Socio-demographic characteristics
A total of 368 participants were included; 188 (51.1%) living in their homes and 180 (48.9%) in a public institution in the province of Marrakech. Table 1 shows the socio-demographic and economic characteristics of participants. The mean ages of the institutionalized and non-institutionalized elders were 69.19 years (SD = 9.12) and 70.42 years (SD = 8.94), respectively. Of those interviewed, 45.9% were men and 54.1% were women. The majority of older people have reported the low socio-economic and poor health status in this study. In comparison to non-institutionalized elders a high proportion of institutional residents were significantly illiterate (80.0%), unemployed or had low-income (95.5%) and they had less children with an average equal to 1.52 ± 2.35. Moreover, the institutionalized elders were more likely to be unmarried (73.3%) and they had no medical coverage (98.9%).
Table 1
Demographic and socio-economic characteristics of institutionalized and non-institutionalized elders
| Institutionalized elders. n = 180 | Non-institutionalized elders n = 188 | p-value |
Age (years ± SD) | 69.19 ± 9.12 | 70.42 ± 8.94 | 0.748 |
Gender Male Female | 87 (48.3) 93 (51.7) | 82 (43.6) 106 (56.4) | 0.364 |
Marital status Without partner With partner | 132 (73.3) 48 (26.7) | 72 (38.3) 116 (61.7) | 0.001 |
Education status Illiterate Primary Secondary Tertiary level | 144 (80.0) 23 (12.7) 9 (5.1) 4 (2.2) | 128 (68.1) 20 (10.6) 5 (2.6) 35 (18.6) | 0.001 |
Health insurance None Yes | 178 (98.9) 2 (1.1) | 113 (60.1) 75 (39.9) | 0.001 |
Previous occupation and income With low income With middle income With high-income | 172 (95.5) 6 (3.3) 2 (1.1) | 146 (77.6) 13 (6.9) 29 (15.4) | 0.001 |
Origin Urban Rural | 84 (46.7) 96 (53.3) | 101 (53.7) 87 (46.3) | 0.176 |
Number of children | 1.52 ± 2.35 | 4.84 ± 2,63 | 0.001 |
Abbreviations: SD: standard deviation; ( ): absolute frequency |
Table 2
shows the clinical, nutritional characteristics and self-reported morbidities of elderly people. According to MNA-SF, the institutionalized residents are significantly three times more likely to suffer from possible malnutrition with an average equal to 9.42 points (SD = 1.93). In this investigation, more than half of participants suffered from at least two chronic diseases. Furthermore, there were statistically no significant differences between the two groups on common chronic diseases (P > 0.05). Hence, the non-institutionalized elders are complaining about the high proportion of hypertension and heart diseases (37.8%), musculoskeletal diseases (33.5%), gastrointestinal diseases (20.7%) compared to institutionalized elders that suffered from visual disorders (32.8%) and metabolic disorders (22.2%) without significant difference. However, institutionalized individuals were significantly more likely to develop malnutrition (22.2%), severe edentulism (43.3%) and hearing impairments (35.6%) (P < 0.05). According to Self-reported activities, 12.8% of institutionalized elders had many difficulties to perform their activities of daily living without assistance compared to those at home (P = 0.385). Therefore, when analysing GDS-SF, a proportion of severe depression is slightly assessed in institutionalized elders than those living at home (P = 0.313). Table 3 illustrate the independent variables significantly associated with groups of study. We found that the health insurance (P = 0.001; OR = 107.49; 95%CI: 14.292-808.524), the number of children (P = 0.001; OR = 1.74; 95%CI: 1.498–2.023) and the nutritional status (P = 0.001; OR = 3,853; 95%CI: 2.152–6.898) were relatively the predictive variables associated to institutionalized elderly.
| Institutionalized elders n = 180 | Non-institutionalized elders n = 188 | p-value |
MNA-SF score | 9.42 ± 1.93 | 12.55 ± 1.42 | 0.016 |
MNA-SF Malnutrition: 0 to 7 points Risk of malnutrition: 8 to 11 points Normal: 12 points or greater | 40 (22,2) 114 (63,3) 26 (14.4) | 15 (8,0) 66 (35,1) 107 (56.9) | 0.001 |
Number of self-reported morbidity | 1.63 ± 0.89 | 1.66 ± 1.05 | 0.142 |
Morbidities Perceived Heart diseases/hypertension (I10-I15) Respiratory diseases (J40-J47) Infectious diseases (B95-B98) Skin diseases (B35-B49) Musculoskeletal diseases (M00-M99) Gastrointestinal diseases (K00 - K93) Metabolic disorders (E00 - E90) Kidney diseases (N00 - N99) Visual disorders (H00 - H59) | 53 (29.4) 7 (3.9) 6 (3.3) 5 (2.8) 47 (26.1) 28 (15.6) 40 (22.2) 17 (9.4) 59 (32.8) | 71 (37.8) 13 (6.9) 1 (0.5) 3 (1.6) 63 (33.5) 39 (20.7) 38 (20.2) 11 (5.9) 60 (31.9) | 0.091 0.201 0.049 0.437 0.121 0.197 0.637 0.194 0.860 |
Degree of dehydration Severe dehydration Moderate dehydration | 42 (23.3) 138 (76.7) | 43 (22.9) 145 (77.1) | 0.916 |
Hearing status Without problem Hearing impairments (H90-H95) | 116 (64.4) 64 (35.6) | 132 (70.2) 56 (29.8) | 0.014 |
Dental status Good status Partial edentulism (K00-K14) Severe edentulism (K00-K14) | 19 (10.6) 83 (46.1) 78 (43.3) | 32 (17.0) 95 (50.5) 61 (32.5) | 0.043 |
Activity of daily living (ADLs) No difficulties in everything A moderate difficulties Difficulties in everything | 113 (62.8) 44 (24.4) 23 (12.8) | 106 (56.4) 50 (26.6) 32 (17.0) | 0.385 |
GDS-SF score | 5.64 ± 4,13 | 5.01 ± 3,87 | 0.513 |
GDS (Short form) Normal: 0–5 Moderate depression: 6–10 Severe depression: 11–15 | 106 (58.9) 41 (22.8) 33 (18.3) | 115 (61.2) 49 (26.1) 24 (12.8) | 0.313 |
Abbreviations: GDS: Geriatric Depression Scale ; MNA-SF: Mini nutritional assessment short form test ; |
( ): absolute frequency, (-): code of CID-10 to transpose diagnoses of diseases and related health problems. |
Table 3
Variables independently associated with institutionalized (n = 180) and non-institutionalized elderly (n = 188) according to the multiple logistic regression model.
| β | Wald | P-value | OR (95% CI) |
Origin: (Urban) | 0.197 | 0.288 | 0.591 | 1.218(0.593–2.501) |
Marital status: (Without partner) | 0.512 | 1.756 | 0.185 | 1.669 (0.782–3.558) |
Education status: (Illiterate) | 0.252 | 0.289 | 0.591 | 1.286 (0.514–3.218) |
Health insurance: (None) | 4.677 | 20.643 | 0.000 | 107.495 (14.292-808.524) |
Previous occupation level: (low income) | -0.645 | 2.670 | 0.102 | 0.525 (0.242–1.137) |
Number of children: (None) | 0.554 | 52.407 | 0.000 | 1.741 (1.498–2.023) |
Heart diseases/hypertension (I10-I15) | -0.616 | 2.465 | 0.116 | 0.540 (0.250–1.165) |
Infectious diseases (B95-B98) | -3.581 | 5.063 | 0.024 | 0.028 (0.001–0.630) |
Musculoskeletal diseases (M00-M99) | 0.586 | 2.364 | 0.124 | 1.796 (0.851–3.790) |
Gastrointestinal diseases (K00 - K93) | 0.133 | 0.085 | 0.770 | 1.142 (0.469–2.780) |
Hearing status/ Hearing impairments (H90-H95) | 0.188 | 0.337 | 0.561 | 1.206 (0.641–2.272) |
Dental status/ severe edentulism (K00-K14) | -0.061 | 0.121 | 0.728 | 0.941 (0.667–1.327) |
MNA-SF: (malnutrition) (E40-E46) | 1.349 | 20.597 | 0.000 | 3.853 (2.152–6.898) |
Abbreviations: MNA-SF: Mini nutritional assessment short form; β: Coefficient; P: Significance level of the Wald test; OR: Odds ratio; and CI: Confidence interval; (-): code of ICD-10 to transpose diagnoses of diseases and related health problems. |
Health Characteristics And Nutritional Status
Most elderly complained significantly from chronic diseases but with a higher prevalence of malnutrition, depression, hearing impairments and severe edentulism among institutionalized elders. In fact, the multiple illnesses are the common burden of elderly people in institutions [11, 16]. For elderly people, the decision to move into health facilities is most often made in case of severe cognitive or functional impairment, in the absence of support and home-care [11]. The degree of malnutrition in Morocco is under-reported among the elderly people. Furthermore, institutionalized elders are significantly more likely to suffer from malnutrition in our study. Indian studies showed that more than 50% of the elderly people are underweight and 90% have an energy intake below the recommended allowance [4, 10]. In Mexico, it can reach as high as 15%, 21% and 23% in persons with cognitive impairments, those in institutional care, and those hospitalized, respectively [3]. These findings are confirmed by other studies elsewhere [1, 17, 18]. The prevalence of malnutrition is from 21 to 71% among the elderly living in special housing [3]. Nevertheless, prevalence of malnutrition is lower among Chinese, Spanish and Taiwanese elders [18, 19, 20]. As a result, aging is often decreasing the acuity of taste and smell as well as dental health and gastrointestinal function, which may affect the quality of nutrient intake [6, 10, 17]. Saltetti et al. noted that only 8% of non-institutionalized elders were malnourished, because they are often well supported by their families and relatives [21].
Concerning health status, the majority of elderly suffered from many chronic diseases. Similar findings are published elsewhere in the world [6, 22, 23]. These chronic diseases are often leading to an increased need for medical care and long-term support services for older persons as active members in their society. Following an earlier study, most residents are independent to carry out their basic daily activities [24]. In tropical country, Mexican study indicates that nearly 24–28% of elderly have the physical limitations to do their activities of daily living [1]. Hence, 53% of institutionalized residents are heavily dependent in tropical country such as Brazil [25]. Therefore, when we analysed oral health, a higher rate of edentulism is significantly observed among institutional residents. Earlier studies found similar results in Spanish, Indonesian and Brazilian elderly [26, 27, 28]. Similarly to tropical country, this finding can be attributed to unhealthy behaviours and attitudes towards dental care in Morocco. In this terms, poor education, low income, lack of health insurance, poor hygiene, malnutrition, diabetes, hypertension may increase tooth impairments [26, 27, 28, 29]. Moreover, 63.7% and 16.8% of Singapore and South Korean elders are suffered from these impairments, respectively [30, 31]. Hence, the proactive efforts are needed to identify the risk factors and develop the measures to prevent negative consequences of hearing impairments. Concerning depression, a minority of participants suffered from severe depression. However, the high prevalence of depression is observed among nursing homes residents [10, 11]. As a tropical country, Mexico has reported a prevalence of depression from 10–37% among non-institutionalized elderly individuals [1]. Adequately managing depression in the elderly may lead to essential healthcare cost savings for our society [1, 32]. This problem could be reduced by improving nutritional status and social relationship with friends and relatives [10]. Our study has several limitations. This study uses self-reported data to examine autonomy, dehydration, hearing and dental status. Further, it was conducted on a small sample of institutional elderly.