Nutritional and Social Aspects of elderly people living in old age homes of Kathmandu

Ageing population is expanding through-out the globe with estimates that people age over 60 years and older constitute 12% of global population. The proportion of this age group is expected to double (22%) by 2050. In Nepal, individuals over 60 years of age are considered elderly. According to the 2011 census of Nepal, there were 2.1 million elderly inhabitants, which constitute 8.1 percent of the total population in the country. Percent of elderly inhabitants during the years 1951, 1991, 2001, and in 2011 are 5.0%, 5.8%, 6.5% and 8.1% respectively which shows that there has been a sharp increase in the number of elderly persons between 2001 and 2011. The current statistics for the elderly in Nepal shows chances for a new set of medical, social, and economic problems that could arise if a timely initiative in this direction is not taken by the policy makers. There is urgent necessity to highlight the problems that are being faced by the elderly people and explored the ideas for bringing about an improvement in their quality of life. The study performed by Geeta Karki in 2017 in old age homes of Kathmandu, presented the nutritional status of elderly population and factors associated with the nutritional status in old age homes of Kathmandu Metropolitan city, Kathmandu. A cross sectional study was conducted in which a total of 141 senior citizens (60 years and above) of both sexes living at seven old age homes of Kathmandu were assessed for their nutritional status using Short Form Mini Nutritional Assessment (MNA-SF) tool.

MNA is a validated tool used in institutionalized and hospitalized patients or elder people to assess their nutritional status. It comprises of six questions; food intake, involuntary weight loss, mobilty, psychological stress or acute disease and Body Mass Index (BMI)/calf circumference(CC). Scores are made variously seeing the severity or optimum nutritional status and are categorized as malnourished (<7 points), risk of malnutrition (11 points or lesser) and normal (12 points or greater).

34% (48) of participants were normal, 12.1% (17) were malnourished and 53.9% (76) were found to be at risk of malnutrition. Prevalence of malnutrition was higher in the age group of 77 and above than age group of 60-77. The risk of malnutrition was more than half in age group of 60-77. Female elderly were comparatively more malnourished in comparison to male elderly and the risk of malnutrition was also high in female elderly. The study showed that ethnicity was directly associated with the nutritional status of people in old age homes as Brahmin/Chhetri were malnourished in greater number than any other ethnic group. Old age homes are also the religious places with the Hindu people especially Brahmin and Chhetri living in a large number. Bound with the spiritual and religious beliefs many were found to restrict meat, skip evening meals and deprived themselves from their morning sleep for their prayers and religious activities. This might be reason that malnutrition was prevalent in them. Percentage wise distribution showed that the illiterate people were found more malnourished in comparison to literate one. Risk of malnutrition was also seen in higher proportion in illiterate elderly. Likewise participants who spent lesser than six hours in sitting position were comparatively less malnourished in comparison to those who spent more than six hours in sitting position. It was found that malnutrition was dominant in elderly who had neck or back problem followed by respiratory problem, diabetes, gastritis, depression and hypertension respectively. Similarly, the risk of malnutrition was remarkable in the elderly having depression. It was found that those who had greater than twenty number of teeth were comparatively less malnourished to those who had twenty or lesser than twenty number of teeth. The percentage of malnourished elderly from government institutions outnumbered the percentage of malnourished elderly people who were from private institutions. More than half of total percentage of participants living in government old age homes and half of total participants from private old age homes were at risk of malnutrition. It was found that those who slept for lesser than 7 hours were more malnourished in comparison to those who slept for more than or equal to seven hours. Those who took 4 and more than 4 types of medicines were malnourished in greater percentage than those who took 3 or less than 3 drugs. Those who were on prescribed medication category of (0-3) were on greater risk of malnutrition. The percentage of disable participants who were malnourished exceeded the percentage of able participants who were malnourished. The study showed that majority of people who took complete meals for only once were malnourished in comparison to those who took meals twice in a day. According to the guidance by MNA a complete meals consisted more than two items to eat at a time. Lesser number of meals might make a person deprived of sufficient energy that he might need for his age and health status. Taking lesser number of meals was directly associated with nutritional status of elderly people in the study.

Pashupati Bridhashram was the first old age home I visited. It had large accommodation separately for males and females. I came to know background, living status and nutritional status of people living there. Many elderly people stated the reason for coming to the old age homes. Many women were widow. Some deserted home because of polygamy. Sita Adhikhari said that her husband deserted her because her speech was slurry and thereby disliked her. She had multiple diseases like high blood pressure, asthmas, gastritis and also arthritis. Bhagwati Dhakal, another active respondent had just recovered from illness and was complaining of half cooked rotis served there that day. The day was Ekadashi when many elderly women were on fasting. The facility of toilet was far from residence. One of the respondent said that she couldn’t control her continence for more than five minutes. Other said that she used to avoid meals in the evening because of difficulty of toileting. The provision of meat and eggs was cut off after the earthquake that occurred in 2072. This provision was almost same in most of the old age homes I visited. Sita Karki said that she along with others bought cooked meat and eggs from outside. The provision of fruits and milk was well made in the institution by donors from various places. People frequently smoked there and the health of non smokers was also largely affected as they had to adjust in one large accommodation. The provision of care from care takers was given only to the disabled people. The normal elderly had to do all their activities by themselves. When they were ill, they said that they took care of each other. On the second day I met Chetnath Pokhrel. He was from Okhaldhunga. He said that he had been living in India since his childhood, had been married there but had no children. He said that he returned after his wife died there. He was ill at the time of assessment. I measured his calf circumference and had hardly achieved at around twenty-five. This was the most vulnerable condition I observed in Pashupati. The care taker said that it was hard to manage sanitation for all compartments due to large habitations. After this, I visited Nishaya Sewa Sadan, Aamako Ghar, Mtatirtha, Tapasthali and Divine Home and Hope Hermitage. Nishaya Sewa Sadan was excellent in providing services to the elderly. Fooding, lodging, caring were best to feel by anyone there. Tapasthali supported the countryside lifestyle for elderly living there. There was enough land to grow maize, pumpkin tendrils, chilies and also several cows were reared there. Many elderly said that they actively participated in the kitchen gardening there. There was one caretaker and one male member in the name of gothala. In Divine Home one elder woman named Ambika said that she lost six children after every birth. She became victim of depression in early age and came to reside there after she lost her husband also. Manamaya Neupane from Pashupati Bridhashram said that her daughter loved her a lot and wanted her to be with her after second marriage by her father. But her in laws forwarded a choice between them and her mother. The daughter was compelled to leave her there. She said that she cried the whole day she came there. I somehow concluded that daughters took better care of their parents than a son did. I saw them taking time from their schedule to visit their parents with eatables they liked along with their children. I saw that the affection and caress from a daughter was a big hope for many elderly women living there. The head of Matatirtha old age home said that the food for elderly was collected via “Muthi Daan” where people from community of Patan and Kalanki gave a palmful of cereals and veggies to feed the people. The Hope Hermitage located at Lazimpat was mainly targeted for senior citizens and also had adjustments for dementia and Alzeimer patients. There was a couple living there who came because their home was devastated in earthquake. The other women named Krishna Shrestha came to take care of her paralysed husband. She had six children who were all settled in aboard and there were none for taking care of them. It was hard for her to take care of her husband who was so much restless and violent. She said that the condition wouldn’t had been the same if she had been in her husband’s place. She even said that women were thus for enduring any grief and getting accustomed to any situation of life.

Every elderly had various reasons behind leaving homes and residing in old age homes. Some complained of polygamy, many spoke of mistreatment by family, a few told of medical complication and many told of loneliness. People going for aboard in hope of better life could only leave their parents in old age homes. I wondered whether or not they knew about grief their parents were living with or they might be unaware of these because they were lost in their own. Reasons might be many and compulsion might vary from people to people, these wouldn't matter so big if these institutions worked hard to meet the purposes they had set for these homeless and lonely elderly. This could turn the happiest place for them to live for rest of their lives despite thousands of sorrows and compulsion they came there because of.

Old age homes and age care centers are the one to create employment opportunities for thousands of people in aboard. When people get old and fragile to earn life, government take total responsibility of those citizens and create large manpower for their services in this sector. Because of declining fertility rate and increasing life expectancy, the elderly population is on rise in Nepal. This will definitely put burden to economy of the country because of higher dependency rate and demand for better health services.  So, the government should timely sort out problems of elderly and provide better services by creating manpower in this sector. I drew some important recommendations as per my conclusion in my research. I suggested frequent monitoring of health and nutrition by professionals. It should then intervene to treat malnourished by appropriate diet enhancement and weight monitoring as well as treat and manage co-morbidities side by side.