Assessment of adults and older people in emergencies: Approaches, Issues and priorities, Recommendations By Dolline Busolo HelpAge International

HelpAge International is a global network of over 70 NGOs Mission to work with and for older people world-wide Improve quality of their lives. Introduction

Body Changes that occur with Ageing Age affects body size, shape and composition Adults tend to loose fat free mass Increase fat mass with age. The changes may alter the functional significance of conventional nutritional assessment indices at different ages.

Current Assessment and Intervention Practices Body Mass Index requiring weight and height measurement Mid-Upper Arm Circumference (MUAC) (clinical and social indicator) Oedema But there is no agreement about cut off points Options for assessing older people and adults are limited Currently similar indices are used for adults and older people Based on resource availability and context

Issues Widely differing approaches and criteria Inclusion /exclusion criteria undefined (deaf and dumb and bedridden) Sampling procedure not defined The respondents (role of caregivers especially for those with impairments) Admission into selective feeding programmes Discharge from selective feeding programme Research Support

Body Mass Index (BMI) BMI, defined as weight/(height) 2, developed in non-famine situations A measure of chronic energy deficiency. Studies have shown that lower BMIs are correlated to higher risks of mortality Higher number of sick events, days in bed Capacity for physical activity.

Adult BMI Varies according to shape, gender and age Height and weight difficult to assess during peak famine Calculation unfamiliar with field workers Oedema is common during famine therefore increases weight Pregnant women cannot be included BMI not designed for emergencies Correction required

Challenges of measuring older people  Measuring height due to spinal curvature common in older people  Cultural issues; anthropometry regarded as “invasive”  Determining the age of on older person  The process may take a longer time  Religion or cultural issues may be stronger (necessary to have respect for similar sex measurement)  Necessary to treat older people with dignity, e.g. not rushing, listening

Issues with BMI n Using a proxy for height n Adjust for different body shapes n Gather baseline information n Additional information needed for interpretation

n Findings are interpreted in the context of: – CMRS –Prevalence of malnutrition among 5 year olds n Adjusting for Cormic Index in emergencies is impractical. n The adjustment calculation is complicated and perhaps impractical n The recommendations to use Cormic Index not endorsed by WHO.

Mid-Upper Arm Circumference (MUAC) Advantages  Easier to perform  Easier to perform  Correlated with mortality in children/ TFCs  Correlated with mortality in children/ TFCs  Not confounded by oedema  Not confounded by oedema  Independent of height  Independent of height  Correlation with BMI: linear and robust  Correlation with BMI: linear and robust  More sensitive to acute weight loss  More sensitive to acute weight loss

Limitations The measurement error (intra- and inter- observer error), Mortality correlation with MUAC are not described for adults and older people No consensus on cut-offs. Tentative proposal for emergency assessment needs further research

Fig. 1: Nutritional Risk Factors for Older People at an individual level

Key question for discussions Key question for discussions ( a) W hich methodologies should be used to assess the nutritional status of adults and older people in emergencies (Prevalence, monitoring, evaluation, programming?) ( b) What sampling approach should be used to arrive at the required representative sample size for older persons ( c) What cut-off points that should be used to categorise the nutritional status of adults and older people.

Follow up activities for assessment and intervention Definition of protocol Definition of key indicators

Who n All stakeholders but especially HAI USAID, FANTA and research and institutions involved in emergency work

Recommendations

Acknowledgement Food and Nutrition Technical Assistance (FANTA