© Borgis - Postępy Nauk Medycznych 7/2014, s. 518-524
*Beata Babiarczyk1, Małgorzata Schlegel-Zawadzka2, Agnieszka Turbiarz1
Chorobowość a stan odżywienia osób powyżej 65. roku życia hospitalizowanych na oddziale chorób wewnętrznych
The morbidity and nutritional status in people 65 years and older hospitalized in medical ward
1Department of Nursing, Faculty of Health Sciences, University of Bielsko-Biała
Head of Department: prof. Monika Mikulska, MD, PhD
2Department of Human Nutrition, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków
Head of Department: prof. Tomasz Brzostek, MD, PhD
Streszczenie
Wstęp. Stan odżywienia odgrywa ogromną rolę we wzmacnianiu stanu zdrowia osób starszych.
Cel pracy. Celem niniejszej pracy było porównanie chorobowości i stanu odżywienia osób powyżej 65. roku życia hospitalizowanych na oddziale chorób wewnętrznych.
Materiał i metody. Do badania zakwalifikowano 104 osoby starsze hospitalizowane na oddziale chorób wewnętrznych. Wykorzystano metodę sondażu diagnostycznego i technikę wywiadu kwestionariuszowego. Stan odżywienia oceniono na podstawie badań antropometrycznych i wybranych badań laboratoryjnych.
Wyniki. Biorąc pod uwagę kryteria BMI, u 31,7% badanych stwierdzono nadwagę, a u kolejnych 45,2% otyłość, co stanowi większy odsetek niż podawany w doniesieniach z innych polskich badań. Porównując badanych zakwalifikowanych na podstawie wyników BMI do jednej z czterech grup, stwierdzono istotne statystycznie różnice w zapadaniu na choroby metaboliczne i endokrynne oraz krwi. Nie potwierdzono istotnego związku BMI z wiekiem, wykształceniem, stanem cywilnym badanych czy wynikami ich badań laboratoryjnych. U 88,5% badanych stwierdzono wielochorobowość. Średnia liczba chorób wynosiła 3,5 ± 1,6 (1-8) i nie miała istotnego związku z wartościami BMI. Ocena badań określanych jako markery stanu odżywienia (poziom albumin, cholesterolu, TLC w osoczu krwi) nie wykazała istotnych różnic pomiędzy badanymi.
Wnioski. Otyłość i wielochorobowość są znaczącymi problemami u osób starszych. Potwierdzono, iż otyłość może mieć związek z zapadaniem na choroby metaboliczne i endokrynne, ale nie potwierdzono tego związku dla chorób układu sercowo-naczyniowego. Niezbędne jest prowadzenie dalszych badań oceniających związek pomiędzy chorobowością i stanem odżywienia u osób starszych.
Summary
Introduction. Nutritional status plays an important role in maintaining elderly people’s health.
Aim. The aim of the study was to compare the morbidity and nutritional status of people 65 years and older, hospitalized in medical ward.
Material and methods. A total of 104 individuals hospitalized on medical ward were included. The study used a questionnaire method and the nutritional status was assessed using anthropometric measurements and laboratory tests.
Results. Relying on BMI criteria, 31.7% of participants were found overweighted and 45.2% were obese, what was in fact more than results revealed in other polish studies. Between four BMI groups, there were found statistically significant differences in terms of having metabolic and endocrine and hematology diseases. No significant correlation of BMI with participants’ age, education, marital status nor laboratory tests was found. Polypathology was observed in 88.5% of participants. The mean number of chronic diseases was 3.5 ± 1.6 (1-8). There was not confirmed that number of chronic diseases significantly differed in the groups with different BMI values. The assessment of laboratory indexes known to reflect the nutritional status (concentration of albumin, cholesterol, TLC in serum) did not show statistically significant differences among participants.
Conclusions. The obesity and polypathology were shown to be a problem in elderly. The present study showed that obesity may play some role in having metabolic and endocrine diseases but not cardiovascular problems. Nevertheless, further studies aimed at determining the relationship between nutritional status and morbidity of elderly people are needed.
Introduction
One of the significant factors influencing both the Polish and the global health situation is the process of demographic and epidemiological transition of societies. Polish society has already crossed the threshold for old age (12%) and joined the ranks of the so-called “demographically old societies”. The Polish Central Statistic Office projects that due to decreased population growth, decreased mortality and increased average life expectancy, the number of people 65 years and older in Poland will increase to 22% by 2025 (1).
This appears to be a global tendency. Older people in Europe currently represent around 20% of the total population and the proportion is expected to increase to 29% by 2025. The proportion of the population aged 60 and over is expected to reach 25% in North America, 21% in eastern Asia, 14% in Latin America and 11% in south and central Asia as well (2).
An ageing society poses a major challenge to health care systems as it is integrally connected with increased demand for medical and care services. In view of the fact that older people are often afflicted by multiple diseases and disabilities, the priority of geriatric care should be to take action towards maintaining independent living amongst this population. Appropriate nutritional monitoring of elderly people, in particular those hospitalized in medical institutions can significantly improve their health status.
Elderly individuals are at increased risk of both obesity and undernutrition. Obesity, especially obesity distributed predominantly in the abdominal area, is one of the most serious public health problems in Europe and across the globe. It is associated with insulin resistance, which can in turn cause diabetes and may also play a role in hypertension and hyperlipidemia (2-4).
However, current data does not support conjectures that mild to moderate overweight is associated with higher mortality or disability in the elderly (5, 6).
In populations of elderly people there is a strong inverse relationship between their disability, morbidity and as a consequence poor quality of life and poor nutritional status (7-9).
Elderly persons are vulnerable to undernutrition, especially protein-energy malnutrition (PEM), which is associated with infections, falls, pressure sores, fractures, reduced autonomy and it may worsen the progression of several age-related diseases as well (10-12).
A number of factors related to physiology and pathology of ageing can increase the risk of improper nutrition in elderly people (13-17).
In Poland there are still very few studies regarding the nutritional status of elderly hospitalized patients, but international findings are indeed cause for concern. According to number of authors, undernutrition can affect up to 50% of elderly people hospitalized in short-term care wards and significantly higher, up to 85%, of people living in long-term care wards.
Aim
The aim of this study was to compare the morbidity and nutritional status of people 65 years and older, hospitalized in medical ward in south Poland.
Material and Methods
Study design and population
The study was carried out between November 2008 and July 2010, in Bielsko-Biała district, in South Poland. Data was collected in one medical ward (The Public Railwaymen’s Hospital in Wilkowice Bystra). The study involved people who were at least 65 year old on the day of the examination. Initially, the overall number of people hospitalized on medical ward fulfilling the age criterion was 176. Eligibility for participation in the study was assessed based on the initial interviews and analysis of medical documentation. All participants were informed that they could refuse to participate at any stage of the study.
The following non-inclusion criteria were implemented:
– < 65 years,
– lack of subject’s consent to participate in all stages of the study,
– active phase of neoplastic disease on course of chemo- or radiotherapy,
– patients with severe cognitive impairment,
– physical condition hindering anthropometric examination (such as immobile patients, contraindication to lifting or amputation of both lower extremities),
– period of hospitalization on the medical ward longer than 10 days.
Ethics
The procedure of the study was approved by the local Bioethical Commission (the opinion number 26/01/2008).
Instruments and data collection
The study used a questionnaire method and was conducted by means of direct interview. The nutritional status was assessed anthropometric measurements and laboratory tests. All measurements were recorded by one individual on the patient information form. It contained sociodemographic (age, gender, marital and educational status) and clinical data (morbidity).
Anthropometry measurements
The baseline body weight was obtained by weighing all patients in a state of fasting, using the same calibrated electronic wheelchair scale (SECA-EC, type approval D 05-09-024). The height was calculated using the patients age and knee height (KH) measured in centimeters in accordance with Chumlea’s formula:
for men: H (cm) = 64.2-0.04 x age + 1.83 x KH,
for women: H (cm) = 84.9-0.24 x age + 1.83 x KH.
KH is a surrogate measurement employed to estimate the height of elderly and non-ambulatory patients (18-22).
Body Mass Index (BMI) is an index of weight-for--height that is commonly used to classify overweight and obesity in adults as well as describe the degree of undernutrition (23). It is calculated using the formula: Wt(kg)/Ht(m2).
Laboratory tests
Blood samples for serum albumin, cholesterol concentration and total lymphocytes count (TLC) were analyzed according to standard protocol in the clinical laboratory at The Public Railwaymen’s Hospital in Wilkowice Bystra, which operates a rigorous quality control program (Quality Control Service, Roche).
Statistical analysis
All data was analysed and verified statistically using Statistica software (version 10). Quantitative features have been presented with the arithmetic mean and standard deviation. The Mann-Whitney non-parametric U test was used in the assessment of differences between the groups of independent variables. The Kruskal-Wallis test was used to compare variables in study participants with different nutritional statuses. In order to measure the statistical dependence between variables the Spearman’s rank correlation test was performed. P-values below 0.05 were considered significant.
Results
A total of 104 individuals hospitalized on medical ward, aged 65 years and older were included in the study. Their sociodemographic characteristics are summarized in table 1.
Table 1. Sociodemographic characteristics of the study group according to the gender, mean ± SD (range), n (%).
| Variables | Females | Males | Total | p-value* |
Number
Age (years) | 78
76.1 ± 5.8
(65-89) | 26
75.2 ± 6.9
(65-89) | 104
75.8 ± 6.0
(65-89) | 0.46 |
Marital status:
Single
Married
Divorced/Widow(er) | 7 (9.0)
17 (21.8)
54 (69.2) | 3 (11.5)
9 (34.6)
14 (53.8) | 10 (9.6)
26 (25.0)
68 (65.4) | 0.26 |
Education:
None
Primary school
Vocational school
College
High school | 2 (2.6)
44 (56.4)
8 (10.3)
21 (26.8)
3 (3.9) | 0
9 (34.6)
3 (11.6)
9 (34.6)
5 (19.2) | 2 (1.9)
53 (51.0)
11 (10.5)
30 (28.9)
8 (7.7) | 0.02** |
| Length of stay in medical ward (days) | 2.9 ± 2.4
(1-8) | 3.8 ± 2.5
(1-8) | 3.2 ± 2.5
(1-8) | 0.10 |
| Number of chronic diseases | 3.6 ± 1.6
(1-8) | 3.0 ± 1.5
(1-6) | 3.5 ± 1.6
(1-8) | 0.11 |
*Mann-Whitney test
**statistically significant differences
The study group consisted of 26 men and 78 women. The age of participants ranged from 65 to 89 years (75.8 ± 6.0). A significant majority of the study population (65.4%) were divorced or widows(ers) while 25% of them were married and 9.6% were single. Over half the participants had completed only primary school (51%) or had no formal education (1.9%). The mean length of the hospital stay was 3.2 ± 2.5 days (range 1-8) and the mean number of chronic diseases was 3.5 ± 1.6 (1-8).
Nutritional data according to gender
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
- Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
- Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
- Aby kupić kod proszę skorzystać z jednej z poniższych opcji.
Opcja #1
24 zł
Wybieram
- dostęp do tego artykułu
- dostęp na 7 dni
uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony
Opcja #2
59 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 30 dni
- najpopularniejsza opcja
Opcja #3
119 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 90 dni
- oszczędzasz 28 zł
Piśmiennictwo
1. The Polish Central Statistical Office. The prognosis of the Poland’s population by 2030 [accessed 24 July 2012]. Available from: http://stat.gov.pl/gus/45_648_PLK_HTML.
2. WHO (World Health Organization). 2002. Keep fit for life. [Accessed 10 June 2012]. Avaliable from: http://whqlibdoc.who.int/publications/9241562102_annexes.pdf.
3. Kaleta D, Ruszkowska-Majzel J, Kwaśniewska M, Drygas W: Overweight and obesity as a risk factor of selected chronic diseases – phenomenon characteristic and some elements of preventive recommendations. Kardiodiabet 2007; 2: 19-23.
4. Szymocha M, Bryła M, Maniecka-Bryła I: The obesity epidemic in the 21st century. Public Health 2009; 119: 207-212.
5. Zamboni M, Mazzali G, Zoico E et al.: Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 2005; 29: 1011-1029.
6. Flegal KM, Graubard BI, Williamson DF, Gail MH: Cause-specific excess deaths associated with underweight, overweight and obesity. J Amer Med Assoc 2007; 298: 2028-2037.
7. Heiat A, Vaccarino V, Krumholz HM: An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 2001; 161: 1194-1203.
8. Crogan NL, Pasvogel A: The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol 2003; 58A: 159-164.
9. Miller SL, Wolfe RR: The danger of weight loss in the elderly. J Nutr Health Ageing 2008; 12(7): 487-491.
10. Parnicka A, Gryglewska B: Cancer cachexia and ageing sarcopenic. Gerontol Pol 2006; 14: 113-118.
11. Stefanski JL, Smith KJ: Home Health Care. Manag Pract 2006; 18: 293-299.
12. Hengstermann S, Fischer A, Steinhagen-Thessen E, Schulz RJ: Nutrition status and pressure ulcer: what we need for nutrition screening. J Parenter Enteral Nutr 2007; 31: 288-294.
13. Dudek S: Malnutrition in hospitals: who’s assessing what patient eat? Amer J Nurs 2000; 100: 36-43.
14. Moriguti JC, Moriguti EKU, Ferriolli E et al.: Involuntary weight loss in elderly individuals: assessment and treatment. Sao Paulo Med J/Rev Paul Med 2001; 119: 72-77.
15. Feldblum I, German L, Castel H et al.: Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutr J 2007; 6: 37-46.
16. Bauer JM, Kaiser MJ, Anthony P et al.: The Mini Nutritional Assessment – its history, today’s practice and future perspectives. Nutr Clin Pract 2008; 23: 388-396.
17. Bogus K, Borowiak E, Kostka T: Obesity and low physical activity as important factors determining quality of life of elderly people. Geriatria 2008; 2: 116-120.
18. Chumlea WC, Guo S: Equations for predicting stature in white and black elderly individuals. J Gerontol 1992; 47: M197-M203.
19. Schenker S: Undernutrition in the UK. British Nutrition Fundation Bulletin 2003; 28: 87-120.
20. Bouillanne O, Morineau G, Dupont C et al.: Geriatric Nutritional Risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777-783.
21. Babiarczyk B: Monitoring of nutritional status in elderly care residents. Gerontol Pol 2005; 16: 16-24.
22. Ritz P: Obesity in the elderly: should we be using new diagnostic criteria? J Nutr Health Aging 2009; 13: 168-169.
23. Cook Z, Kirk S, Lawrenson S, Sandford S: Use of BMI in the assessment of undernutrition in older subjects; reflecting on practice. Proc Nutr Soc 2005; 64: 313-317.
24. Chernoff R: Normal ageing, nutrition assessment and clinical practice. Nutr Clin Pract 2003; 18: 12-20.
25. Rosenthal RA: Nutritional concerns in the older surgical patients. J Amer Coll Surg 2004; 199: 785-791.
26. Mowè M: Treatment of undernutrition in elderly patients. Tidsskr Nor L?geforen 2002; 8: 815-818.
27. Marinos E: Obesity in the elderly. Obes Res 2001; 9: 244-248.
28. Kondrup J, Allison SP, Elia M et al.: ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415-421.
29. Panasiuk L, Wdowiak L, Paprzycki P, Lukas W: Occurrence of overweight and obesity among adult rural population in ekstern Poland, relationship between obesity and selected socio-economic factors. Ann Agric Environ Med 2008; 15: 149-152.
30. Jarosz M, Rychlik E: Overweight and obesity among adults in Poland, 1983-2005. Adv Med Sci 2008; 53: 158-166.
31. Dzieniszewski J, Jarosz M, Szczygieł B et al.: Nutritional status of patients hospitalized in Poland. Europ J Clin Nutr 2005; 59: 552-560.
32. Hansen FR, Moe C, Schroll M: Geriatri. 3rd ed., Munksgaard, Kobønhavn, Danmark 2002.
33. Jóźwiak A, Guzik P, Wieczorkowska-Tobis K: Body mass index as a risk factor for in-hospital mortality amongst patients in geriatric department. Gerontol Pol 2005; 13: 266-270.
34. Salvá A, Corman B, Andrieu S et al.: Minimum data set for nutritional intervention studies in elderly people. J Gerontol 2004; 59A: 724-729.
35. Kagansky N, Berner Y, Koren-Morag N et al.: Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr 2005; 82: 784-791.
36. Kuzuya M, Kanda S, Koike Y, Iguchi A: Lack of correlation between total lymphocyte count and nutritional status in the elderly. Clin Nutr 2005; 24: 427-432.
37. Schalk BMW, Visser M, Deeg DJH, Bouter LM: Lower levels of serum albumin and total cholesterol and future decline in functional performance in older persons: the Longitudinal Ageing Study Amsterdam. Age Ageing 2004; 33: 266-272.
38. Onder G, Volpato S, Liperoti R et al.: Total serum cholesterol and recovery from disability among hospitalized older adults. J Gerontol 2006; 61A: 736-742.
