Assessment of nutritional and functional status of patients attending the geriatric clinic of a tertiary care hospital in Gujarat, India.

Abstract

The geriatric population is increasing rapidly in developing countries. India and China are the main contributors to this rise in Asia.(1) It is estimated that by 2050, about 53% of the total world population aged more than 60 years will be living in these two countries.(2) In India, where there is inadequate income and no social security, older persons often find it difficult to support themselves. The impact of population ageing is already affecting India.(3) A great number of older individuals require long-term care, and the old age dependency has increased. In addition, the steady decline of the traditional support system of the joint family has put a strain on their overall health and well-being. The increasing elderly population poses a definite challenge to the country’s healthcare system. It has become essential to ensure good nutrition in older people so that they can lead an active and independent life. Studies have shown that undernourished older people require more hospitalisation and prolonged hospital stays as compared to well-nourished individuals.(4,5) This can be prevented by early and periodic nutritional and functional assessments of the elderly population. A useful tool that is standard and validated is the Mini Nutritional Assessment (MNA).(6,7) The MNA includes six components for screening: decreased food intake; weight loss and psychological stress/acute disease in the last three months; mobility; neuropsychological problems; and body mass index (BMI). It also includes 12 components of assessment: living independently; taking more than three prescription drugs per day; pressure sores; number of daily full meals consumed; daily protein intake; daily fruit/vegetable intake; daily fluid intake; mode of feeding; self-view of nutritional status; self-perception of health status; mid-arm circumference (MAC); and mid-calf circumference (MCC). The MNA is a simple tool consisting of an easy questionnaire that only takes a few minutes to complete. In patients who have malnutrition or are at risk of malnutrition, nutritional intervention can be instituted early so as to improve quality of life. The physical and cognitive abilities that are needed for a geriatric patient to live an independent life can be comprehensively evaluated through functional assessment. This includes evaluation of daily activities, cognition, mobility, and bladder and bowel continence. Specific tools and scales can detect moderate impairment of functional capacity in an older person, which is very significant because it may indicate the beginning of a disease. Geriatric patients have multiple problems that are often difficult to recognise clinically. Thus, structured assessment of functional status is essential in the elderly, not only for diagnosis but also for comprehensive management.(8,9) Tools available include the Barthel Index for activities of daily living (ADL), Katz Index of Independence in ADL, and instrumental ADL (IADL) scales such as the Lawton-Brody IADL scale. Additionally, muscle strength or physical performance can be measured using simple and easily available instruments such as sphygmomanometers or mechanical dynamometers. Assessing hand grip strength using a sphygmomanometer helps in identifying elderly people who are at risk of functional disability.(10,11) There is a paucity of data regarding the nutritional and functional status of the geriatric population from the western part of India. Thus, this study was undertaken with the goal of assessing the nutritional and functional status of these geriatric patients and to find a correlation between the two, if any.