Situational analysis of free-living elderly in Umlazi township
Mkhize, Nkumbulo Xolile
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The objective of the study was to conduct a situational analysis of elderly people on state pension living in Umlazi, KwaZulu-Natal South Africa. The research focused on the socioeconomic status, dietary intake, nutritional status, and health status of this community. Methodology The sample comprised 270 (224 women and 46 men) randomly selected elderly people within the 12 wards of Umlazi. The methods used for assessment included a sociodemographic questionnaire which determined the socioeconomic status. A 24-hr recall questionnaire and food frequency questionnaire were used to determine dietary intake, while anthropometric measurements were conducted to determine the nutritional status. A health questionnaire, including a salt administration questionnaire was used to determine the health status of the elderly in this community. Trained field workers and nurses assisted in data collection and food consumption data was captured and analysed by a qualified dietician using Food Finder version 3.0 computer software program. Descriptive statistics (frequencies, means, standard deviations and confidence intervals) were determined with the assistance of a bio-statistician. Socio-demographic and health data were captured onto an Excel(R) spreadsheet by the researcher. These questionnaires were analysed using the Statistical Package for Social Sciences (SPSS) for Windows version 17, 0 software program. Results The majority of respondents lived in brick houses (84.8%) and the living space generally consisted of more than three rooms (87.4%). However, the majority of respondents who lived with >4 to 10 members were 67.4% whilst only 32.6% of households consisted of less than 4 members. The mean household size was 5.1 (±SD 2.9) people, this further illustrates that the majority of respondents lived with 5 people per household. Grandchildren were present in 70% of the households with a mean of 3 (±SD 5) grandchildren in each household. Results also indicate that 84.6% of the elderly were the bread winners in these households. The vast majority of 87.8% of the population had no other source of income. The majority of vi Pagevi respondents with an income had a total monthly income of R500- R1500 (82.9%) followed by R1501- R2500 (14.1%) and only 3% had more than R2500 total income. Food expenditure for most (80%) households was >R500 of the total income. Food shortages due to limited income were frequent in 54% of households who regularly experienced this problem, whilst 26% sometimes experienced shortages, 15.4% often encounted shortages whereas 2.6% encounted shortages seldomly and 2.2% never. A large majority of respondents owned electrical assets, the most commonly owned included a televison (80.3%) , a radio (75.5%) and a refrigerator (75.1). The majority of food items consumed were carbohydrate based and the portion sizes were relatively big, on average 1348.5g per day. The energy contribution from carbohydrates was 65% which is considered to be on the high side (WHO goals 55-75%). Protein intake was fairly common, with a 15% contribution to energy from total protein (WHO goals 10-15%). The frequency of vegetable and fruit intake was very low, the portion sizes were also small and did not meet the recommended daily intake. The energy contributions showed that 89.2% of the women consumed a diet that supplied <100% of Estimated Energy Requirements (EERs) and all the men consumed <100% of the EERs for energy. Sixty three percent of the women and 91.1% of the men consumed <100% of the EARs for protein. The mean carbohydrate intake in the sample was significantly higher than the EAR but the women consumed <100% of the EARs for carbohydrates (4.1%) and all men consumed >100% of the EARs. The majority of the vitamins for both genders indicated low intakes except for vitamin B12 and B6 in the case of men only. The majority of minerals indicated low scores for micronutrients except for iron (36.6% for men) and potassium (39.0% for men) which was consumed mostly by men than women. The mean Food Variety Score (FVS) (±SD) for all the foods consumed from all the food groups in a period of seven days was 25.8 (±14.6). The results revealed poor dietary diversity scoring. The cereal group had the highest mean variety score 5.3 (±2.5) followed by vegetables 4.5 (±2.6), fruit 3.5 (±3.1), flesh foods 3.2 (±1.6), vitamin A-rich fruit and the vegetable group 3.1 (±1.7). The anthropometric indices indicated that the mean age was 69.7 years (±SD 7.1) and mean weight of 76.5 kg (±SD 17.3). The BMI scores for the total group indicated that 52% of the respondents fell into the obese category (BMI = obese 1 >30, obese 2 >35 and obese 3> 40) and 24% of the respondents were overweight (BMI = 25-29.9). Only 20% were of moderate weight (BMI 18.5- 24.9). Although more men were overweight (34.2%) compared to 21.9% vii Pagevii of women, more women (60.1%) were obese compared to men (18.8%). The majority (83%) of the women were above the cut-off points for waist circumference ( 88cm) and 17% were within the normal values whilst 74% of the men were within recommended cut-off points ( 102cm) and only 26% exceeded the recommended scores. The results indicate that 77% of respondents were at risk of developing metabolic syndrome exceeding >0.5 waist-to-heightratio (WHTR) and 23% were at lower risk. However, the women showed a higher risk of 87.4% and men only 47.9% for metabolic risk. The correlation was significant at the p=0.01 level. There was thus as highly significant relationship between BMI and WHTR ratio for women. The health survey results indicated that 90% of the elderly population were in various stages of hypertension and 6% showed signs of developing hypertension. However, hypertension was more prevelant in women (91%) than in the men (83%). There was a statistical significant correlation (p=0.01) between waist circumference and systolic pressure for both women and men. A high percentage (82%) of the participants reported that they were currently on chronic medication whereas 18% were not using any chronic medication at the time. Although hypertension was prevalent in most respondents, it was followed by self reported diabetes (26.7%) and cancer (1.9%). Results show that elderly experienced problems with following ereas in the body skeletal joints (72.6%) as well as eyes and teeth were problematic in 75.9% of the respondents, followed by skin problems (29.6%) and ears and nose problems (28.6%). Results in the salt administrative questionnaire indicate that sodium intakes were below WHO goals <2000mg. Results also show that a high percentage of respondents (60%) generally never added salt to cooked food as the majority saw it as a health risk. Only 13% added it always to cooked food and 21% added it sometimes. Conclusions The results in the study indicate the high prevelance of poverty, food insecurity and poor nutritional and health status that compromises the quality of life of elderly living in this community. Recommendations Long-term intervention studies must be prioritised to address economic, health, social and demographic factors and future research is needed to cater for the growing needs of this population group.