Measuring Health: A Guide to Rating Scales and Questionnaires

Little is known about the health, nutrition, and quality of life of the aging population in Nepal. Consequently, we aimed to assess the nutritional status, depression and health-related quality of life (HRQOL) of Nepali older patients and evaluate the associated factors. Furthermore, a secondary aim was to investigate the proposed mediation-moderation models between depression, nutrition, and HRQOL. A cross-sectional survey was conducted from January–April of 2017 among 289 Nepali older patients in an outpatient clinic at Nepal Medical College in Kathmandu. Nutritional status, depression and HRQOL were assessed using a mini nutritional assessment, geriatric depression scales, and the European quality of life tool, respectively. Linear regression models were used to find the factors associated with nutritional status, depression, and HRQOL. The potential mediating and moderating role of nutritional status on the relationship between depression and HRQOL was explored; likewise, for depression on the relationship between nutritional status and HRQOL. The prevalence of malnutrition and depression was 10% and 57.4% respectively; depression-malnutrition comorbidity was 7%. After adjusting for age and gender, nutritional score (β = 2.87; BCa 95%CI = 2.12, 3.62) was positively associated and depression score (β = − 1.23; BCa 95%CI = − 1.72, − 0.72) was negatively associated with HRQOL. After controlling for covariates, nutritional status mediated 41% of the total effect of depression on HRQOL, while depression mediated 6.0% of the total effect of the nutrition on HRQOL. A sizeable proportion of older patients had malnutrition and depression. Given that nutritional status had a significant direct (independently) and indirect (as a mediator) effect on HRQOL, we believe that nutritional screening and optimal nutrition among the older patients can make a significant contribution to the health and well-being of Nepali older patients. Nonetheless, these findings should be replicated in prospective studies before generalization.

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Depression, malnutrition, and health-related quality of life among Nepali older patients

Nepal’s demography is aging rapidly, yet few studies to date have examined how this has affected the health and well-being of the elderly, defined as those above 60 years in Nepal’s Senior Citizen Act (2006). Our study, abbreviated NepEldQOLII, aims to assess perceived life satisfaction, and evaluate its relationship with nutritional health and mental well-being among the burgeoning Nepalese elderly population. A cross-sectional survey among 289 Nepalese elderly, aged ≥60 years, attending an outpatient clinic of a hospital in Kathmandu, Nepal was conducted. Nutritional status, depression, and life satisfaction were assessed by a mini-nutritional assessment scale (range: 0–14), a geriatric depression scale (range: 0–15), and a satisfaction with life scale (range: 5–35), respectively. Mediation analyses, adjusted for age, sex, marital status, and family type, were used to assess mediating relationships between nutritional and mental wellbeing with life satisfaction as the outcome. Approximately 21% of the participants were dissatisfied with their life. Life satisfaction was positively associated with being married, high family income, involvement in active earning, and a high nutritional score. Conversely, life satisfaction was inversely associated with living in a nuclear (as opposed to joint) family, the perception of having worse health than peers, the perception of being ignored/hated due to old age, and a higher depression score. In mediation analyses, both nutrition (β = 0.48, bias-corrected and accelerated (BCa) 95% CI: 0.27, 0.69) and depression (β = − 0.87, BCa 95% CI: -1.01, − 0.74) had significant direct associations with life satisfaction. Furthermore, both nutrition (β = 0.30, BCa 95% CI: 0.13, 0.49) and depression (β = − 0.07, BCa 95% CI: -0.14, − 0.03) mediate each other’s association with life satisfaction. Nutritional score mediated 7% of the total association between depression and life satisfaction; depression mediated 38% of the total association between nutrition and life satisfaction. Life satisfaction shows a pattern of decline as nutritional and mental health status decrease. Both depression and under-nutrition had a significant association with life satisfaction. The pathway by which nutrition affects life satisfaction is influenced by depression as a mediator. Moreover, nutritional status explained a small portion of the relationship between depression and life satisfaction. These observed preliminary findings should be confirmed in future longitudinal studies.

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Life satisfaction among elderly patients in Nepal: associations with nutritional and mental well-being

https://research.vu.nl/ws/files/105342234/Validity_of_Nutritional_Screening_Tools_for_CommunityDwelling_Older_Adults_A_Systematic_Review_and_MetaAnalysis.pdf

Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 30 years of clinical research and practice using the MNA® worldwide.

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Nutritional Assessment in Older Adults: MNA® 25 years of a Screening Tool & a Reference Standard for Care and Research; What Next?

Background Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal’s health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool. Methods A cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated. Results 111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts. Conclusions The MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention.

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Nutritional assessment of community-dwelling older adults in rural Nepal.

Is selenium intake associated with the presence of depressive symptoms among US adults? Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2014.

Diabetes has been recognized as a “global health emergency” with an estimated 9% of adults being affected. However, about half of these adults remain undiagnosed. Conventional screening tools like fasting plasma glucose (FPG), oral glucose tolerance testing (OGTT) and glycosylated haemoglobin (HbA1c) can be inconvenient and expensive in a community-based setting. The Indian Diabetes Risk Score (IDRS) is a simple, non-invasive tool which has been validated for use in the Indian population. Age, abdominal obesity, family history of diabetes and physical activity levels have been weighted for a maximum score of 100. Persons with IDRS of 60 as high risk for diabetes. A community based, cross-sectional, analytical study was planned to assess the performance of IDRS among adults in a semi-urban area in Kathmandu, Nepal. A total of 256 (170 female, 86 male) persons without diabetes from 260 households were screened during the study period. A majority (46.09%) were classified as high risk, 44.53% as moderate risk and 9.38% as low risk for developing diabetes. Among them, 162 (63.28%) volunteered for definitive testing. The prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI: 1.75% to 8.70%) and 7.14% (95% CI: 3.89% to 12.58%) respectively. IDRS predicted the combined risk of diabetes and prediabetes with sensitivity of 84.21% and specificity of 55.24% in adults with score of 60 and above. The area under the ROC curve (AUC) of IDRS for identifying diabetes and prediabetes was 0.69 as compared to the gold standard (2hour Plasma Glucose) AUC of 0.98. IDRS may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population.
Keywords : Diabetes, IDRS, prediabetes,screening, sensitivity, specificity

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Community based screening for diabetes and prediabetes using the Indian Diabetes Risk Score among adults in a semi-urban area in Kathmandu, Nepal

The natural history of type 2 diabetes includes a preceding period of impaired fasting glucose or impaired glucose tolerance which is referred to as prediabetes. During the asymptomatic phase of prediabetes, an estimated 20-30% of persons may develop complications like retinopathy, cardiovascular disease, neuropathy and nephropathy. Screening and lifestyle management may help to delay or arrest progression to diabetes. In primary care settings, point of care devices that measure glucose in capillary blood can be used for diagnosis of diabetes. This study was carried out to evaluate the performance of fasting capillary glucose (FCG) and fasting plasma glucose (FPG) measurement in screening for diabetes and prediabetes among adults in a semi-urban community in the Kathmandu district of Nepal. An observational, cross-sectional study design was used and FCG, FPG performance was evaluated by the 2-hour plasma glucose levels (2-hr PG) following Oral glucose tolerance test (75g glucose) using WHO 1998 criteria. Linear regression was performed to assess correlation co-efficient (r) between FPG, FCG and 2 hr PG. Bland Altman plot and Receiver operator characteristic (ROC) curves were constructed to assess concordance, measure ROC AUC and determine sensitivity and specificity of the measurements at recommended cut-off values for identifying diabetes and prediabetes. Among the study participants (n=162), 104 were female and 58 were male. Prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI 1.75% to 8.70%) and 7.14% (95% CI 3.89% to 12.58%). Strong positive correlation was seen between FPG and FCG (Spearman’s r 0.67). FPG & FCG had a moderate positive correlation (r = 0.49 & 0.45) with 2 hr PG levels (p<0.0001). FCG and FPG ROC AUC was 0.91 (95% CI 0.85 to 0.97) and 0.87 (95% CI 0.78 to 0.97) in comparison to 0.98 (95% CI 0.97 to 1.0) for the gold standard 2 hr PG. At 110 mg/dl and above, FCG had an optimal sensitivity and specificity of 84.21% and 81.12% in comparison to 47.37% and 100% for FPG. At 100 mg/dl, the sensitivity and specificity of FCG was 100% and 51.75% in comparison to 57.89% and 97.20% for FPG. In conclusion, at each recommended cut-off value, FCG was more sensitive than FPG with no significant difference between ROC AUCs of the two tests. Hence, FCG may be a suitable, sensitive, and convenient screening tool for diabetes and prediabetes in community-based settings. Larger prospective studies may validate the cost-effectiveness and efficiency of similar screening strategies in the Nepalese community.

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Evaluation of Fasting Capillary Glucose and Fasting Plasma Glucose as Screening Tests for Diabetes and Prediabetes among Adults in a Semi-Urban Area in the Kathmandu District, Nepal

Binaya Kurmar Baral

Papers

Nutritional assessment of community-dwelling older adults in rural Nepal.

Life satisfaction among elderly patients in Nepal: associations with nutritional and mental well-being

Is selenium intake associated with the presence of depressive symptoms among US adults? Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2014.

Community based screening for diabetes and prediabetes using the Indian Diabetes Risk Score among adults in a semi-urban area in Kathmandu, Nepal

Evaluation of Fasting Capillary Glucose and Fasting Plasma Glucose as Screening Tests for Diabetes and Prediabetes among Adults in a Semi-Urban Area in the Kathmandu District, Nepal