Al-najah national university Nursing college 2012

Corse : Nursing Research (Proposal Idea) Prepared by:

Ashraf Qotmush
Hassan Makhlouf Oday Al-sayed Supervised by : Dr. Aidah Abu El Soud Alkaissi

8/3/2012

1. Introduction
Nutritional status impacts upon the health and physical function of older people, who face a high risk of nutrient deficiencies and malnutrition. Poor nutritional status is particularly related to loss of skeletal muscle mass and strength.
Web link Reference: http://www.personal.reading.ac.uk/~sis05fh/nana/introduction.html

A number of factors affect nutritional status in older people, although the specific relationships are not well understood. Physical factors, such as problems with chewing, swallowing and impaired mobility all contribute towards nutritional decline. Mental health is another contributing factor, particularly the presence of depression, which has been proposed as the main cause of weight loss in the ageing population (Morley, 2001). Treatment of depression can be an effective way to increase appetite and improve nutritional status. So that measuring old adult people depression level is as important as the quality of nutritional status that old people have, as it plays an important role in the degree of the old people health status. A number of factors affect the nutritional status of the elderly, although the specific relationships are not well understood. Physical factors, such as problems with chewing, swallowing, and reduced mobility all contribute to the nutritional decline. Mental health is another contributing factor, especially the prevalence of depression, which has been proposed as the main cause of weight loss in the aging population (Morley, 2001). Treating depression can be an effective way to increase appetite and improve nutritional status. Measuring the old adult human depression level is as important as the quality of the nutritional status of old adults is, as it plays an important role in the degree of the old adult health

2. Purpose of the Study :

The purpose of the study is to investigate whether there is association between depression and nutritional status among Community-dwell old people.

3. Research Problem :
Does the depression influence on the nutritional status among the community-dwelling or elder?

4. Research Hypothesis:
The depression among old adult people in the Community-dwelling has a negative effect on their nutritional status.

5. Definition of concepts :
Old adult : Most developed world countries have accepted the chronological age of 65 years as a definition of 'elderly' or older person.
Web link Reference: http://www.who.int/healthinfo/survey/ageingdefnolder/en/index.html

Depression: is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.
Web link Reference: http://www.who.int/mental_health/management/depression/definition/en/

Operational definition (Operational Definition of the Concept of Depression DSM-IV-R Criteria for Major Depressive Disorder) : At least five of the following symptoms are present during the same period. At least (1) depressed mood or (2) loss of interest or pleasure must be present. Symptoms are present most of the day, nearly daily for at least 2 weeks. (1) Depressed mood most of the day, nearly every day. (2) Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day (as indicated by either subjective account or observation by others of apathy most of the time (3) Significant weight loss/gain.

(4) (5) (6) (7) (8) (9)

Insomnia/hypersomnia. Psychomotor agitation/retardation. Fatigue (loss of energy). Feelings of worthlessness (guilt). Impaired concentration (indecisiveness). Recurrent thoughts of death or suicide.

Web link Reference: https://www.msu.edu/~nurse/classes/summer2001/813/ODDepression.htm

Nutritional status : The state of a persons health in terms of the nutrients in his or her diet. Operational definition The following four specific terms, essential to ensuring adequate nutritional status, are important to consider. Nutrition screening: Screening refers to a proactive process that is used systematically in clinical practice to identify individuals who are malnourished or who are at risk for developing malnutrition. Nutrition screening identifies those individuals who subsequently should undergo a comprehensive nutritional assessment.

Nutrition assessment: A comprehensive approach to defining nutritional status that uses Medical, nutrition, and medication histories Physical examination Anthropometric measurements Laboratory data. A comprehensive nutritional assessment should provide all of the requisite information for developing a nutritional care plan. Nutrition care plan: This refers to the documented nutrition goals and interventions prescribed for an individual using data obtained from a nutrition assessment. Nutrition care plan development involves input from multidisciplinary specialists and should state nutritional goals, monitoring parameters, the most appropriate route of administration for nutritional support (oral, enteral, and/or parenteral), method of nutritional access, anticipated duration of therapy, and training and counseling goals and methods. Specialized nutrition support (SNS): The administration of nutrients by routes prescribed in the nutrition care plan, with therapeutic

intent. This includes (but is not limited to) the provision of total enteral or parenteral nutrition support and provision of therapeutic nutrients to maintain or restore health.
Reference for definition: August, D.A., Teitelbaum, D., Albina, J., Bothe, A., Guenter, P., Heitkemper, M., et al. (2002). Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Journal of Parenteral and Enteral Nutrition, 26(1, Suppl.), 2SA.

6. Literature review :
Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community-dwelling elderly people
German L, Kahana C, Rosenfeld V, Zabrowsky I, Wiezer Z, Fraser D, Shahar DR.

Source :Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev,
PO Box 653, Beer-Sheva 84105, Israel.

Web link Reference http://www.ncbi.nlm.nih.gov/pubmed/21267514

This study was conducted in the city of Lod, which is ranked by the Israeli Central Bureau of Statistics as town at intermediatelow socioeconomic status. the time of the study, December 2003. This study clarify the temporal relationship between the emotional and nutritional domains in vulnerable of old adult population, and it is studied the relationship between depression and nutritional deterioration in older persons and is highly prevalent among people of low socioeconomic status (LSES). The objective of this study was to determine the prevalence of depressive symptoms and food insufficiency, and to examine the relationship between dietary intake with depression, in LSES community dwelling elderly. The study included a One hundred and twelve participants had complete data between ages of 60 to 92 years in the Community-dwelling , and measurement for Depression was assessed by 15 item Geriatric Depression , also the dietary intake was evaluated by using a 24-hour dietary recall. Food

insufficiency was defined by participants reporting that they did not have enough food to eat sometimes or often. At the result of this study, The prevalence of food insufficiency was more than 4-fold higher among depressed (41.5%) compared to non-depressed (10.2%) study participants. And the participants who reported food insufficiency were 10 times more likely to be depressed compared with those who reported sufficient food. In addition the elderly persons with depressive symptoms are common among low socioeconomic subjects with an overall prevalence of 47% compared to a rate of 31.7% among physically disable older women or 28% among elderly in shortterm general hospitalization.

Nutrient intake and psychological health in an elderly Chinese population

Web link Reference http://onlinelibrary.wiley.com/doi/10.1002/gps.1603/abstract

This article conducted at 2006 in Hong Kong China The researcher goals of this research are to study the relationship between the nutrition and cognitive impairment, and nutrition and depression in old adult persons, Elderly people are at risk of malnutrition, and also have higher prevalence of cognitive impairment and depression, and this achieved by examining relationship between the nutritional status and psychological health in elderly, adjusting the confounding factors. The study sample was Three thousand nine hundred and ninety-nine men and women aged 65 years and over living in the community, with approximately equal numbers in three age groups, ( 6569), (7074), (75+ ) years. The researchers here using Geriatric depression scale (GDS), and Community Screening Instrument for Dementia (CSID) to determine the cognitive impairment and depression in Community-dwelling elderly people, and using a 7-day food frequency questionnaire to assess dietary intake , in addition of assessing the cognitive and nutritional status the researchers taking into account the confounding

factors: demographics, educational level, socioeconomic status, medical history, smoking, alcohol intake, and physical activity, Logistic regression analyses were carried out to examine associations between lifestyle and dietary variables, and CSID and GDS, controlling for confounders. The result was positively because Both CSID and GDS scores were associated with co-morbidity, demographic and socioeconomic factors, Dietary factors inversely associated with GDS score include total fat intake, vitamins, fibre, and vegetables. In terms of nutrient density, iron and isoflavone intake were additional factors. The researchers advices was to conducted a new follow-up studies of this cohort or interventional studies to Elucidate cause effect relationship, due to the Association exists between intake of various nutrients and psychological health independent of other confounding factors in the elderly population.

Risk of malnutrition is associated with mental health symptoms in community living elderly men and women.
Web link Reference http://www.biomedcentral.com/

Introduction: This article conducted at 2011 Tromso in Norway. Purpose : The researcher goals of this research are to assess the associations between mental health (particularly anxiety and depression) and both the risk of malnutrition and body mass index (BMI, kg/m2)in a large sample of elderly men and women from Tromso, Norway. Method: The study sample was 1558 men and 1553 women aged 65 to 87 years, The researchers here using, The MUST tool is the nutritional screening instrument recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) for use in the community, Two other nutritional screening tools have been recommended by the ESPEN, the Nutrition Risk Screening 2002 (NRS 2002) and the Mini Nutritional Assessment (MNA).

Assessment of mental health symptoms, Mental health status was assessed by the Hopkins Symptoms Check List-10 (SCL-10), which has been widely used in epidemiological studies. The SCL-10 is a self-administrated instrument that mainly explores symptoms of anxiety and depression .The ten items of the SCL-10 were part of the questionnaire that was included in the invitation to the survey. The questionnaire was completed by participants at home and handed in at the study centre. The SCL-10 questions explored the presence and severity of the following ten symptoms during the preceding week: (1) Sudden fear without apparent reason, 2) Afraid or worried ,(3) Faintness or dizziness ,(4)Tense or upset, (5) Easily blaming yourself , (6)Sleeplessness ,(7) Depressed or sad, (8) Feeling worthless ,(9) Feeling that everything is struggle, (10) Feeling hopelessness with regard to theuture.

Result : The risk of malnutrition (combining medium and high risk) was found in 5.6% of the men and 8.6% of the women. Significant mental health symptoms were reported by 3.9% of the men and 9.1% of the women. (SCL-10 score 1.85) were positively associated with the risk of malnutrition , the association was positive also for sub threshold mental health symptoms. For individuals with BMI < 20.0 the adjusted odds ratio for significant mental health symptoms was 2.0 [95% CI 1.0 4.0]. Conclusions: Impaired mental health was strongly associated with the risk of malnutrition in community living elderly men and women and this association was also significant for sub threshold mental health symptoms.

7. Methodology:
7.1 Sites and Settings: Site: The site it will be in Province of Nablus and associated Camps, The total population is 167447. (palestinian Central Bureau of Statistics, 2010). Settings: The Subjects will taken from hospitals, outpatient clinics, geriatric nursery homes, and homes visits. 7.2Study design: Cross-sectional design: We will test the hypothesis (The depression among elderly people in the Community-dwelling has a negative effect on their nutritional status) by using cross-sectional design . We will collect the data at one time by using research tool (questionnaire).

7.3 sample: The sample of our study will be clients from the site and setting we determined, the participant will be chosen randomly, after having the permission to conduct the study and assuring confidentiality ,we will take 150 subjects(participants),75 subjects are male (50%), and 75 are female (50%). The inclusion subjects are: subject who are more than 65 years old. any elderly person in our site and settings after taking the permission to be included in our study. any subject having a depression according the GDS (geriatric depression scale) more than 8 on GDS.

The execlusion subjects : any subjecte refuse to be included in our study. any subjects is out of site and settings of our study. any subject doesnt have depression ( GDS less than 8 ). any subject less than 65 years old .

7.4 Materials and methods: We will use the questionnaire tool, the questionnaire will consist of psychological assessment by using the Geriatric depression scale (GDS), Nutritional assessment by using Mini nutritional assessment (MNA), and some question to determine the socioeconomic status at the end of the questionnaire, Furthermore we will use the consent form to take approval from the subject to be included in the study . we collect data manually to help the subjects who cant use the GDS, and MNA in correct way. 7.5 Data collection: The data will be collected through the distribution of the questioner to 150 subjects in the determined site and sitting.

7.6 Ethical consideration: We will use consent form to take approval from the subject to be included and this considered formal ethical approval.