© Borgis - New Medicine 1/2008, s. 20-24
*Joanna Wyka, Jadwiga Biernat
NUTRITIONAL KNOWLEDGE AND EATING HABITS OF ELDERLY WOMEN FROM BIG-CITY ENVIRONMENT
Chair of Human Nutrition Department of Agricultural Technology and Storage Wrocław University of Environmental and Life Sciences Head of Chair: Jadwiga Biernat, MD, PhD
Aim: The study was undertaken to evaluate nutritional knowledge and eating habits of women over 60 years of age from the big-city environment.
Material and methods: Nutritional knowledge and eating habits of 234 senior women over 60 years of age from Wrocław were evaluated by means of a direct interview and based on a validated questionnaire elaborated at the Chair of Human Nutrition.
Results: Ca. 91% of the examined senior women claimed that diet exerted a significant effect on human health. Amongst food products recommended for frequent consumption the women included fruits and vegetables (93% of answers), white meat (78% of answers) and dairy products (70%), whereas amongst those from the group – „I consume rarely” the included: red meat (75%) and sweets (74%). The proper number of glasses of beverages drunk daily (i.e.8-9) was indicated by as little as 23% of the subjects. Usually, the women were eating 3 meals a day (47%) and did not salt them additionally on the plate (70%). Ca. 60% of the seniors were using dietary supplements every day (usually of two types). The qualitative assessment of nutrition patterns demonstrated that everyday consumption of milk was declared by 45% of the women, that of fruits – by 75% of the women, that of vegetables – by 80% of the women, and that of non-carbonated mineral water – by 60% of the seniors. Ca. 63% of the women examined evaluated their eating habits as satisfactory. Most of the respondents (85%), however, pointed to the need of nutritional education, dietetic in particular, amongst the elderly.
Conclusion: The level of nutritional knowledge was good in most of the women examined, which has been indicated by answers collected in the survey. In order to improve health status, however, additional intensified health-promoting actions are necessary in the entire population of the elderly people.
Problems of body ageing and also these of nutrition patterns of the elderly are a subject of sample contempo-rary research. This has been affected, to a substantial extent, by the elongation of the average life span of humans observed in recent years. In the year 2000, the number of people over 60 years of age world-wide reached 0.8 mld and is estimated to increase to 1.8 mld in the year 2030 [26,27]. In Poland, in the year 2004 the percentage of people over 60 years of age reached 17% and is forecast to increase to 24%, namely ca. 9.1 millions, in the year 2030 . Likewise in other European countries, the demographic situation of Poland requires undertaking actions aimed at improving living standards in the basic spheres of social life in that age group [10,24].
The proper nutrition patterns of people in advanced age are one of the factors affecting, to a significant extent, both their nutritional and health status. They determine the apt functioning of the body as well as are likely to contribute to delayed occurrence of symptoms of the ageing process [20,21]. The elderly people, with their preferences and diseases recovered, often necessitate additional, intensified dietary intervention. There is a number of factors that affect the nutrition patterns of humans, including: educational status, mode of live and work, bearing stress, financial status as well as nutritional knowledge and eating habits. Comprehension of the effect of those factors is significant due to both the possibility of assessing the risk of diet-dependent diseases and their prevention. Some behavioral factors, i.a. tobacco smoking, alcohol abuse, incorrect eating habits and low physical activity, may be subject to modifications through an apt change of lifestyle [6, 19].
An overview of domestic and international literature points to a number of irregularities linked with the process of nutrition observed amongst the elderly [2,4,9,18]. Most of people of that age group have insufficient nutritional knowledge and make numerous mistakes in their eating habits, which is in turn reflected in their health status .
A study was undertaken, therefore, to evaluate nutritional knowledge and eating habits of women over 60 years of age living in the city of Wrocław.
Material and methods
In March and April of 2007, a survey was conducted in three Seniors Clubs and one selected clinic to evaluate the nutritional knowledge and eating habits of 234 elderly women from the city of Wrocław.
Eating habits were evaluated by means of the direct interview method. The interview questionnaire consisted of three parts. The first one referred to socio-demographic data and lifestyle, it additionally comprised ten questions linked, among others, with: personal data, economic status, evaluation of physical activity, potential problems encountered by the respondents in everyday life, and possibilities of spending free time. The second part of the questionnaire entitled "Nutritional knowledge and eating habits” included eighteen detailed questions about, i.a.: level of the nutritional knowledge of the respondents, frequency of consumption of particular meals within a day, type of diet applied, the use of table salt and sugar as well as the application of commercially-available dietary supplements. The third part of the questionnaire – „Nutrition history” comprised questions referring to consumption frequency of selected food products as well as nutritional preferences and likings of the respondents. Data on the customary nutritional patterns were obtained based on answers to 62 questions.
Validation of a self-constructed questionnaire
Reliability and repeatability of results obtained with the use of the self-constructed questionnaire were evaluated with the validation method. The suitability of a given method was evaluated by determining correlation coefficients as well as indices of sensitivity and specificity . A statistical analysis of results was conducted with the use of "Statistica 8” software, a chi2 test and Spearman´s correlation.
In the evaluation of the reliability of the questionnaire used in the study there participated 27 women who filled in the same questionnaire twice in a two-week interval. Individual variability, indicating the repeatability of answers obtained for the same respondents in the first and second questionnaire, was verified by determining coefficients of Spearman correlation ®. In turn, inter-individual variability was evaluated with the use of the chi2 test (at a significance level of p=0.05), by comparing mean frequencies of the traits examined for the entire group in the first and second interview.
A comparison of the results obtained in the first and second questionnaire survey did not demonstrate any significant differences in the answers provided. The percentage of answers consistent in both questionnaires reached 96.2%. The obtained high coefficient of Spearman correlation (r=0.77) pointed to a low intra-individual variability and to a good repeatability of the results achieved. Due to diversity of questions included in the questionnaire, the consistency of answers and correlation coefficients were determined separately in the three parts of the questionnaire. In the part referring to the socio-demographic data and lifestyle the percentage of consistent answers accounted for 98.7% and the Spearman correlation coefficients varied between r=0.47 and r=0.93. In the second part of the questionnaire referring to the nutritional knowledge and eating habits the correlation coefficients ranged from r=0.41 to r=0.93. In turn, the consistency of answers in that part of the questionnaire accounted for 95.9% and in the last part referring to the history of nutrition – for 95.8%.
A lack of differences (statistically insignificant p value) determined with the chi2 test and high coefficients of Spearman correlations obtained for both the questionnaires indicated low intra-individual as well as inter-individual variability. It enables classifying the self-constructed questionnaire used in the evaluations of the nutritional patterns of the elderly as a suitable tool for both individual and collective assessment.
Lifestyle of women under study
In the study, the highest percentage of women were at the age of 60-75 years (64% of the subjects), next those at the age of 76-85 years (32% of the subjects), and 4% of the subjects were over 86 years of age. Amongst the women surveyed, 21% had primary education, 14% – vocational education, 44% – secondary education, and 21% – higher education. In majority of respondents (88% of the subjects) the main source of income was retirement pension, for 10% of the subjects – state pension, and for 2% of the women – salary. Ca. 34% of the women declared their monthly income in the range of 701-1000 PLN, and 14% – in the range of 501-700 PLN, whereas 52% of the respondents declared their earned incomes to exceed 1000 PLN. Ca. 45% of the elderly women examined declared that they lived with their closest family (i.e.: with wife/husband/children or grandchildren), whereas the other women lived alone without the help of other persons (38%) or alone but with the help of other persons (9% of the subjects).
Amongst the women surveyed, the most often form of leisure activity was the so-called "passive rest”. In the questionnaire, the women could choose 3 out of 7 possible answers; most often they chose reading newspapers and books (63%) as well as watching TV (51%). Half the women evaluated the level of their physical activity as average, 36% as active, and 15% as non-active. Most of the respondents (72%) did not encounter any problems while doing shopping. In the other group of the elderly women the greatest difficulties included: carrying a shopping basket, climbing stairs and reading out the price specified on a product.
Nutritional knowledge and eating habits
Most of the respondents claimed that the level of their nutritional knowledge was good (63%), or sufficient (25%). Worthy of notice is the fact that none of the elderly women surveyed evaluated their nutritional knowledge as bad, whereas 12% of the women declared to have very good knowledge of nutrition. Once asked about the source of information on nutrition (3 answers could be chosen) the women declared: own experience (63%), the press (53%), and TV programmes (34%). To a small group of women (ca. 10%), the source of nutritional knowledge were either nutritional courses or workshops or labels of food products.
In the survey, the respondents were also asked about their opinion on the necessity of introducing programmes of nutritional educations amongst seniors. Ca. 85% of the women found the nutritional education for the elderly necessary since nutrition has a significant impact on health (91% of positive answers). A lack of any relationship between nutritional patterns and health status or "I do not know” answer were confirmed in 3% and 6% of the respondents, respectively.
The application of diet was declared by 43% of the seniors. It usually resulted from the necessity of adjusting their diets to disease entities they suffered from. A therapeutic diet used most often by the women surveyed was: a diet applied in arterial hypertension (21 of the seniors) or in diabetes (26 of the seniors) as well as an easily digestible diet (34 of the seniors).
The women were also asked to answer a question about the use of dietary supplements. The answers collected demonstrated that dietary supplements were applied by 43% of the women. The reasons of taking the supplements were mainly their benefits emphasized in TV advertisements or in a pharmacy (31% and 20% of answers, respectively), whereas dietary supplements prescribed by a physician were taken by 25% of the women. Most of the respondents (61%) declared taking vitamin preparations (including vitamin C, B complex, vitamin B12). The second preferred type of dietary supplements were complexes of vitamins (i.e. Centrum, Biovital), applied by 38.3% of the women.
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