Malnutrition and its Relation to Food System among Elderly Home Male Residents in Cairo , Egypt

Food and environmental conditions that may affect intake should be considered in a continuing evaluation. Consideration of food preferences, food consistency, food temperature, and snacks should be included. Provision of pleasant, well-lighted, unhurried mealtimes Abstract Background: Malnut r i t ion in inst i tu t ional ized elderly is of indiv idual and publ ic co ncern s ince i t negat ively affects heal th outcome and qual i ty of l i fe and is o ften preventable. Assessing this problem is an important step of the residents’ assessment to combat morbid sequences .

.The institutional setting, which may have rigid routines, low staffing levels and un-homely environment, may exacerbate the existing medical problem, by minimizing the positive aspects of enjoyment and social contact.Similarly, a narrow range of food choices is associated with poorer nutritional status. 7As a vicious cycle this inadequate dietary intake and malnutrition contributes not only to the progression of already existing chronic diseases such as cardiovascular disease, osteoporosis or mental disorders but can also predispose the subject to various acute health problems such as infection or dehydration.
About this problem, Egypt is of no exception.
Investigations regarding nutritional status in nursing homes in Egypt have demonstrated the same results, that malnutrition is a serious problem in nursing homes, demanding special attention.Population ageing is expected to be experienced in our country, therefore it is important to consider and address the needs and concerns of this group, which might have direct impacts on their well-being and quality of life.

Methods
Through a stratified random sampling from public and private nursing homes in Cairo, Egypt, 7 nursing homes were selected and 200 elderly male residents were chosen as the study population.The inclusion criteria were: being elderly males, aged 60 years and older, living in elderly home and period of stay was at least 6 months and accepting to participate in the study.The exclusion criteria were: having extreme illnesses (end stage diseases such as end stage liver disease and end stage renal disease) and intentional regimen to lose weight.
Data on the subjects' demographic characteristics and nutritional and health status were gathered during 2015 to 2017.Demographic characteristics included age, gender, educational level, marital status, smoking status, alcohol consumption.Medical history and drug history were taken from the resident or caregiver to assess health status.Quick general and local examination was done.
To assess the risk of malnutrition in the subjects the Mini Nutritional Assessment (MNA) tool was used.
The Mini Nutritional Assessment (MNA) 9 has been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes.The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min.The sum of the MNA score distinguishes between elderly patients with: adequate nutritional status, MNA ≥24; protein-calorie malnutrition, MNA < 17; at risk of malnutrition, MNA between 17 and 23.5.With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%.The MNA scale was also found to be predictive of mortality and hospital cost.Most importantly is the possibility to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur.These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.
As regards food system in the elderly home, our questionnaire included asking about number of residents per room, presence of refrigerator inside resident room, if the resident eats in dining room or not, is there food variability more than 2 times per week, availability of providing an alternative meal if the resident requested, presence of dietician in the elderly home

Statistical analysis
The collected data were coded, tabulated, and statistically analyzed using IBM SPSS statistics (Statistical Package for Social Sciences) software version 22.0, IBM Corp., Chicago, USA, 2013.The level of significance was taken at P value < 0.05 , otherwise is non-significant.The p-value is a statistical measure for the probability that the results observed in a study could have occurred by chance.

Results
Two

Discussion
Malnutrition is associated with significantly increased morbidity and mortality in independently living elderl y, as well as the residents of nursing homes and hospitalized patients. 10 The primary purpose of this study was to determine the relation between different grades of malnutrition and food system in elderly homes' residents in Cairo, Egypt.
The current study demonstrated that among the 200 participants, 8.5% of them were malnourished, 48% were at risk of malnutrition and 43.5% were well nourished; this was done by using The Mini Nutritional Assessment (MNA) .This was consistent with the study conducted by El Zoghbi et al. 11 among 111 older adults, living in three long stay institutions in Beirut, which showed that 14 (12.6%) were malnourished, 54 (48.7%) were at risk of malnutrition and 43 (38.7%) had an adequate nutritional status.
Regarding the demographic criteria, the current study showed that the mean age of malnourished group was significantly higher than those at risk and those who were well nourished.
This was compatible with what was conducted by Kruizenga et al. 12 in their study that showed a significant association between aging and malnutrition in elderly.
Being alone in the room may help the resident to feel more comfortable, but on the other hand this can lead to emotional isolation, lack of motivation to prepare a meal that lonely he will eat.A frequent problem among the elderly is the emotional isolation due to loss of a partner or close friend.This emotional isolation is detrimental to health, and mortality has been well demonstrated. 13r study showed that having refrigerator inside the room, eating in dining room had a protective role against malnutrition in elderly living in elderly homes.
No doubt that providing all residents a choice of food and beverages, based on the available menu and in a manner suitable to each Resident's ability and/or limitations e.g.visual, verbal or written, has an important role in improving resident's appetite and thus improving his nutritional status.
So, the current study recommends monitoring and supervision during dining, including meals, snacks and other food-related activities, to promote Residents' safety, comfort, independence and dignity in eating and drinking, to monitor Residents' overall response to the meal service/pleasurable dining program and to monitor each Resident's nutritional well-being.

Conclusion
While many older adults remain healthy and eat well, those in poorer health may experience difficulties in meeting their nutritional needs.Meeting the diet and nutrition needs of older people is crucial for the maintenance of health, functional independence and quality of life.Elderly home play an important role in provision of comfortable environment for residents to achieve better nutritional status for them.Higher nursing staffing levels were associated with decreased likelihood of malnutrition.Long term care professionals may use this study to inform quality improvement efforts to targeting individuals at high risk for poor nutrition in their facilities.