Suraiya J Ismail

Nutritional risk factors for older refugees.

This study describes risk factors for poor nutrition among older Rwandan refugees. The most important areas of nutritional risk for older refugees are: physical ability and mobility; income and access to land; access to appropriate food rations; meeting basic needs such as water, fuel, shelter; equal access to essential services (food distribution, health services, mills, feeding programmes); and psycho-social trauma. Women and older elderly (> 70 years) are significantly more often in disadvantaged positions, such as having poor socio-economic status, poor health, poor mobility, lower food intake, diminished social status, respect and social network. Older refugees are at higher risk than younger refugees and at higher risk than older people in stable situations. They should remain in good nutritional and general health for their own well-being and that of their dependants. In addition to an adequate diet, a support network seems to be an important preventive aspect.

Improving food provision in a Guyanese home for the elderly: a participatory approach

OBJECTIVES To conduct a needs assessment of all aspects of food provision in a residential home and to evaluate a subsequent nutrition intervention. DESIGN An intervention study using a before and after design. A participatory approach was adopted and quantitative and qualitative methods used throughout. The intervention involved a revised menu, kitchen equipment, and establishing wholesale shopping and food donations. SETTING A residential home for senior citizens in Guyana. RESULTS Meals at the home were nutritionally inadequate and deeply unpopular with the residents. Intakes of fruits and vegetables were low and the home was heavily reliant on donated soya mince and rice. Meals were served within an eight-hour period to accommodate the staffs hours of work. Cutbacks in the food budget indicated that the financial state of the home explained some of the problems. The intervention was unable to address all problems identified, but led to substantial improvements in the nutritional adequacy of the food provided following the inclusion in the menu of a number of nutrient-dense foods such as chicken liver. The new menu was acceptable to the cooks and largely popular with the residents, although some problems persisted. CONCLUSIONS The results show that improvements in the nutrient profile of the diet could be achieved with a flexible, community-based, participatory approach that addressed all elements of a homes food provision system. The changes also proved largely popular with the residents, thus potentially contributing to their quality of life.

The nutritional vulnerability of older Guyanese in residential homes.

OBJECTIVE To assess the nutritional status, functional ability and food intake of older Guyanese in residential care. METHODS Eighty-four residents of one public and two private homes underwent an anthropometric and functional ability assessment including height, weight, armspan, arm and calf circumferences and handgrip strength. Food intake in two private homes was measured over seven days by direct weighing and the use of consumption units. RESULTS The overall prevalence of underweight was 26.2% and of overweight was 17.8% but the prevalence of underweight was higher in the public home (29.3% underweight and 17.2% overweight in the public home, and 19.2% underweight and 19.2% overweight in the private home). Mean handgrip strength was 26 kg in males and 17.7 kg in females. The nutritional adequacy of the diet provided by one of the homes was poor with the food providing less than 50% of the required amount of zinc and vitamins A, D and C. Neither home met the requirement for energy. CONCLUSION A high prevalence of malnutrition exists in a public home for the elderly and, to a lesser degree, in two private homes. In the context of a rapidly ageing population and tight financial constraints, the challenge of providing an adequate diet must be given priority.

Using Participatory Approaches with Older People in a Residential Home in Guyana: Challenges and Tensions

Participatory approaches are a popular and entrenched strategy in community development, yet a number of unresolved issues and tensions persist regarding the definition, rationales, outcomes and ethics of participation. Despite its popularity there are relatively few examples of participatory projects with older people or in institutional settings so their potential with this group is poorly understood. This case study presents some of the practical and ethical challenges that arose over the course of a participatory project that aimed to analyse and improve quality of life in a residential home for older people in Guyana. Through a qualitative process evaluation it examines the degree of participation achieved, the determinants of the participatory process, the benefits the approach brought and the ethical dilemmas encountered. Although the degree of participation achieved was limited, beneficial outcomes were observed, notably the selection of appropriate and desirable interventions and the effect on the residents themselves, who valued their part in the project. The participatory process was unpredictable and complex, however, and key determinants of it included the organizational dynamics of the home and the skills, actions and attitudes of the researcher. Adopting a participatory approach brought valuable benefits in a residential home, but others adopting the approach should ensure they critically consider at the outset the ethical and practical dilemmas the setting and approach may produce and have realistic expectations of participation.