Report For Health And Wellbeing In Older People

Background and significance

Describe the Report for Health and Wellbeing in Older People.

Nutrition is a vital component for maintaining health and wellbeing in the older people and linked with the process of aging. The frequency of malnutrition is rising in the older people of Singapore and is connected with a degeneration in efficiency status, reduced functioning of muscle, declined bone mass, immunity dysfunction, anemia, cognitive impairment, deprived healing of wounds, deferred recovery from the operation, higher rates of hospital admission and mortality. This healthcare program was commenced to detect nutrition interventions that could deliver a foundation for planning effective and assessable nutrition education curriculums for the older population in Singapore. The older population of Singapore is very diverse in nature, such as fit, active, healthy elders, extremely weak, completely reliant on others, elders with chronic diseases, severe disabilities and of different ethnicity. In the aging population, malnutrition is an imperative jeopardize that has been observed in hospitals, housing care and in the community.

The project topic was identified on basis of rigorous searching and evaluation of the problems among the older age group of Singapore. Malnutrition is not an inescapable consequence of getting old however several alterations related with the course of aging can encourage undernourishment (Volkert, 2013). For instance, aged people are often found with decreased palate perception and smell, worsening of dental strength and decreased physical activity (Visvanathan et al., 2014 and Moreira et al., 2016). These factors individually or altogether can negatively impact nutrient consumption. Any alteration in food consumption can promote malnutrition with the potentially severe consequences (Fontana & Partridge 2015). Numerous studies have demonstrated a direct association between the extent of undernourishment and a greater stretch of stay in hospitals, increased treatment expenses, and reoccurrence to normal lifestyle (Moreira et al., 2016). Thus, the management and inhibition of malnutrition, which is very prevailing in the older population (Visvanathan et al., 2014) have become a significant challenge for this health promotion program.

The older population of Singapore is very diverse, thus the project was designed to give emphasis on the mentally distressed older population. Undernourished elders of the communities are likely to have deprived health outcomes, presented by greater rates of death events (Visvanathan et al., 2014). The core contributors to this death rate are chronic obstructive pulmonary diseases, coronary heart diseases and other circulatory diseases (Volkert, 2013). The target elder group for this program is mentally disturbed or depressed aged people. The strength of social networks was found to be the biggest determinants of mental wellness and mental wellness is one of the main contributors of malnutrition (Boulos et al., 2016).

Discussion

The older population tends to lack knowledge about food, cooking and nutrition factors in this stage of life (Gougeon et al., 1015). Detailed planning is done on the intervention procedures and the main challenge is to successfully implement them and promote knowledge among the targeted group.

In the first part of planning, the risk factors have been identified which can cause mental distress and in turn cause malnutrition. The medical risk factors are poor appetite, oral and dental problems, respiratory disorders, neurological disorders, loss of taste, higher frequency of infections, drug interactions, and physical disabilities etc. (Haber, 2013). Social and lifestyle factors contributing for malnutrition may include poverty, isolation, and loneliness, lack of knowledge about nutritious foods and incapability to shop or cook food (Donini et al., 2013). The most common psychological risk factors are dementia, confusion, anxiety, depression, and bereavement (Pérez et al. 2013).

To reduce the contributing problem of malnutrition, the older population of the remote areas are needed to have knowledge about their nutrition requirement. A survey group will interview the older persons in the selected areas of Singapore. The interview queries will contain questions about age, physical status, medical histories, food habits, social activities and financial situations.

 The survey consists of 5 key factors: general health inquiries, health status, dietary behaviors, nutrient screening initiative checklist and nutrient intake assessment of target group. General inquiries include household arrangement, education level, and financial status. Health and wellbeing behaviors include self-rated insights about depression and health, smoking and drinking habits, physical activities and former involvement in diet and nutrient instructions. The height and weight, blood sugar level, total cholesterol, triglycerides, albumin and hemoglobin level will be checked for determining health status. Dietary behaviors were identified by questioning individually (Taweel et al., 2016). The malnourished aged can be identified by the below-mentioned method (Fauziana et al., 2016) and a checklist will be prepared.

Body Mass Index < 18.5 kg/m²

Unplanned weight reduction > 10% within the last 3 to 6 months

Body Mass Index < 20 kg/m²and unplanned weight reduction > 5% within the last 3 to 6 months

Percentage of weight loss =	original weight – current weight	x 100
current weight

Body Mass Index =	Weight (kg)
Height (m)2

Application of Malnutrition Universal Screening Tool (MUST) can also be done. It takes few minutes to complete the test and provides clear management plans depending on the degree of identified risk (Visvanathan et al., 2014). The quality and quantity of foods consumed will be examined over a 7 days period. To assess nutrient intake computer aided nutritional analysis program will be used.

Plan and intervention

The next level of this health promotion program includes nutrition education sessions for the targeted age group and their family members. The gaol of these education sessions will deliver vital knowledge about appropriate diet in the old-age stage, prevention measures of malnutrition and self-management. The education sessions will be based on induvial talks, group discussions, visual powerpoint seminars, leaflets, brochures and pamphlets for effortless understanding. The education sessions will be held twice in a week and it will be continued for five weeks. The individual session will be continued for an hour during the initial 4 weeks. Sessions will be broken down into twenty minutes of information giving and interaction period and forty minutes of applied preparation and games. In the fifth week, the session will be for 2 hours, comprising of meal scheduling and nutritional counseling for each aged person individually (Kim et al., 2012). There is also a plan for involving this target group in some social activities to improve their mental health.

In the 1^st week, the session will be focused on physiological and mental changes that occur in the course of aging and importance of balanced diet and nutrition management. In the 2^nd week, participating members will learn about vital nutrients and their minimum requirements, their utilities in the body, and the main food materials for each nutrient. In the 3^rd week, the session will be concentrated on dietary recommendations for the aged, reduced salt intake model and the importance of mental wellbeing ((Kim et al., 2012). The 4^th week will be focused on self-management educations (Taweel et al., 2016).  In the 5^th week, participants will practice nutritious meal item planning and will receive individualized nutrition counseling (Kim et al., 2012 and Nykänen et al., 2014).

 For successfully conduct the program and implementing the interventions the support of local healthcare groups will be needed. The community nurses can also play an important role in reducing malnutrition. Involvement of trained dieticians is also necessary for this malnutrition prevention program. This program will need the assistance of local voluntary and support groups. Participation of the family members of the aged people can effectively reduce this problem. Each partner and stakeholder have their own importance and networking them is vital for this health promotion project.

The resources need to support this project are community resources. A proper location for conduction the education sessions are essential. Rental cost will be there for booking a good place. A community hall or any large hall with technological facilities will be needed. Technological resources include the availability of telephones, computers, and internet. There will be also costs for staff members.

Key partners and stakeholders

The nutritional status of the aged of Singapore was reported to be poorer than that of other age groups. According to Hamirudin et al. (2016) and several other surveys revealed that malnutrition interventions may be highly effective when participants hold interest about their wellbeing and that elderly persons who were extremely depressed or under severe anxiety  tend to be more vulnerable to malnutrition risks (Pérez et al., 2013 and Yoshimura et al., 2013). This project is planned after evaluating numerous journals and articles and hopes to achieve better nourishment rate among the mentally distressed elderly people of Singapore.  At first, the program will be conducted in selected areas but doing programs like this at a national level is the imminent goal. But at first, the emphasis will be given on this project. After the end of this 5-week project, behavior and mentality changes will be identified. Follow up surveys will be done to evaluate the impact of this project on the target population. To analyze whether there are any enhancements in nutritional levels, comparisons between changes in dietary behaviors, health behaviors, and nutrient intakes will be done. The project expects positive modifications in nutrient intakes, health and dietary behaviors after the end of nutritional education, and improvement in self-rated perceptions of mental health and depression.

References

Boulos, C., Salameh, P., & Barberger-Gateau, P. (2016). Social isolation and risk for malnutrition among older people. Geriatrics & gerontology international.

Donini, L. M., Scardella, P., Piombo, L., Neri, B., Asprino, R., Proietti, A. R., & Di Bella, G. (2013). Malnutrition in elderly: social and economic determinants. The journal of nutrition, health & aging, 17(1), 9-15.

Fauziana, R., Jeyagurunathan, A., Abdin, E., Vaingankar, J., Sagayadevan, V., Shafie, S., & Subramaniam, M. (2016). Body mass index, waist-hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study. BMC geriatrics, 16(1), 125.

Fontana, L., & Partridge, L. (2015). Promoting health and longevity through diet: from model organisms to humans. Cell, 161(1), 106-118.

Gougeon, L., Payette, H., Morais, J., Gaudreau, P., Shatenstein, B., & Gray-Donald, K. (2015). Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians. The journal of nutrition, health & aging, 19(4), 431-436.

Haber, D. (2013). Health promotion and aging: Practical applications for health professionals. Springer Publishing Company.

Hamirudin, A. H., Charlton, K., & Walton, K. (2016). Outcomes related to nutrition screening in community living older adults: A systematic literature review. Archives of gerontology and geriatrics, 62, 9-25.

Kim, B. H., Kim, M. J., & Lee, Y. (2012). The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior, dietary behavior, nutrition risk level and nutrient intake. Nutrition research and practice, 6(1), 35-44.

Moreira, N. C. F., Krausch-Hofmann, S., Matthys, C., Vereecken, C., Vanhauwaert, E., Declercq, A., & Duyck, J. (2016). Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data. Advances in Nutrition: An International Review Journal, 7(3), 507-522.

Nykänen, I., Rissanen, T. H., Sulkava, R., & Hartikainen, S. (2014). Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on nutritional status: a population-based intervention study. The journal of nutrition, health & aging, 18(1), 54-58.

Pérez, C. E., Lizárraga, S. D., & Martínez, E. M. R. (2013). Association between malnutrition and depression in elderly. Nutricion hospitalaria, 29(4), 901-906.

Taweel, A., Barakat, L., Miles, S., Cioara, T., Anghel, I., Tawil, A. R. H., & Salomie, I. (2016). A service-based system for malnutrition prevention and self-management. Computer Standards & Interfaces.

Visvanathan, R., Newbury, J. W., & Chapman, I. (2014). Malnutrition in older people. Geriatric Medicine: An Introduction, 4(20), 216.

Volkert, D. (2013). Malnutrition in older adults-urgent need for action: a plea for improving the nutritional situation of older adults. Gerontology, 59(4), 328-333.

Yoshimura, K., Yamada, M., Kajiwara, Y., Nishiguchi, S., & Aoyama, T. (2013). Relationship between depression and risk of malnutrition among community-dwelling young-old and old-old elderly people. Aging & mental health, 17(4), 456-460.