Nutritional status of elderly assisted in primary care and their relationship with social determinants of health

BANDEIRA, Georgia Ferreira da Silva; MOREIRA, Rafael da Silveira; SILVA, Vanessa de Lima

doi:10.1590/1678-9865201932e190042

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Sumário

Original • Rev Nutr 32 • 2019 • https://doi.org/10.1590/1678-9865201932e190042 copy

Nutritional status of elderly assisted in primary care and their relationship with social determinants of health

Estado nutricional de idosos assistidos na atenção básica e sua relação com determinantes sociais da saúde

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To review the influence of social determinants of health in the nutritional status of the elderly assisted in a primary care Unit in a Recife, Pernambuco, Brazil, community.

Methods

This was a cross-sectional study with an analytical approach. The universe was composed of 129 elderly attending a family health unit in Recife, Pernambuco, Brazil. The data were collected according to a protocol. The effect of the association of independent variables with the body mass index was estimated using hierarchical logistic regression models, simple and multiple multinomial. The significance level was set at 5%.

Results

There was a higher percentage of elderly people with excess weight (52.34%) in the assessment of body mass index. On analysis of the Mini nutritional assessment, the risk of malnutrition was 38.76%. On analysis of the calf circumference 13.39% of the elderly were malnourished. In the final model, the criteria for maintaining the elderly patients were the following: excess weight, marital status, hypertension, osteoarthritis and sewer destination. Elderly widowers had a higher chance (OR=5.17) of having excess weight and not to have sewage network serving their home and be hypertense (OR=2.71 e 2.83). The fact that the elderly have osteoarthritis also indicated a greater chance (OR=3.76) that they present excess weight.

Conclusion

Among the social determinants of health, the nutritional status of the elderly was associated with marital status, high blood pressure, osteoarthritis and basic sanitation. The social setting of the elderly is associated with their nutritional status.

Keywords
Elderly; Nutritional status; Social determinants of health

Variables			BMI
			Low weight			Overweight
	n	(% total)	OR^a a a: Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.	OR^a a a: Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.
Age
Below the median (67)	66	(51.6)	0.61	0.18-1.99	0.41	1.06	0.50-2.25	0.87
Above the median (67)^* * Reference category;	62	(48.4)	1.00	–	–	1.00	–	–
Gender
Female	91	(71.1)	0.67	0.21-2.18	0.50	2.43	1.04-5.71	0.04
Male^* * Reference category;	37	(28.9)	1.00	–	–	1.00	–	–
Marital status
Single	20	(15.6)	1.20	0.23-6.06	0.82	0.93	0.28-3.02	0.90
Separated and divorced	24	(18.7)	1.00	0.16-6.25	1.00	2.33	0.77-6.98	0.13
Widower	44	(34.4)	2.50	0.56-11.05	0.22	5.16	1.85-14.41	<0.01
Married*	40	(31.3)	1.00	–	–	1.00	–	–
Race / color
White	26	(20.3)	0.49	0.09-2.51	0.39	0.76	0.30-1.90	0.56
Nonwhite race^* * Reference category;	102	(79.7)	1.00	–	–	1.00	–	–
Diabetes Mellitus
Yes	34	(26.6)	0.83	0.22-3.06	0.78	0.71	0.30-1.66	0.43
No^* * Reference category;	94	(73.4)	1.00	–	–	1.00	–	–
Systemic Arterial Hypertension
Yes	93	(72.7)	0.73	0.22-2.37	0.60	3.66	1.49-8.97	<0.01
No^* * Reference category;	35	(27.3)	1.00	–	–	1.00	–	–
Arthrosis
Yes	30	(23.4)	1.02	0.18-5.71	0.97	3.25	1.20-8.84	0.02
No^* * Reference category;	98	(76.6)	1.00	–	–	1.00	–	–
Arboviruses
Yes	48	(37.5)	0.56	0.15-2.05	0.38	0.98	0.45-2.12	0.97
No^* * Reference category;	80	(62.5)	1.00	–	–	1.00	–	–

Variables			BMI
			Low weight			Overweight
	n	(% total)	OR^a a Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.	OR^a a Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.
General socioeconomic and environmental conditions
Source of income	–	–	–	–	–	–	–	–
Informal work	13	(10.2)	1.50	0.15-14.4	0.72	1.00	0.16-5.98	1.00
Retirement/Social benefit/Pension	103	(80.5)	0.52	0.08-3.29	0.49	0.96	0.25-3.65	0.95
Third parties^* * Reference category;	12	(9.3)	1.00	–	–	1.00	–	–
Family income
0 to 1 minimum wage	96	(75.8)	1.41	0.33-5.87	0.63	1.03	0.44-2.44	0.93
1.1 to 3 minimum wage^* * Reference category;	31	(24.2)	1.00	–	–	1.00	–	–
Life and work conditions	–	–	–	–	–	–	–	–
Sewer Destination	–	–	–	–	–	–	–	–
Pit. ditch and others	59	(46.1)	2.36	0.72-7.74	0.15	2.40	1.09-5.24	0.02
Sewerage system^* * Reference category;	69	(53.9)	1.00	–	–	1.00	–	–
Working time	–	–	–	–	–	–	–	–
Below the median (30 years of age)	67	(58.3)	1.22	0.34-4.32	0.74	1.96	0.86-4.42	0.10
Above the median (30 years of age)^* * Reference category;	48	(41.7)	1.00	–	–	1.00	–	–

Variables			BMI
			Low weight			Overweight
	n	(% total)	OR^a a Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.	OR^a a Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.
Social and community networks
Participation of socialization group activity
Yes	38	(29.7)	0.49	0.09-2.51	0.39	1.89	0.81-4.38	0.13
No^* * Reference category;	90	(70.3)	1.00	–	–	1.00	–	–
Individuals life style
Physical activity
Yes	24	(18.8)	0.58	0.06-5.45	0.63	3.01	1.02-8.81	0.04
No^* * Reference category;	104	(81.2)	1.00	–	–	1.00	–	–
Perception of nutritional health
Excellent and good	71	(55.5)	3.38	0.37-30.39	0.27	0.65	0.24-1.76	0.40
Regular	32	(25.0)	2.00	0.17-22.79	0.57	0.70	0.23-2.18	0.54
Bad and very bad^* * Reference category;	25	(19.5)	1.00	–	–	1.00	–	–
Stress
Yes	50	(39.1)	0.35	0.08-1.43	0.14	1.02	0.47-2.18	0.95
No^* * Reference category;	78	(60.9)	1.00	–	–	1.00	–	–

Variables			BMI
			Low weight			Overweight
	n	(% total)	OR^a a Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.	OR^a a Odds Ratio;	95%CI^b b 95%CI: Confidence Interval;	p value^c c p value: <0.05; BMI: Body Mass Index.
Individual characteristics
Marital status
Single	20	(15.6)	1.15	0.22-5.99	0.86	0.76	0.21-2.75	0.67
Separated and divorced	24	(18.8)	0.83	0.12-5.52	0.85	1.95	0.59-6.39	0.26
Widower	44	(34.3)	2.64	0.57-12.24	0.21	3.96	1.31-11.89	0.01
Married^* * Reference category;	40	(31.3)	1.00	–	–	1.00	–	–
Referred morbidity
Systemic Arterial Hypertension
Yes	93	(72.7)	0.69	0.20-2.39	0.56	3.27	1.21-8.83	0.01
No^* * Reference category;	35	(27.3)	1.00	–	–	1.00	–	–
Arthrosis
Yes	30	(23.4)	0.98	0.17-5.75	0.99	3.73	1.22-11.38	0.02
No^* * Reference category;	98	(76.6)	1.00	–	–	1.00	–	–
Live and work conditions
Sewer Destination
Pit. ditch and others	59	(46.1)	2.36	0.69-8.00	0.16	2.71	1.12-6.55	0.02
Sewerage system^* * Reference category;	69	(53.9)	1.00	–	–	1.00	–	–

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[1] Correspondence to: VL SILVA. E-mail:vanelima@gmail.com.