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Geriatr Gerontol Int 2012

ORIGINAL ARTICLE

Mini Nutritional Assessment and

functional capacity in
community-dwelling elderly in
Rural Luozi, Democratic
Republic of Congo ggi_852 1..8

Muzembo Basilua Andre, Narongpon Dumavibhat, N’landu Roger Ngatu,

Masamitsu Eitoku, Ryoji Hirota and Narufumi Suganuma

Division of Social Medicine, Department of Environmental Medicine, Kochi Medical School,

Kochi University, Kochi, Japan

Aim: Good nutrition is beneficial both for the health and the functional capacity of the
elderly. However, malnutrition is a serious health problem among the elderly, particularly
the elderly living in rural areas in many developing countries. The aim of the present study
was to carry out a cross-sectional study of the elderly in the city of Luozi, Democratic
Republic of Congo, through the use of the long and the short forms of the Mini Nutri-
tional Assessment (MNA) scale.
Methods: We carried out a cross-sectional study in the city of Luozi, a city facing serious
socioeconomic problems as a result of wartime conditions in the country. The study
included 370 volunteer community-dwelling elderly people aged 65–88 years, both male
and female. Investigations took into account the MNA, the activities of daily living, and the
instrumental activities of daily living, falls, current diseases and lifestyle.
Results: Approximately 57.8% of the participants were at risk of malnutrition, whereas
28.4% were malnourished according to the MNA scale. MNA scores were significantly
lower (Student’s t-test, P = 0.03) in those with a fall history (MNA score 18.3 1 4.0)
compared with those who did not (MNA score, 21.0 1 2.7). All the participants with
malnutrition suffered from at least one chronic disease. The percentage of participants
with dependency was significantly higher in the malnourished participants (87.6%) than in
well-nourished participants (50.9%).
Conclusion: These findings provide information that malnutrition is a serious health
concern among elderly people in the city of Luozi, and shows the need for adequate
nutrition and social programs for the elderly. Geriatr Gerontol Int 2012; ••: ••–••.

Keywords: activities of daily living, elderly, fall, instrumental activities of daily living,
Luozi, Mini Nutritional Assessment.

Accepted for publication 14 February 2012.
Correspondence: Dr Muzembo B Andre MD, Division of Social
Medicine, Department of Environmental Medicine, Kochi
Medical School, Kochi University, Kohasu, Oko-cho,
Nangoku-shi, Kochi 783-8505, Japan.
Email: andersonbasilua@yahoo.fr
Introduction
The number of elderly is on the increase, both in devel-
oped and developing countries.1 Aging is associated
with various physiological changes and needs, which
make elderly people vulnerable to malnutrition.2
Malnutrition is both a common condition and serious

© 2012 Japan Geriatrics Society doi: 10.1111/j.1447-0594.2012.00852.x 兩 1

 MB Andre et al.
health problem among the elderly. It increases morbid-
ity3 and mortality4 among the elderly, is often accom-
panied by anorexia, and it is also a risk factor for
osteoporotic fracture.5,6 The prevalence of malnutri-
tion varies considerably depending on the population
studied and the criteria used for the diagnosis.7 Avail-
able data for malnutrition worldwide shows that the
prevalence of malnutrition as rated by the Mini Nutri-
tional Assessment short form (MNA-SF) among the
elderly is the following: 0–8% for those living in a com-
munity, 0–30% among the non-institutionalized elderly
and 0–74% for the hospitalized and institutionalized
elderly.8 The prevalence of severe malnutrition requir-
ing emergency intervention ranges from 25% to 50%
worldwide. Other conditions connected with malnutri-
tion and found in the elderly are marasmus, protein-
energy malnutrition, and kwashiorkor. Worldwide
percentages for the aforementioned conditions are the
following, respectively: 9%, 19% and 24%.9,10 Although
good nutrition is beneficial both for health and the
ability to resist and recover from disease, malnutrition
leads to dependency.11 Dependency interferes with the
health and quality of life, not only for the elderly, but
also for relatives and health-care providers.12 Activities
of daily living (ADL)13 and instrumental activities of
daily living (IADL)14 reliably identify the dependent
elderly, and assessment of functional capacity is a key
element in geriatric health, as it can help in identifying
what services or programs are needed.15
The MNA-SF is a validated questionnaire for simple
and rapid assessment of the nutritional status of elderly
people.5,8 It is easy to administer and non-invasive, and
is widely used to detect those who could be assisted by
early nutritional intervention. Therefore, it should be
integrated into a comprehensive geriatric assessment.16
In Africa in general, and in the Democratic Republic
of Congo (DRC) in particular, the nutrition of older
people is not considered a priority, and when nutrition
intervention programs are available, they are usually
for children or refugees.17 The DRC, formerly Zaire,
located in west-central Africa, is facing serious security,
political and socioeconomic problems after decades of
dictatorship and devastating civil war. The health sector
has almost collapsed; chronic malnutrition (mild and
severe) is as high as 31%, and the main sectors of the
economy have declined for decades with insignificant
recovery in recent years.18 Rural exodus, poverty and
acquired immunodeficiency syndrome are affecting
young adults who should be caring for the elderly. The
fact that elderly people have to take care of children of
deceased young adults, and also the incidence of social
isolation of elderly people by their families because of
the belief in witchcraft, has put the rural elderly in the
DRC in difficult conditions. To the best of our knowl-
edge, the nutritional and functional capacity of elderly
people living in Luozi city has not been documented.
2 兩
Therefore, assessment of the nutritional status of the
elderly people in Luozi city is an important public-
health exercise vital to understanding their health
needs.
The present study was designed to evaluate the nutri-
tional status and the functional capacity of the elderly in
the rural city of Luozi.
Materials and methods
Luozi city is a rural area located in Bas-Congo province,
DRC. Until May 2011, it had a population of 13 723
people. The city of Luozi is facing serious socioeco-
nomic problems as a result of wartime conditions in the
country, an exodus of young adults from the rural areas
to the big cities and superstitious beliefs that contribute
to the abandonment of the elderly. The main source
of income for the locals is from agricultural activities.
The present study was a cross-sectional study enrolling
a total of 370 elderly persons, both male and female.
Selection was on a voluntary basis at home, churches
and markets. The participants were asked a series of
questions by the same nurses at a Catholic Church-
owned dispensary in the city of Luozi, supervised by
a physician between May 2011 and September 2011,
while at the same time blood pressure, height and body-
weight were measured.
Nutritional status was evaluated using the MNA-SF
and MNA long form (MNA-LF). The MNA-SF and
MNA-LF scores combined together were used for data
analysis, and scores were classified as normal (a score
between 24 and 30), at risk of malnutrition (17–23.5)
or as showing malnutrition (<17).8,19 The short form
(MNA-SF) contains six items for nutrition screening,
whereas the long form (MNA-LF) consists of 18 ques-
tions that ascertain the risk of malnutrition. The two
forms help to ascertain the following information:
anthropometric measurements, cognitive status, dietary
habits, general health and social life.
The functional capacity of the participants was
evaluated using scores from the ADL and the IADL.
The ADL are considered to be the following: bathing
or showering, dressing, carrying out personal toileting,
moving from bed to chair, bowel continence or urine
continence and eating, whereas the IADL questionnaire
analyses the ability to use the telephone, shopping,
meal preparation, housekeeping, laundry, transporta-
tion, responsibility for one’s own medications and han-
dling finances. ADL items were scored according to the
Katz index,13 with an individual total score ranging from
zero (total dependence) to six (independence). Partici-
pants were classified as having limitations when they
needed help to carry out tasks or as without limitation
when they were autonomous. IADL items were assessed
using the scores published by Lawton and Brody.14 Par-
ticipants were asked if they could carry out IADL tasks
© 2012 Japan Geriatrics Society
 Elderly in Rural Luozi
without help, with some help, or if they were unable
to carry them out at all. Individual total scores were
calculated ranging from less than seven (with limitation)
to seven (without limitation), as the item concerning
transportation was difficult to assess.
In addition, the number of falls, current diseases,
smoking habits and alcohol consumption were
assessed. A fall was defined as “unintentionally coming
to rest on the ground, floor or other lower level, exclud-
ing intentional change in position to rest in furniture,
wall or other structures”.20 The present study was
approved by the Research Ethics Committee of Kochi
Medical School and by the local authorities of Luozi
city. The study was carried out in accordance with the
Helsinki Declaration.
Statistical analysis
Data processing was carried out with the Stata software
package version 10 (STATACORP LP, College Station,
TX, USA), and a significance criterion of probability
value of P < 0.05 was used. The c2-test and Student’s
t-test were used respectively to assess differences in cat-
egorical variables and continuous variables. Pearson’s
correlation test was carried out in order to evaluate the
relationship between studied parameters. The general
characteristics of the participants, nutritional status,
falls, and ADL and IADL status were summarized by
frequency and percentage of participants. The results
are presented as mean 1 SD for quantitative variables.
Results
The general characteristics of the participants are
shown in Table 1. Data analysis was carried out for
370 participants. Their mean age was 69.9 1 5.6 years
(range 65–88). The mean body mass index (BMI) was
19.8 1 1.3 (range 16.3–23.9), and 34.3% of the partici-
pants were underweight. The study included more
males than females. Approximately 16% of the partici-
pants were tobacco smokers and 27.5% consumed
alcohol everyday, whereas 15% reported to consume
alcohol occasionally. A total of 65% of the participants
were married and 25% were widowers, whereas 15% of
males had remarried after losing their wives.
As shown in Table 2, a small percentage of partici-
pants, 2.7%, were free of chronic diseases. All the par-
ticipants with malnutrition suffered from at least one
chronic disease. Hypertension, arthritis, osteoporosis,
anaemia, stomach ulcer, diabetes and heart attack were
the morbidities most reported. The drugs reportedly
used were those against malaria, hypertension, pain,
arthritis, stomach ache, heart disease and diabetes.
Comorbidity, hearing impairment and poor vision were
common among participants.
© 2012 Japan Geriatrics Society
The nutritional status of the elderly in the rural city of
Luozi rated by the MNA score is shown in Figure 1.
The mean of the MNA score was 19.7 1 4.1, meaning
that participants in the present study were somewhat at
risk of malnutrition. Approximately 13.8% of the par-
ticipants had normal nutritional status (MNA score,
25.4 1 1.0), 57.8% of the participants were at risk of
malnutrition (MNA score, 20.5 1 1.8) and 28.4%
of the participants were malnourished (MNA score,
13.8 1 2.2). There were more malnourished females
than males (P < 0.001). None of the participants had full
meals three times a day (Fig. 2), whereas 11.4% reported
having one meal once a day. A total of 62% of the
participants who reported having one meal a day were
victims of falls at least once a year. The prevalence of
falls was 55.1%, and 24.6% of the participants reported
to have experienced two fall episodes in the previous
year (Table 3); a positive correlation was found between
falls and ADL limitation (r = 0.21; P = 0.001). In addi-
tion, falls were negatively correlated with MNA scores
(r = -0.22; P = 0.009); MNA scores were significantly
lower (Student’s t-test, P = 0.03) in those who fell (MNA
score 18.3 1 4.0) compared with those who had not
(MNA score 21.0 1 2.7).
The analysis of ADL items by the Katz score showed
that of the 370 participants, 76.5% had dependence in
at least one ADL item, whereas the Lawton and Brody
score showed that 72.7% of the studied population
had limitation in at least one item of IADL. Bathing/
showering, continence and transferring were the tasks
reported as most difficult by participants. In regard to
the relationship between the MNA score and the func-
tional capacity as analyzed by ADL, the percentage
of participants with dependency was significantly
higher in the malnourished participants (87.6%) than in
well-nourished participants (50.9%). The results were
similar regarding the functional capacity when quanti-
fied by IADL; 94.3% of the malnourished participants
had IADL limitations compared with just 11.8% in
well-nourished participants.
Approximately two-thirds of the participants walked
by themselves to reach the dispensary, whereas one-
third were carried to the dispensary by bicycles. The
majority of the participants were surviving predo-
minantly through subsistence agriculture, and 63% of
them were illiterate or had little education.
Discussion
The present study analyzed the nutritional status and
the functional capacity of elderly people in the city of
Luozi. The MNA score showed that approximately
57.8% were at risk of malnutrition, whereas 28.4% were
malnourished. Results from the present study also
showed that 76.5% of the participants were classified as
dependent in the performance of ADL as estimated by
兩 3
 MB Andre et al.

Table 1 General characteristics of the participants

Variables Normal nutritional Risk of malnutrition Malnutrition Total P*

status (n = 51) (n = 214) (n = 105) (n = 370)
Sex
Males 38 111 45 194
Females 13 103 60 176 –
Age group (%)
65–69 years 72.5 73.8 35.2 62.7
70–79 years 27.5 26.2 38.1 29.7
80–89 years 0 0 26.7 7.6 –
Mean age (years) 68.4 1 4.0 68.3 1 3.9 74 1 6.7 69.9 1 5.6 <0.001
Body mass index (kg/m2)
<18.5 8 (15.7) 34 (15.9) 85 (81.0) 127 (34.3) <0.001
18.5–24.9 43 (84.3) 180 (84.1) 20 (19.04) 243 (65.7)
Smoking
No 35 (68.6) 174 (81.3) 102 (97.1) 311 (84.0)
Yes 16 (31.4) 40 (18.7) 3 (2.9) 59 (‘16.0) <0.001
Alcohol consumption
No alcohol 27 (52.9) 124 (58.0) 62 (59.0) 213 (57.5) 0.47
Every day 19 (37.3) 51 (23.8) 32 (30.5) 102 (27.5)
Occasionally 5 (9.8) 39 (18.2) 11 (10.5) 55 (‘15.0)
Physical exercise (time/week)
No 0 179 (83.6) 102 (97.1) 281 (76.0)
1–5 51 (100) 35 (16.4) 3 (2.9) 89 (24.05) <0.001
Takes more than three prescription drugs per day
No 41 (80.4) 178 (83.2) 33 (31.4) 252 (68.1)
Yes 10 (19.6) 36 (16.8) 72 (68.6) 118 (31.9) <0.001
Activities of daily living
Without limitation 25 (49.0) 49 (22.9) 13 (12.4) 87 (23.5)
With limitation 26 (50.9) 165 (77.1) 92 (87.6) 283 (76.5) <0.001
Instrumental activities of daily living
Without limitation 45 (88.2) 50 (23.4) 6 (5.7) 101 (27.3)
With limitation 6 (11.8) 164 (76.6) 99 (94.3) 269 (72.7) <0.001
Falls 18 (35.3) 122 (57.0) 64 (61.0) 204 (55.1) 0.003
*P = comparison between malnourished and well-nourished participants.

Table 2 Participants’ chronic diseases according to the Mini Nutritional Assessment score

Chronic disease Normal nutritional Risk of malnutrition Malnutrition Total

status (n = 51) (n = 214) (n = 105) (n = 370)
None 10 (9.5) 0 0 10 (2.7)
Hypertension 49 (96.1) 38 (17.8) 102 (97.1) 189 (51.1)
Arthritis 42 (82.4) 19 (8.9) 69 (65.7) 130 (35.1)
Osteoporosis 15 (29.4) 25 (11.7) 43 (41.0) 83 (22.4)
Anemia 14 (27.5) 27 (12.6) 41 (39.0) 82 (22.2)
Stomach ulcer 3 (5.9) 26 (12.1) 32 (30.5) 61 (16.5)
Diabetes 19 (37.3) 4 (1.8) 28 (26.7) 51 (13.8)
Heart disease 4 (7.8) 22 (10.3) 26 (24.8) 52 (14.1)
Tuberculosis 0 12 (5.6) 16 (15.2) 28 (7.6)
Cancer 3 (5.9) 0 7 (6.7) 10 (2.7)

4 兩 © 2012 Japan Geriatrics Society


the Katz score, whereas 72.7% required help in carrying
out IADL as rated by the Lawton and Brody score.
These findings provide further information that malnu-
trition is a serious health concern among elderly people
in the city of Luozi, and highlights the need for
adequate nutrition and social programs. The mean age
of the participants was 69.9 1 5.6 years (range 65–88), a
surprising statistic, as the mean life expectancy at birth
in the DRC is approximately 55 years.
The present study was the first to assess the nutri-
tional status of rural elderly persons in the city of Luozi.
The overall prevalence of malnutrition and risk of mal-
nutrition found in the present study was not surprising,
as the majority of the elderly people in Africa age in
misery, poor health and food insecurity.
As one example, in the present study, no participant
reported having adequate meals three times a day. The
prevalence of malnutrition was 12.2% in males and
16.2% in females. This correlated with the general
reported prevalence in older Africans.17,18 This preva-
lence is a challenging situation considering the fact that
malnutrition increases morbidity and mortality in the
elderly, and in addition, malnutrition leads to functional
13.8%
28.4%
57.8%
Normal nutrition status (MNA > 24) Malnutrition (MNA <17)
Risk of malnutrition (MNA: 17-23.5)
Figure 1 Nutritional status of elderly in the rural city of
Luozi rated by Mini Nutritional Assessment (MNA) score
(n = 370); 51 participants were well-nourished, 214
participants were at risk of malnutrition, and 105 were
malnourished.
100
Participants (%)
Figure 2 Full meals eaten daily by
elderly in the rural city of Luozi,
classified by their nutritional status;
none of the participants had full meals
three times daily (n = 370).
© 2012 Japan Geriatrics Society
Elderly in Rural Luozi
decline and dependency. Therefore, this prevalence
reinforces the importance of early detection of malnu-
trition or the risk of malnutrition in the elderly, so
that nutritional intervention can occur. These findings
concur with the study carried out in rural Bangladesh by
Kabir et al., which found a prevalence of malnutrition
of 26% (vs 28.4% in the present study), and a risk of
malnutrition of 62% (vs 57.8% in the present study)
among 457 rural elderly with a mean age of 69 1 8 years
(vs 69.9 1 5.6 in the present study).21 The primary dif-
ference between the study by Kabir et al. and the present
study is the number of MNA items used; we used 18
items of the MNA, whereas Kabir et al. used 16 items.
Kabir et al. did not include information on calf cir-
cumference and the query regarding comparison of
health status with other elderly.
Another study carried out in western Rajasthan,
northwest of India,22 using the 18 items of the MNA
scale, found that 7.1% of the elderly were malnourished
(vs 28.4% in the present study), with 50.3% at risk of
malnutrition (vs 57.8% in the present study), and 42.6%
with a good nutritional status (vs 13.8% in the present
study). Possible reasons for the discrepancy are that the
socioeconomic conditions are quite different, with the
civil war and political instability in the DRC possibly
contributing to the higher percentage of malnutrition
among the elderly. In addition, the study carried out in
western Rajasthan included both rural elderly and urban
elderly; the same study found that rural elderly were
more malnourished or at risk of malnutrition compared
with the urban elderly.
More females were found with malnutrition than
males. Apart from disease, old age and poverty, which
have all been reported to contribute to malnutrition in
the elderly,23 we strongly feel that the higher prevalence
of malnutrition in women in the present study could
partly be a result of the effect of the traditional habits of
eating. In many families, men usually eat before women.
Women first serve the men, who usually eat at a table.
Women and children are the last people to eat, and
usually sit on the floor and share the remaining food. As
their portions are smaller, this might result in poor
nutrition.
In studying the prevalence of malnutrition and
the risk of malnutrition using the MNA tool among
90.2
90
80 72.6 69.5
70
60 One meal daily
50 Two meals daily
40 27.4 30.5 Three meals daily
30
20 9.8
10
0
Normal nutrition status Risk of malnutrition Malnutrition
Nutrition status rated by mini nutritional assessment
兩 5
 MB Andre et al.

hospitalized or institutionalized elderly and non-

Total

370

51
214
105

42
328

87
283
institutionalized elderly, several researchers24,25 have

–
reported that malnutrition and the risk of malnutrition
Table 3 Frequency (percentage) of participants who reported falls during the previous year according to the Mini Nutritional Assessment score, full

is high among institutionalized or hospitalized elderly.

In the present study, the prevalence of malnutrition and
the risk of malnutrition correspond with those reported
Fell five times

among the institutionalized elderly.4,26 The absence of

institutions for the care of the elderly in the city of Luozi
or more

might be one possible explanation for this situation.

5 (1.3)

5 (2.3)

5 (1.8)
The prevalence of malnutrition found in the present
0

0
0

0
–
study as assessed by MNA (28.4%) correlates with
the prevalence of participants who were underweight
according to the body mass index (34.3%) and also with
the prevalence of malnutrition of 31%, as reported in
Fell four

the whole population in the DRC,18 showing that the

10 (2.7)

6 (2.8)
4 (3.8)

5 (1.5)

10 (3.5)
times

MNA tool can be used for assessing the nutritional

0

0
status of Congolese elderly people.
–

Falls and fall-related injuries have been recognized as

a serious public health hazard for elderly people. In the
present study, the prevalence falls was 55.1%, and there
was a strong correlation between history of fall and
Fell thrice

47 (12.7)

30 (14.0)
12 (11.4)

10 (23.8)
37 (11.3)

44 (15.5)
5 (9.8)

3 (3.4)

malnutrition. The prevalence of falls in the present

study was almost double compared with the reported
prevalence of 32% of elderly persons falling at least once
–

a year.27,28
We found that episodes of falls were significantly
higher in malnourished participants, whereas functional
capacity was significantly lower in this group. These
Fell twice

91 (24.6)

8 (15.7)
52 (24.3)
31 (29.5)

9 (21.4)
83 (25.0)

87 (30.7)
4 (4.6)

episodes of falls among the elderly in the city of Luozi

raise some concerns considering the fact that falls might
sometimes lead to death among the elderly. The com-
–

parison of MNA scores between those who fell and

those with no history of falling showed a significant
reduction of the MNA scores in fallers, possibly as a fall
Fell once

51 (13.8)

29 (13.6)
17 (16.2)

7 (16.7)
44 (13.4)

10 (11.5)
41 (14.5)

would incapacitate the subject and make him or her less

5 (9.8)

likely to engage in physical activity. However, the fre-

quency of falls reported by well-nourished participants
–

in the present study cannot be ignored. It is widely

Frequency of fall

believed that because of their mobility and risk-taking

behavior, well-nourished older people might have more
meals eaten daily and activities of daily living

opportunity of being exposed to fall hazards compared

166 (44.8)

33 (64.7)

41 (39.0)

16 (38.1)
150 (45.7)

70 (80.5)
96 (33.9)

with older people with poor health who would likely

92 (43)
None

reduce the activities that cause them to fall.

Late-life anemia is common among elderly people,
–

MNA, Mini Nutritional Assessment.

and has been found to be associated with malnutrition

and falls.29,30 As malnutrition and the risk of malnutri-
tion were common among participants with anemia
in the present study, we assume that the presence of
Activities of daily living
Risk of malnutrition

Full meals eaten daily

anemia could be another explanation for falls found in

Without limitation
Normal nutrition

the present study, in addition to the absence of regular

With limitation

meals and the incidence of diseases.

Malnutrition

Three meals
Two meals

To interpret the relationship between MNA and

One meal
MNA score

functional capacity, it is important to consider the

mechanism by which poor nutritional status leads to
Overall

frailty. A study by Cappola et al. reported that poor

nutrition in association with comorbid illness reduces

6 兩 © 2012 Japan Geriatrics Society

 Elderly in Rural Luozi
insulin-like growth factor production, which leads to
the reduction of muscle strength. The muscle fatigabil-
ity, in association with chronic diseases, leads to the
reduction of mobility, and therefore to frailty or depen-
dency.31 Conversely, there is a report showing that good
nutrition is beneficial for the ability to recover from a
disease while improving functional capacity.11 All the
participants with malnutrition were ill and approxi-
mately 97.3% of the participants reported to suffer from
at least one disease. This is in agreement with a study
carried out among rural elderly in Bangladesh, which
reported that all the participants had at least one dis-
ease.32 The spectrum of chronic disease found in the
present study is a challenging situation considering the
context of living conditions in the DRC, which are
disastrous in general; health infrastructures and envi-
ronmental sanitation had retrogressed for decades, a
consequence being that more than half of the Congo-
lese have no access to basic health care.
Findings from the present study showed that the
functional capacity was significantly reduced in mal-
nourished participants compared with well-nourished
participants. These findings are in line with findings
reported by Romagnoni et al., who found that impaired
functional capacity was strongly associated with malnu-
trition.33 The impact of malnutrition on the participants
in the present study can be also discussed in relation to
the occupation of the participants. The city of Luozi is
located in a rural area without manufacturing compa-
nies, with traditional agriculture being the main source
of income. Traditional agriculture is physically demand-
ing, meaning that the malnourished elderly with func-
tional limitations might not be able to work in the fields,
thus contributing to poor health and a decreased quality
of life.
Based on the data presented here, 76.5% of the par-
ticipants had a reduced ability in carrying out ADL,
whereas 72.7% were dependent in carrying out IADL.
These data clearly denote that these participants need
support from health-care providers or family members.
However, the reality is that in the rural areas, there are
almost no formal services to take care of the elderly in
their daily activities. Other family members are their
only source of support, but in many cases the family
members have migrated to urban areas to look for jobs,
leaving the elderly without adequate support.
A greater number of participants in the present study
had more ADL than IADL limitations, and this was in
contrast with the widely held belief that IADL requires
more cognitive integrity than ADL. The reason for
this discrepancy was that the mode of transportation
was not assessed, as none of the participants were using
either private or public transportation. In addition, the
use of the telephone was difficult to assess, as none of
the participants had a telephone at home, and just 15%
were using mobile phones.
© 2012 Japan Geriatrics Society
As a questionnaire was used to evaluate ADL, IADL
and some items of MNA, the answers received from
participants might have contained some recall bias; this
is a common limitation when using questionnaires. To
minimize these potential errors, interviews were carried
out by well-trained nurses in the language spoken by
the local population.
The present findings provide information that mal-
nutrition is an issue of serious health concern among
elderly people in the city of Luozi. Malnutrition is high
among the elderly in the city of Luozi, and reduced
functional ability is common among these elderly.
Results from the present study highlight the need for
adequate nutrition and social programs for these elderly
people.
Acknowledgments
This work was financially supported by the Department
of Environmental Medicine of Kochi Medical School.
The authors thank all the participants of this study.
They are also grateful to Mr Daniel Ribble, Mr Mugo
Andrew and Ms Mansongi Biyela Carine for their advice
and contributions to the manuscript.
Disclosure statement
The authors declare no conflict of interest.
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© 2012 Japan Geriatrics Society