INTRODUCTION
A risk factor is something that increases a person’s chance of developing a diseases or a situation. According to Lee and Berthelot (2010) poor nutrition amongst the elderly is increasing and is associated with impaired muscle function, decreased bone mass, poor wound healing, higher hospital bills and death. Elderly people often have reduced appetite and energy expenditure which is combined with a decline in biological and physiological functions such as reduced lean mass. Many of the diseases suffered by the elderly are the result of poor nutrition for example diabetes and osteoporosis (loss of bone density). Another risk factor related to poor nutrition is the price of foods rich in micronutrients (vitamins and minerals) which further dismays their consumption. Micronutrients play a major role in promoting the elderly’s health and reduce morbidity and mortality rate. As people grow older their immune system become weaker which affect them more often. Specific risk factors that can contribute to poor nutrition amongst the elderly include; medical factors (arthritis and hypertension), social factors (lack of social interaction), lifestyle habits, physical factors (injury) and economic factors (financial issues). Therefore the main focus of this paper is to address the four main risk factors that are associated with poor nutrition among the elderly and the interventions that are used to minimise them both locally and internationally.
Risk Factors of Poor Nutrition of the Elderly and how they Influence Nutritional Status of the Elderly
SOCIAL FACTORS
Social interaction among the elderly people is usually an unnoticed risk factor that can lead to serious illness. Social relationships are an important aspect of a person’s social environment that can protect against a wide range of chronic conditions and ease nutritional recovery. A person’s social context can influence the type and variety of foods consumed in multiple ways. The prevalence of depression in patients aged 65 and older are high as 40% in hospitals, 30 % in nursing homes and 8-15% in community based cares as supported by Tilly (2017). Elderly are liable to depression which is related to poor nutrition and living alone may also be exposed to social isolation, particularly if many of their life-long friends or spouse have died. Eating alone can also affect nutrition by leading to poor appetite (Sheehan, 2017).
FINANCIAL ISSUES
Aging is expensive because one has to go to the doctor every week and get prescriptions that are costly and unexpected hospitalisation which many elderly people cannot afford. Increased cost of food often lead to changes in the quantity and the type of foods that are purchased in households, nutritious foods are expensive and not everyone can afford them. According to Szanton, Thorpe and Whitfield (2010) malnutrition is associated to a deficiency of both energy and protein combined with decreased fat-free mass. Older adults of low socio-economic status can be undernourished even if consuming a high energy diet because the food they eat is lower in nutrient content (not balanced). Many older adults lack regular access to food even with income which is above the poverty line.PHYSICAL FACTORS
Decreased physical activity result in increased body fat and this may lead to decreased energy intake. Injury is also major risk factors that can lead to complications because many of injuries are the result of falls due to decline in skeletal muscle mass which become increasingly more dominant as individual ages. As identified on the website of abacus settlement studies have shown that between 30 and 50 per cent of people in long term care facilities receive fall-related injuries annually and they can be harmful to an individual’s health as they often require hospitalization. Aging is also associated with changes in gastrointestinal system because elderly tends to have a progressive loss in the number of taste buds and remaining with the one which detect bitter or sour taste therefore making them to loss appetite. The number of taste buds begins to decrease at the age of 50 in women and 60 in men, reducing taste sensations and decreasing the sense of smell and making them to eat less which results in difficulty to get all the nutrients they need for good health.
MEDICAL FACTORS
The elderly who only have access to foods with little nutritional value such as fast food, highly processed foods and sugary foods tend to be overweight or obese compared to those who have access to fresher, healthier foods. Obesity can lead to health conditions like heart diseases, diabetes and high blood pressure. The elderly are also at a risk of having weak bones especially those do not get enough calcium in their diets. Calcium deficiency can also prevent broken bones from healing properly. They are also at higher risk for constipation because they do not eat enough fibre-rich foods. According to Guenter, Jensen and Patel (2015); one third of patients who are not malnourished upon admission become so during the hospitalisation and 2/3 have their nutrition status decline during admission.
Interventions with Potential to Minimize Risk Factors of Poor Nutrition in the Elderly
1 Home Based Care Strategies and Rehabilitation Centres
There are senior centres and elderly day-care programs that provide shared meals, making dining an enjoyable social experience that can positively affect the nutrition of an elderly person. Transportation of the elderly person to a facility where elderly people gather for meals daily and helping an elderly person’s minder who visits daily to assist with activities of daily living.
2. Pension and Food Baskets
Food banks and the supplemental Nutrition Assistance Program can help by providing low-income people access to free food. For elderly with disabilities or transport issues meals can be delivered to them (Kirkpatrick & Tarasuk, 2008).
3. Regular Screening
It helps the health care professionals to determine who is at risk of poor nutrition and those found at risk will be assessed. Addressing the risks involve provision of meals, meal enhancements and nutrition supplements. According to Bauer et. al. (2010) as mentioned in the journal written by Tilly (2017); “those receiving home and community based services should receive a quarterly screening and hospital patients should have screening on admission”.
Botswana’s Performance in Providing for Elderly’s Nutrition Needs
Old Age Pension
It is meant for Botswana citizens who are only 65 years and above (elderly) and they have to be registered with pension officers at the District Commissioners Office and Post Offices (where they collect their money). It is used to meet the daily needs of the elderly including the necessary foods to keep their bodies strong. But the problem with the old age pension is that all elderly people are given the same amount without looking at the background of their financial status. Some elderly members do not really need that pension especially those are financially stable; therefore those are have low income (poor) their pensions should be doubled so that they meet their daily needs. The elderly who cannot afford to get their pensions on their own or who have disabilities have proxy (a person who get the money on their behalf) and should be registered by the pension officer. Even though the proxy is registered, the pension officers do not make a follow up if that he/she received their pension which is risky and not a good thing because that elderly person would not be able to meet their basic needs.
Home Based Care
The government provide food basket to the elderly who have chronic diseases to help them sustain their lifestyles. According to the local government the cost of prescribed food basket for elderly patients on oral tube feeding is P1200 per month. These patients are also transported to nearby health facilities for routine check-ups for their nutritional status with the help of a social worker or a nurse. The purpose of home based care is to support the elderly, poor and the vulnerable (destitute) and primarily provide services such as daily meals, social activities to people who need social support. However, the local government give more attention to the elderly who have chronic illnesses only neglecting those who are living alone at their homes (empty nest) but they also need attention because they have depression and they are unable to make their own food or eat nutritious meals.
CONCLUSION
Poor nutrition is associated with decreased bone mass, higher hospital bills that some elderly people cannot afford and higher death rates due to chronic illness. As people grow older they have reduced appetite which leads to reduced lean mass and loss of bone density. Even though these risk factors of poor nutrition are increasing daily amongst the elderly there are interventions or strategies that are used to minimise them both in Botswana and internationally such as rehabilitation centres where the elderly are taken for social meals gathering, screening and assessment, pension funds and home based care strategies. These interventions are not perfectly effective because they do not meet all the basic needs of the elderly. The pension fund is too small to buy foods that are rich in micronutrients that are needed by the body to function well such as Vitamin A (eye-sight), calcium (strong bones and joints) and proteins (tissues and cells). The government should also make sure that every community not districts have offices where the elderly are taken care of without having to travel for long distances since they are a vulnerable group. Another recommendation is that; there should also be routine medical check-ups for every elderly person in the community and more rehabilitation centres where the elderly meet and socialise together, preparing meals and giving each other tips on healthy lifestyle.
