NUTRITIONAL STATUS OF THE ELDERLY IN MALAYSIA: PAST, CURRENT AND - PowerPoint PPT Presentation

NUTRITIONAL STATUS OF THE ELDERLY IN MALAYSIA: PAST, CURRENT AND FUTURE Hanis Mastura Yahya 1 , Suzana Shahar 2 1 Nutritional Sciences Program, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia 2 Dietetics Program, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia

Ageing population  Malaysia is moving towards becoming an ageing country with 14 % of elderly population in the year 2035 • 2010: • 2010: • 2010: 0-14 15-64 27.4% 67.6% 5.0%  65 yo yo yo • 2040: • 2040: • 2040: 18.6% 66.9% 14.5% Source: Department of Statistics Malaysia, Population Projection (Revised), Malaysia, 2010-2040

Introduction  Increase of age  increase of life expectancy  DOSM: Year Male Female 2016 14.8 years 16.9 years 2017 15.0 years 17.1 years  65 th birthday plus the expected year to live  increase the octogenarian population Source: Department of Statistics Malaysia, Selected Demographic Estimates Malaysia 2016

Nutritional status of the elderly

The past  In the early 90’s: reports on health and nutritional observation among elderly in rural populations Malaysia Zaitun & Suriah et al. Shahar et Terry (1991) (1996) al. (2000)    Mean energy intake Mean intake of energy Underweight and & other studied was less than the obesity appear to be recommendation by nutrients were below prevalent  Malaysian RDA except Malaysian RDA. WHR: excess body  Total mean energy for protein & vitamin C fat deposited in the  intake decline with Despite meal intakes, abdominal region the dietary intake was age increment for both sexes. inadequate.

The past  Study among elderly from in 9 publicly funded shelter homes in Peninsular Malaysia (N=1081): Parameters: Findings: • BMI <18.5 kg/m 2 : 14.3% • Survey using questionnaires: • BMI 18.5 to 20 kg/m 2 : demographics, 18.2 % nutritional & cognitive • 26.6% were at high risk status, physical function of undernutrition & psychological well- according to the being. Nutritional Health Checklist Visvanathan et al. (2005)

The past: summary  Increase in mean BMI over time  Majority of Malaysian elderly were still in their normal range of BMI, however, overweight and obesity had preceded underweight  Overweight & obesity at the rise, but reduced with advancing age

Prevalence of underweight & normal was reduced within 10 years period. Prevalence of overweight increased by Prevalence of obesity increased by two folds from 15.6 % (1996)  29.8% three folds from 3.1% (1996)  10.8% (2006) (2006) (NHMS)

The present Author(s) Study Parameters Findings population • Suzana et al. N=4746, elderly BMI & WC In men, prevalence of overweight & obesity were 29.2% & 7.4%  (2012) (NHMS III) decreased with age • In women, prevalence of overweight & obesity were 30.3% & 13.8% • Prevalence of abdominal obesity was 21.4% (7.7%: men & 33.4% in women) • Chen et al. N=236, elderly Weight, Underweight: 17.4% • (2012) resided in height, BMI, Overweight: 28.4% • government- MUAC, WC A significant decline funded shelter anthropometric measurements home elderly at 60- 69 years & ≥80 years.

The present Author(s) Study Parameters Findings population • Shahar et al. N=160, elderly Malnutrition risk & 42.5%: at risk of (2013) Malays in an appetite (MNA-SF & malnutrition • agricultural SNAQ), functional 61.2%: poor appetite • settlement, i.e. status (IADL, EMS & Lower mean scores of FELDA Sungai handgrip strength), IADL and EMS among Tengi, Selangor MMSE, GDS & De Jong subjects at risk of Gierveld Loneliness malnutrition Scale • Singh et al. N=47, A battery of physical Elderly scored poorly on (2014) undernourished performance tests, the physical performance elderly from 2 biochemical profiles, tests, had depression & at residential falls risk, functional high risk of falls. • institutions test & GDS 10.9 % were anemic & 21.7 % were at risk of PEM

NHMS (2015) Risk of malnutrition • Muscle wasting  measured by calf circumference • Prevalence: 20% 60- 65- 70- Normal weight* 75+ 64 yo 69 yo 74 yo • Prevalence: 40.4 to 55.9 % (increase with age) • Highest among elderly (≥75 years old) Overweight* • Prevalence: 27.1 to 35.7% • Highest: 70-74 years old Physically active: 30-60.9 % (reduce with age) Obese* • Prevalence: 6.1 to 20.5 % • Highest: 60-64 years old *Classification by WHO (1998)

Author(s) Study population Parameters Findings • Vanoh et al. N=1993, elderly Socio-demographic, Underweight: 4.7 % • (2016) from 4 states in cognitive Normal: 45.9 % • Malaysia (Perak, function, functional Overweight: 35 % • Selangor, Kelantan, status, dietary Obese: 14.4 % Johor) intake, lifestyle & psychosocial status • Saleh Hudin N=289, elderly Weight, height, food Underweight: 7.6 % • et al. (2017) from (FELDA) at insecurity, Normal: 40.8 % • Lubuk Merbau, depressive Overweight: 36.7 % • Kedah symptoms, stress, Obese: 14.9 % social support & functional status • Zainuddin et N=72, elderly in Anthropometrics Underweight: 15.3% • al. (2017) Klang Valley parameters, socio- Normal: 43.0% • demographic, Overweight: 41.7% • health status, food Abdominal obesity: 75.0% • insecurity, cognitive Pre-frail (58.3%), frail status & frailty (27.8%) & non-frail (13.9%) assessments

Consequences of obesity Low & middle cost housing Increased the risk of area in Cheras: obesity was chronic diseases, the risk factors of mild immobility & frailty 1 cognitive impairment (MCI) among women 3 Physical dysfunction and TUA study: risk factors of are predictive of a cognitive decline, especially decline in functional among women 4 status and future disability 2 1 Houston et al. (2009); 2 Davison et al. (2002); 3 Lee et al. (2012); 4 Won et al. (2015)

Malnutrition  Malnutrition is still a concern: sarcopenia, frailty & pre-frailty Norshafarina et al. Sathasivam et al. Badrasawi, Shahar, & (2013) (2015) Singh (2016) • Study in Cheras • Study in urban • Study in Klang areas Valley • Almost half of the respondents were • Frailty: 5.7 %; pre- • Frailty: 8.9%; pre- sarcopenic  lean frailty: 67.7% frailty: 61.7% sarcopenia (36.3%) • Cognitive function, • Obesity and & obese physical disability physical disability sarcopenia and history of falls were the risk (23.5%). were the risk factors factors

Nutrient intake  Nutrients of concern: Energy, vitamin A, Energy, vitamin A, Energy, B2, B3, B1, B2, B3, calcium, B1, B2, B3, calcium, calcium (Zainorni iron (Azirah & iron (Shahar et al. 1992) Suriah, 1992) 2000) Vitamin B1, B3, folic Vitamin B1, B2 & acid, vitamin E & calcium (Shahar et calcium (Fakhruddin al. (2007) et al., 2016)

The future: challenges  Coexistent of chronic diseases  have effect on nutritional status  Underdeveloped geriatric care: could not meet the rapidly increasing demand  Provision of adequate social protection  financial support, depression & loneliness  Planning & implementation of intervention for the elderly: data on health, nutrition, social, functional, cognitive, physical fitness

Moving forward  The need to change our perspective on elderly Elderly: aged but not helpless

Take home messages  Overweight & obesity is prevalent among elderly.  We need a collaborative effort among multidisciplinary experts to plan and implement sustainable intervention program to improve the health and well-being of the elderly.