status among Elderly Malays in an Agricultural
  • Settlement. Mal J Nutr. 19(1): 65-75.
  • Suriah, A.R., Zainorni, M., Shafawi, S., Mimie Suraya, S., Zarina, N., Wan Zainuddin, W. & Zalifah, M., 1996. Nutrient intake among elderly in southern

Peninsular Malaysia. Malaysian Journal of Nutrition, 2(1), pp.11–19.

  • Vanoh et al. 2016. Predictors of poor cognitive status among older Malaysian adults: baseline findings from the LRGS TUA cohort study. Aging Clin Exp
  • Res. 29(2):173-182.
  • Visvanathan et al. 2005. The nutritional status of 1081 elderly people residing in publicly funded shelter homes in Peninsular Malaysia. Eur J Clin Nutr.

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  • Won , H et al. 2015. A wide range of body composition measures are associated with cognitive function in community dwelling older adults. Geriatr Gerontol
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  • Zaitun, Y. & Terry, R.D., 1991. Anthropometric characteristics of rural elderly females in Malaysia. Ecology of Food and Nutrition, 26(2), pp.109–117.
  • Zainuddin et al. 2017. Association between Nutritional Status, Food Insecurity and Frailty among Elderly with Low Income. Jurnal Sains Kesihatan Malaysia

15(1) 2017: 51-59.