Background to the Study
Ageing is not a disease, and getting old and getting sick are two different things. Ageing is a dignified honour for those who are lucky enough. In the early 19th century, even in the richest countries, there were fewer older people, but today, older adults form the fastest growing population group on earth (Crimmins, 2004). Each month, one million people worldwide are reaching the age of 60 years (Nakejima, 1997). By the year 2030, it is estimated that in many countries one out of every five people will be 60 years or older, and more than two-thirds of the world’s population of over 100 million older people will be living in developing countries (Truelsen, Bonita & Jamrozin, 2001).
Presently, the actual age used in determining an older adult differs among researchers. Some considered an older adult at age 60 years and above (Palloni & McEniry, 2007). Others held that an older adult is one aged 65 years and over (Nutrition Insight, 1999). The United Nations World Assembly on Ageing held in Vienna in 1982, used 60 years and over as the cut-off age in deliberating ageing trends (World Health Organization – WHO, 1998a). In Australia, the country with the largest number of older people in the western world, old age commences at 60 years and old-old is 75years and over (National Institute on Ageing, 2001). Given the above facts, an older adult in the present study is considered as one aged 60 years and above. The categories of older adults are set at ten years age brackets as follows: young old 60-69years; old –old, 70-79years; and oldest old, 80 + years. No two older adults are comparable in functional ability, strength and health. They differ in the way they age, and this lends credence to the complexity of ageing process.
Ageing is operationally defined as a period of time one has lived, usually counted by years, and characterized by decline in functional ability, whether in physical, social or mental dimension. It has a connotation of deterioration of vitality. Biologically, ageing is accompanied by harmful physical changes commonly described as senescence. Austaad (2002) defined senescence as the progressive deterioration of virtually every bodily function over time.
The biology of senescence emphasizes that the ageing process is complex and dynamic. The human body consists of millions of cells, each with a lifespan of about two years (Eugene & Grant, 2001). Before a cell dies, it reproduces itself about fifty times. With each successive reproduction, the cell goes through some alteration, which basically causes cell deterioration. As cells deteriorate, there is corresponding decline in physiological function, particularly in organs composed entirely of post-mitotic cells, with no opportunity for repair or renewal. Typical example is the nerve cells. When they die, they cannot be replaced (Ross & Wilson, 2001). The rate of cell loss or deterioration increases with age, hence ageing is caused by degeneration of cells. Medina (2002) explained that from head to toe, from proteins to DNA, and from birth to death, untold battalions of processes unfold themselves to create the ageing of a 60-trillion- celled human.
However, ageing is an intrinsic process accompanied by variety of physiological changes that particularly affect the mouth, gastrointestinal tract and sense organs. According to Matteson (1997), the mouths of older adults are characterized by gum disease, loss of teeth, and reduced secretion of saliva. Their gastrointestinal tracts have insufficient secretion of hydrochloric acid and digestive enzymes. These changes negatively impact on the older adults’ desire to eat or his body’s ability to absorb and assimilate nutrients. Perry (1995) found that reduced secretion of digestive enzymes in the mouth, stomach and pancreas led to poor digestion and poor absorption of proteins and minerals including iron, calcium and zinc. In addition, insufficient stomach acid allows the overgrowth of bacteria in the small intestine and reduces the absorption of vitamin B12. Studies (Taylor, Gowman & Quigley, 2003, Abaaba, 2004) showed that older adults are at greater risk of developing certain nutrient deficiencies, which can affect their nutritional status.
Nutritional status is the balance between the intake of nutrients by an organism and the utilization of these in the process of health maintenance (Odenigbo, Odenigbo & Oguejiofor, 2010). Operationally, nutritional status is the measure of the body’s state of nutrition as characteristically marked by nutrients availability to cells and efficiency of nutrients utilization for active and healthy ageing. This implies that one can feed well but still have poor nutritional status if the nutrients from the food eaten are not made available to the cells, and if utilization of nutrients by the body is impaired either by drug or functional abnormality. The process is quite complex and individualized. Nutritional status assessment can be done using different methods such as Body Mass Index (BMI), clinical examination, biochemical examination, anthropometry, questionnaires and checklists. The anthropometric method which involves the measurement of mid-upper arm circumference (MUAC) to determine the nutritional status of an individual is an easy – to – use method because it requires only a tape measure. The MUAC is a more appropriate tool for determining the nutritional status of older adults than the BMI because of changes in their body composition and kyphosis. Kyphosis is a postural defect characterized by curvature of spine which makes it difficult for one to stand erect. Among the older adults, nutritional status assessment is required to identify the population segment at risk for nutrition-related health consequences and to recommend interventions. The nutritional status assessment entails the measurement of certain parameters of the human body to determine the nutritional status of an individual. The present study was concerned only with the measurement of mid-upper arm circumference (MUAC) of the older adults using a tape to determine their nutritional status.
As population age, there is need to ensure that more people not just reach old age but do so in good health, joy and assured capability of contributing to society intellectually, spiritually and physically (Okafor, 2001). To achieve this, proper nutrition in old age is vital. According to the Human Nutrition Research Centre on Ageing (2004}, nutrition is the study of the process by which an organism assimilates and uses food and liquid for normal functioning, growth, and maintenance, and for balance between health and disease. There are vital reasons for nutritional concern in old age. Previous studies (Manandhar, 1995; Mahan & Escott-Stump, 1996) showed that proper nutrition can slow down the ageing process and even prevent many debilitating conditions such as heart disease, osteoporosis and diabetes. People whose diet is rich in vegetables live longer and are healthier (Lowenberg, Tophunter, Wilson, Savage & Lubawski, 1999). Moreover, almost one half of the health problems in the elderly is related to diet and can be prevented through proper nutrition (Stookey, Zhai & Popkin, 2002). Furthermore, it is obvious that for the cells of the body to function efficiently the essential nutritional substances (carbohydrates, proteins, fats, vitamins, mineral salts, water and roughage) must be available to the body in their correct proportion. The macro-nutrients (carbohydrates, proteins and fats) are usually broken down by process of digestion into simpler forms (glucose – for energy production; amino-acid, for building and repairing of tissues; and fatty acid and glycerol for providing heat and energy) and used up for metabolic processes. Except for those older adults who are ill, the macronutrients needs for them do not differ from that of the younger adults, but the needs for some micronutrients do (Foote, 2000). The micronutrients are basically minerals and vitamins. To the older adults, the right foods for both weight control and nourishment are the more complex carbohydrates, fruits, vegetables and proteins, preferably fish and fowl.
Older adults in Akwa Ibom State do not seem to choose their foods adequately to meet up with the Tuft University (2002) recommended food requirements for older adults. Ageing characteristics might be responsible for their food choice problem. Ageing characteristics are those ageing-induced or ageing-associated changes that may directly or indirectly influence the physical, mental and social functioning of an older adult. Some ageing characteristics such as reduced respiratory function, decline in cognitive function, impaired immune function, increased susceptibility to infection and increased risk of heart disease and cancer might be responsible for their food choice problem. In addition, the decline in functional mobility, sensory function (vision, hearing, taste) and alteration in oral physiology with a compromised dentition, chewability, oral sensitivity, tongue function, salivary secretion and deglutition, as outlined by William (2002), might also impact on dietary practices and health status of older adults in Akwa Ibom State.
The term “impact” as used in this context, is synonymous to effect, and closely associated with the term “influence”. It denotes the effect or influence that something has on the other. An impact study, according to Mindell and Joffe (2004), is a research done on a certain topic to determine if certain variable would have or is, having some sort of effect on other related variables. Health impact is assessed by taking stock of some potential health problems, and determining their effects on the overall well-being or health status of the affected population. The assessment of impact of ageing characteristics on dietary practices (food choices, eating habits, nutritional intake) and health status of older adults is important because the result may influence their decision making to minimize the harm and maximize the health benefits of the affected population.
Kochler and Leonhaeuser (2008) explained that in old age, food choice is determined by the changes in the chemosensory systems (e.g. altered taste and smell), medical problems and illnesses and dental state. In addition, lifestyle, socio-economic situation, social framework (interpersonal relationship and social roles including companionship associated with food choice), food context (the physical surroundings and cultural environment of the food choice setting), and psychological factors such as loneliness and depression influence dietary practices (Falk, Bisogni & Sobal, 1996; Conners, Bisogni, Sobal & Devine, 2001).
Dietary practices, according to Bustos and Talavera (2003), refer to the manner by which food is selected, purchased, prepared and consumed including food habits and food beliefs. In this context, dietary practices refer to those practices associated with food choices, eating habits and nutritional intake by older adults.
The term ‘food choice’ denotes an indication that among two or more food alternatives that are presented together in a given time and context, certain options are more desirable than others. Food choice is the willful preferential selection of a particular food among available alternatives at a given time, but dictated by factors such as taste, health, nutrition, convenience, time, effort, price, and traditional beliefs (Ibok, 2007). Falk, Bisogni and Sobal. (1996), in their study on food choices of the elderly in United States, found that older people kept to old customs in food choice decisions. Beside food choice, the assessment of the eating habits of older adults, which was done in the present study, is equally important.
Eating habits offer information on how well nutrients are consumed. The term eating habit, according to Rodrigez (2007), refers to why and how people eat, which foods they eat, and with whom they eat, as well as the ways people obtain, store, use and discard food. In the present context, eating habit is defined as the way and manner people eat food, including their meal scheduling and frequency of eating. Eating habit could be ascertained by assessing the period of time that a specific meal is eaten (e.g. late breakfast, eating at night); the regularity or frequency of eating meals (breakfast, lunch and dinner) per day; the consistency of eating each meal (i.e. whether or not a meal is skipped per day); and the quantity of food eaten (much or less) at every meal. This study utilizes similar approach to determine the eating habits of older adults in Akwa Ibom State.
Eating a variety of foods from different food groups and in their proper proportion enhances good nutrition and health. Igbanugo (2007) stated that no single food group supplies the essential nutrients in the proper proportions to maintain health, but a food plan that includes the suggested number of servings from different groups furnishes the nutrients needed for an adequate diet.
The Food Guide Pyramid developed by Tufts University (2002) offers the recommended dietary guidelines to help people, including older adults eat adequate diet. The apex of the pyramid contains foods rich in fats, oils and sweets, which the older adults are advised to use sparingly. Next group contains foods that are rich in proteins – milk, meat, fish, eggs, cheese, yogurt, beans and nuts, which the older adults are to eat two to three servings daily. The next food group contains fruits and vegetables, which mainly supply the body with vitamins and minerals. The older adults are to take 3-5 servings of fruits and vegetables daily. In the carbohydrate food group (bread, rice, cereals, roots, tubers, pasta), the older adults are to take 6-11 servings daily. The base of the pyramid has eight glasses of water, and the older adults should take that quantity of water daily.
The nutritional concern in relation to health status of older adults in this century has been remarkably noticed. In public health and community medicine, much attention is focused on reducing the risk of diseases and health problems prevalent among older adults. The United States Department of Agriculture (USDA), Human Nutrition Unit (2002) found a strong correlation between inadequate food intake and poor health status among elderly people. The food intake was measured by collecting a 24-hour dietary recall. Health status was measured through self-reported health status questionnaire. Health status is defined as the level of health of the individual, group or population as subjectively assessed by the individual or by more objective measures (Bergner, Bobbit, Carter and Gilson, 1981). These measurements (24-hour dietary recall and self-reported health status questionnaire) were utilized in this study to determine the nutritional intake and health status of older adults respectively.