The Malnutrition Risk and Physical Activities in Home-Dwelling Older Adults During the COVID-19: A Cross-Sectional Study

Abstract

Objective: During the COVID-19 pandemic, elderly adults’ nutritional habits, physical activity levels and the levels of malnutrition were affected. This study investigated the prevalence of malnutrition and physical fitness and exercise activity levels in home dwelling elderly during the COVID-19 pandemic. Material and Method: This cross-sectional study was conducted with a face-to-face questionnaire on 670 (male: 241, female: 429) home-dwelling older adults with a mean age of 70.66±5.83 years. The nutritional screening and evaluation were performed using Mini Nutritional Assessment (MNA), and physical conditions were evaluated with Physical Fitness and Exercise Activity Levels of The Older Adults’ Scale (PFES). Results: Findings were (1) malnutrition risk was higher at both age groups (65-74 and 75-90 aged) (p=0.001), (2) marital status (p=0.025), presence of chronic illness (p=0.001), use of drugs (p=0.006) affected nutritional status, (3) health status was affected by COVID-19 pandemic (p=0.001). Nutritional status and PFES scores did not changed according to malnutrition levels (p>0.05). Conclusion: Age, marital status, comorbidity, and use of drugs were independently associated with malnutrition in the elderly. Due to the time restrictions imposed during the COVID-19 pandemic, older adults might have had to engage in physical activity to meet their nutritional and personal needs.

Keywords

• COVID-19
• older adults
• malnutrition
• physical activity

COVID-19 Pandemisinde Evde Yaşayan Yaşlı Yetişkinlerde Malnütrisyon Riski ve Fiziksel Aktivite: Kesitsel Bir Çalışma

Abstract

Amaç: COVID-19 pandemisi sırasında, yaşlıların beslenme alışkanlıkları, fiziksel aktivite düzeyleri ve malnütrisyon düzeyleri etkilenmiştir. Bu çalışmada, COVID-19 pandemisinde malnütrisyon prevalansı ile fiziksel sağlık ve egzersiz aktivite düzeylerinin evde yaşayan yaşlılar üzerindeki etkisi araştırılmıştır. Gereç ve Yöntem: Kesitsel tipteki bu çalışma, evde yaşayan yaş ortalaması 70,66±5,83 yıl olan, 670 (erkek:241, kadın:429) yaşlı bireyin katılımıyla yüz yüze anket yöntemi kullanılarak gerçekleştirilmiştir. Bireylerin beslenme taraması ve değerlendirmesi Mini Nütrisyonel Değerlendirme (MNA) Testi kullanılarak yapılmıştır, fiziksel aktivite seviyeleri ise Yaşlı Bireylerin Fiziksel Fitnes ve Aktivite Ölçeği (PFES) ile değerlendirilmiştir. Bulgular: (1) Her iki yaş grubunda da (65-74 ve 74-90 yaş) malnütrisyon riskinin yüksek olduğu (p=0,001), (2) medeni durum (p=0,025), kronik hastalık varlığı (p=0,001), ilaç kullanımının (p=0,006) beslenme durumunu etkilediği, (3) sağlık durumunun COVID-19 pandemisinden etkilendiği (p=0,001) saptanmıştır. Malnutrisyon düzeylerine göre beslenme durumu ve PFES skorları değişmemiştir (p>0.05). Sonuç: Yaşlılarda yaş, medeni durum, komorbidite ve ilaç kullanımı bağımsız olarak malnütrisyon ile ilişkili bulunmuştur. COVID-19 pandemisi sırasında uygulanan saat kısıtlamaları nedeniyle yaşlı yetişkinler beslenme ve kişisel gereksinimlerini karşılamak için fiziksel aktivite yapmak zorunda kalmış olabilirler.

Keywords

• COVID-19
• yaşlı
• malnütrisyon
• fiziksel aktivite.

References

1. Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med. 2020;26(4):450-2. doi: 10.1038/s41591-020-0820-9.
2. National Institute of Allergy and Infectious Diseases. Coronaviruses 2021. [cited 2021 25/09]. Available from: https://www.niaid.nih.gov/diseasesconditions/coronaviruses.
3. World Health Organization (WHO). World Health Organization. Coronavirus disease (COVID-2019) situation reports. Geneva: WHO; 2020. [cited 2021 29/09]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/
4. Sun J, He W-T, Wang L, Lai A, Ji X, Zhai X, et al. COVID-19: epidemiology, evolution, and cross-disciplinary perspectives. Trends Mol Med. 2020;26(5):483-95.
5. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):1-5.
6. Jia HP, Look DC, Shi L, Hickey M, Pewe L, Netland J, et al. ACE2 receptor expression and severe acute respiratory syndrome coronavirus infection depend on differentiation of human airway epithelia. J Virol. 2005;79(23):14614-21.
7. Leung C. Risk factors for predicting mortality in elderly patients with COVID-19: A review of clinical data in China. Mech Ageing Dev. 2020;188:111255. doi: https://doi.org/10.1016/j.mad.2020.111255.
8. Butler MJ, Barrientos RM. The impact of nutrition on COVID-19 susceptibility and long-term consequences. Brain Behav Immun. 2020;87:53-4. doi: https://doi.org/10.1016/j.bbi.2020.04.040.

9. TUIK. İstatistiklerle Yaşlılar, 2020 2021 [cited 2021 31/10]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Elderly-Statistics-2020-37227.
10. Agrawal S, Makuch S, Dróżdż M, Strzelec B, Sobieszczańska M, Mazur G. The Impact of the COVID-19 Emergency on Life Activities and Delivery of Healthcare Services in the Elderly Population. J Clin Med. 2021;10(18). Epub 2021/09/29. doi: 10.3390/jcm10184089. PubMed PMID: 34575200.
11. Dor-Haim H, Katzburg S, Revach P, Levine H, Barak S. The impact of COVID-19 lockdown on physical activity and weight gain among active adult population in Israel: a cross-sectional study. BMC Public Health. 2021;21(1):1521. Epub 2021/08/08. doi: 10.1186/s12889-021-11523-z. PubMed PMID: 34362319; PubMed Central PMCID: PMC8343341.
12. Balanzá-Martínez V, Atienza-Carbonell B, Kapczinski F, De Boni RB. Lifestyle behaviours during the COVID-19 - time to connect. Acta Psychiatr Scand. 2020;141(5):399-400. Epub 2020/04/24. doi: 10.1111/ acps.13177. PubMed PMID: 32324252; PubMed Central PMCID: PMC7264786 (CME) speaker over the last 3 years for the following companies: Angelini, Ferrer, Lundbeck, Nutrición Médica and Otsuka. The other authors declare no conflict of interest.
13. Koç AA, Bölük G, Öz İ. Gıda Arz Zincirinde Semt Pazarlarının Yeri ve Önemi Araştırma Raporu (In Turkish): Antalya Semt Pazarcılar Odası; 2021 [updated 01.06.2021; cited 2021 25th October]. Available from: https://www.aspo.org.tr/raporlar/gida-arz-zincirinde-semtpazarlarinin-yeri-ve-onemi-arastirma-raporu/.
14. Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. doi: 10.1186/s12967-020-02399-5.15.
15. Corley J, et al., Home garden use during COVID-19: Associations with physical and mental wellbeing in older adults. Journal of Environmental Psychology, 2021. 73: p. 101545. doi: 10.1016/j.jenvp.2020.101545
16. Hinrichsen MAL, Molinari VA. What practitioners should know about working with older adults. Prof Psychol Res Pr. 1998;29(5):413-27.
17. World Health Organization (WHO). World Health Organization. Men, ageing and health: achieving health across the life span. Geneva: World Health Organization; 2001. [cited 2021 09/10]. Available from: https://apps.who.int/iris/handle/10665/66941
18. Şahin H, Çiçek B, Yılmaz M, Ongan D, Kaya N, İnanç N. Kayseri İlinde Yaşayan 65 Yaş ve Üzeri Bireylerde Beslenme Durumu ve Yaşam Kalitesinin Saptanması. Turk Geriatri Derg. 2013;16(3).
19. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14-7. PubMed PMID: 24834239.
20. Corcoran C, Murphy C, Culligan EP, Walton J, Sleator RD. Malnutrition in the elderly. Sci Prog. 2019;102(2):171-80. doi: 10.1177/0036850419854290. PubMed PMID: 31829839.
21. Poulia K-A, Yannakoulia M, Karageorgou D, Gamaletsou M, Panagiotakos DB, Sipsas NV, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr. 2012;31(3):378-85. doi: https://doi.org/10.1016/j.clnu.2011.11.017.
22. Nestlé Nutrition Institute (NNI). Nutrition screening as easy as MNA: a guide to completing the Mini Nutritional Assessment (MNA) 2009 [cited 2021 28/10]. Available from: https://www.mna-elderly.com/forms/mna_guide_english_sf.pdf.
23. Guigoz Y, Vellas B, Garry P. Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients. Nestle Nutr Workshop Ser Clin Perform Programme. 1997:15-60.
24. World Health Organization (WHO). Physical Status: The Use and Interpretation of Anthropometry. Geneva: WHO1995 [cited 2021 12/11]. Available from: https://apps.who.int/iris/handle/10665/37003.
25. Porter Starr KN, Bales CW. Excessive Body Weight in Older Adults. Clin Geriatr Med. 2015;31(3):311-26. Epub 2015/05/13. doi: 10.1016/j.cger.2015.04.001. PubMed PMID: 26195092.
26. Yılmaz M, Bayık Temel A, Uyanık G, Böckün E, Karahüseyin A. Reliability and validity of Turkish version of “Physical Fitness and Exercise Activity Levels of Older Adults” Scale. JGG. 2017;65:254-62.
27. Razali NM, Wah YB. Power comparisons of shapiro-wilk, kolmogorovsmirnov, lilliefors and anderson-darling tests. Prof Psychol Res Pr. 2011;2(1):21-33.
28. Turkish Statistical Institution. İstatistiklerle Yaşlılar 2020 2021 [cited 2021 22 December]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2020-37227.
29. World Health Organization (WHO). Life expectancy and Healthy life expectancy, data by country World Health Organization; 2020 [cited 2021 12/11]. Available from: https://apps.who.int/gho/data/node.main.688.
30. Phillips MB, Foley AL, Barnard R, Isenring EA, Miller MD. Nutritional screening in community-dwelling older adults: a systematic literature review. Asia Pac J Clin Nutr. 2010;19(3):440-9.
31. Gündüz E, Eskin F, Gündüz M, Bentli R, Zengin Y, Dursun R, et al. Malnutrition in Community-Dwelling Elderly in Turkey: A Multicenter, Cross-Sectional Study. Med Sci Monit. 2015;21:2750-6. doi: 10.12659/MSM.893894. PubMed PMID: 26371941.
32. Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr. 2010;29(4):507-11.
33. Saka B, Kaya O, Ozturk GB, Erten N, Karan MA. Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr. 2010;29(6):745-8. Epub 20100602. doi: 10.1016/j.clnu.2010.04.006.PubMed PMID: 20627486.
34. World Bank. International Comparison Program database. GDP percapita, PPP (current international $) 2021. Available from: https://www.oecd.org/economy/surveys/TURKEY-2021-OECD-economic-surveyoverview.pdf.
35. Flegal KM, Kit BK, Graubard BI. Overweight, obesity, and all-cause mortality—Reply. JAMA. 2013;309(16):1681-2.
36. Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014;99(4):875-90.
37. Wang YF, Tang Z, Guo J, Tao LX, Liu L, Li HB, et al. BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing: a 20-year Cohort Study. Biomed Environ Sci. 2017;30(2):79-87. doi: https://doi.org/10.3967/bes2017.011.
38. Johnson MA, Bales CW. Is there a best body mass index for older adults? Moving closer to evidence-based recommendations regarding “overweight,” health, and mortality. J Nutr Gerontol Geriatr. 2014; 33(1):1-9.
39. Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznarić Ž, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Lijec Vjesn. 2020;142(3-4):75-84.
40. World Health Organization (WHO). Physical status : the use of and interpretation of anthropometry, report of a WHO expert committee Geneva: WHO1995 [cited 2021 14/11]. Available from: https://www.who.int/health-topics/physical-activity#tab=tab_1.
41. Pandey D, Bansal S, Goyal S, Garg A, Sethi N, Pothiyill DI, et al. Psychological impact of mass quarantine on population during pandemics—The COVID-19 Lock-Down (COLD) study. PLoS One. 2020;15(10):e0240501. doi: 10.1371/journal.pone.0240501.
42. Navarrete-Villanueva D, Gómez-Cabello A, Marín-Puyalto J, Moreno LA, Vicente-Rodríguez G, Casajús JA. Frailty and Physical Fitness in Elderly People: A Systematic Review and Meta-analysis. Sports Med 2021;51(1):143-60. doi: 10.1007/s40279-020-01361-1.