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Self-Perceived Health and Nutritional Status among Home-Living Older People: A Prospective Study
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim was to follow the development of nutritional status and its significance for general health status using an epiemiologic method in a representative population‐based selection of older individuals in two cohorts. The main focus was to prospectively examine the significance of demographic, social and medical factors and to establish a basis to investigate the possibilities of preventive measures.

Methods: Five hundred and eighty‐three individuals (278 women and 305 men), 75 and 80 years old, when included, living in a municipality in Östergötland in Sweden, participated in this study. Data collection took place 2001‐2006 with one examination yearly. The examination included a single question regarding self‐perceived health demographical questions, different questionnaires in the areas of nutritional status, symptoms of depression, cognitive function, health‐related quality of life and well being and objective assessments such as anthropometrical, physical and biochemical measurements.

Results: Fifty percent of the women (I) and 58% of the men (II) perceived themselves as healthy. Important factors for women’s health (I) at baseline were no or few symptoms of depression, better physical mobility and better physical health. Among men who perceived themselves as healthy (II) at baseline, important factors were better physical health, maintaining a social network and the ability to walk outdoors. After one year 69% of the women and 75% of the men still perceived themselves as healthy. Among those women (I) who perceived themselves as healthy after one year, better physical mobility and better physical health were still important, with the addition of less or no pain. Important predictors for preserving health among men (II) were no symptoms of depression and the ability to walk up and down stairs. The prevalence of risk for malnutrition (III) was 14.5% (n=84), among women 18.8% and men 10.6%. Risk factors for malnutrition at baseline were a lower TSF, lower handgrip strength and worse physical health according to the PGC MAI. The incidence was 7.6%‐16.2%, and was distributed equally among women and men over time. Predictors for developing malnutrition were lower self‐perceived health, increased number of symptoms of depression.  Especially men with symptoms of depression ran a higher risk. Reported energy intake (IV) was low in relation to the estimated requirement, on average 74% among women and 67% among men. Intake of vitamins A, D, E and folate was below the recommended intake and the same pattern was found over time. A smaller weight loss was found among women and men from baseline to Follow‐up 2.

Conclusions: The experience of a good physical health was the only common factor for a good self‐perceived health among women and men. The highest risk for developing malnutrition was a combination of impaired self‐perceived health and increased number of symptoms of depression.

Clinical implications: A combination of nutritional status, self‐perceived health and symptoms of depression can be a base for clinical judgement and can be used by different professionals in ealth and medical care and in home care service.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1154
Keyword [en]
Energy intake, Gender, Health Physical activity, Risk for malnutrition, Symptoms of depression
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-51276ISBN: 978-91-7393-511-1 (print)OAI: oai:DiVA.org:liu-51276DiVA: diva2:273934
Public defence
2009-11-06, Berzeliussalen, Hälsouniversitetet, ingång 65, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-11-06 Created: 2009-10-26 Last updated: 2010-05-03Bibliographically approved
List of papers
1. Self-perceived health among older women living in their own residence
Open this publication in new window or tab >>Self-perceived health among older women living in their own residence
2007 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 2, no 2, 111-118 p.Article in journal (Refereed) Published
Abstract [en]

Aim. The aim was to characterize women who perceived themselves as healthy and to compare them with women who perceived themselves as less healthy with regard to demographical, social, medical and functional factors. Another aim was to describe changes within the healthy group after one year.

Background. Self-perceived health is influenced by several factors, of which diseases and illness are only a part.

Method and participants. Two hundred and seventy-eight women, 75 and 80 years old, of which 50% (n ¼ 139) perceived themselves as healthy and less healthy, respectively. Data were collected by using the Nottingham Health Profile, Geriatric Depression Scale, Mini Nutritional Assessment, Mini Mental State Examination and Philadelphia Geriatric Center Multilevel Assessment Instrument, in two examinations at intervals of one year.

Results. The women in the healthy group were characterized as having no or low depression symptoms (P ¼ 0.016), better physical mobility (P ¼ 0.029) and better physical health (P < 0.001). Furthermore no or less pain, fewer doctor visits, more energy and fewer negative emotional reactions were predictors for self-perceived health in the healthy group at the one-year follow-up.

Conclusion. The most important predictors associated with perceiving oneself as healthy were no or few depression symptoms, physical mobility and good physical health.

Relevance to clinical practice. Attention has to be paid to women’s mood, physical health, mobility, pain and energy to help them stay healthy.

Keyword
Activity, illness, older people, quality of life, women's health
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-38801 (URN)10.1111/j.1748-3743.2007.00058.x (DOI)45681 (Local ID)45681 (Archive number)45681 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
2. Self-perceived health among older men living in their own residence: a four year follow-up study
Open this publication in new window or tab >>Self-perceived health among older men living in their own residence: a four year follow-up study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This study characterize older men, who perceived themselves as healthy, with focus on demographical, social, medical and functional factors, and describe changes within the healthy group over time and find predictors of self-perceived health. The study has a prospective design and included 303 men, 75 and 80 years old, living in a municipality in the south of Sweden. Data collection took place 2001-2006 in a total of three – five examinations at an interval of one year. The examinations included questionnaires validated and tested for reliability, assessing the nutritional status, (Mini Nutritional Assessment), symptoms of depression (Geriatric Depression Scale-20), cognitive function (Mini Mental State Examination), health-related quality of life (Nottingham Health Profile), wellbeing (Philadelphia Geriatric Centre Multilevel Assessment Instrument), demographic factors, physical- and biochemical assessments. The men were divided into two groups according to their self-perceived health, 58% (n=175) perceived themselves as healthy and 42% n=128) as less healthy. Good physical health, the ability to walk a distance outdoors, an ability to maintain a social network and having energy were factors important to feeling healthy among men at baseline. Analyses at the follow-ups included men whom still perceived themselves as healthy and men who perceived their health as being impaired. Seventy five percent (n=132) of the healthy group at baseline still perceived themselves as healthy at the first follow-up. Important factors for a self perceived good health when growing older were feeling mentally well and being able to walk up and downstairs. These results indicated that areas representing the individuals own perception and ability are important to feel healthy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51551 (URN)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2010-01-14Bibliographically approved
3. Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study
Open this publication in new window or tab >>Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study
2009 (English)In: JOURNAL OF CLINICAL NURSING, ISSN 0962-1067, Vol. 18, no 9, 1354-1364 p.Article in journal (Refereed) Published
Abstract [en]

To prospectively investigate and describe the prevalence and incidence of malnutrition among home-living older people, related to demographic and medical factors, self-perceived health and health-related quality of life. Another aim was to find predictors for developing risk of malnutrition.

Risk factors for malnutrition have previously been identified as diseases, several medications, low functional status, symptoms of depression and inadequate nutrient intake. Most studies are cross-sectionally performed at hospitals or in nursing care settings.

A prospective study with a sample of 579 home-living older people, randomly selected from a local national register. Examinations were performed at baseline and yearly follow-ups two to four times.

Questionnaires validated and tested for reliability, to detect risk of malnutrition (Mini Nutritional Assessment), symptoms of depression (Geriatric Depression Scale-20), cognitive function (Mini Mental State Examination), health-related quality of life (Nottingham Health Profile), well-being (Philadelphia Geriatric Center Multilevel Assessment Instrument) self-perceived health, demographic factors, anthropometry and biochemical examinations. Predictors were searched for through multiple logistic regression analysis with the MNA as dependent factor.

The prevalence of risk for malnutrition was 14.5%, according to the MNA. Two risk factors for malnutrition were lower handgrip strength and lower self-perceived health. The incidence of risk for malnutrition at follow-ups was between 7.6% and 16.2%. Predictors for developing malnutrition were higher age, lower self-perceived health and more symptoms of depression. Men with symptoms of depression had a higher risk of developing malnutrition.

Lower self-perceived health had the highest power to predict risk for malnutrition, with increased number of depression symptoms and higher age as second and third predictors.

A regular and combined assessment using the Mini Nutrition Assessment, Geriatric Depression Scale-20 and self-perceived health as a base for identifying people in need, is one way to prevent the development of malnutrition.

Keyword
Assessment, daily activities of living, depressive symptomatology, elderly, nutrition, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18028 (URN)10.1111/j.1365-2702.2008.02552.x (DOI)
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2009-11-06Bibliographically approved
4. Self-reported energy and nutrient intake among older people: a two year follow-up study
Open this publication in new window or tab >>Self-reported energy and nutrient intake among older people: a two year follow-up study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: The aim was to investigate older people’s energy intake regarding macro- and micronutrients, related to nutritional status, symptoms of depression, self-perceived health and demographical factors, and describe possible changes of energy intake during a period of two years.

Method: The study included 115 individuals 80 years-old who performed a yearly 24h recallvof food intake, a total of three times. Energy requirement was estimated using weight, agevand gender and a Physical Activity Level of 1.6, and the Nordic Nutrition Recommendationsvwere used as a reference for nutrients. Nutritional status was assessed using the MinivNutritional Assessment and symptoms of depression using the Geriatric Depression Scale-20.

Result: Three groups with different self-reported energy intakes appeared in the analysis, onev with <1500 kcal, a second with a fluctuating intake over time (±1500 kcal), and a third with ≥1500 kcal. Intake of vitamins A, D, E, folate and fibre were below the recommended levels in all groups. The same pattern of energy intake and micronutrients was found over time. No correlation between energy intake and MNA and GDS-20 was found.

Conclusion: Reported energy intake and some micronutrients were low in relation to estimated energy requirement. This might be due to a combination of low energy intake, underreporting and the day on which the 24h recall was performed. Weight loss was found in women and men who reported a fluctuating energy intake and among men who reported an energy intake <1500 kcal. This might indicate an inadequate energy intake and an increased vulnerability to malnutrition.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51552 (URN)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2010-01-14Bibliographically approved

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