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      Depression, malnutrition, and health-related quality of life among Nepali older patients

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          Abstract

          Background

          Little is known about the health, nutrition, and quality of life of the aging population in Nepal. Consequently, we aimed to assess the nutritional status, depression and health-related quality of life (HRQOL) of Nepali older patients and evaluate the associated factors. Furthermore, a secondary aim was to investigate the proposed mediation-moderation models between depression, nutrition, and HRQOL.

          Methods

          A cross-sectional survey was conducted from January–April of 2017 among 289 Nepali older patients in an outpatient clinic at Nepal Medical College in Kathmandu. Nutritional status, depression and HRQOL were assessed using a mini nutritional assessment, geriatric depression scales, and the European quality of life tool, respectively. Linear regression models were used to find the factors associated with nutritional status, depression, and HRQOL. The potential mediating and moderating role of nutritional status on the relationship between depression and HRQOL was explored; likewise, for depression on the relationship between nutritional status and HRQOL.

          Results

          The prevalence of malnutrition and depression was 10% and 57.4% respectively; depression-malnutrition comorbidity was 7%. After adjusting for age and gender, nutritional score (β = 2.87; BCa 95%CI = 2.12, 3.62) was positively associated and depression score (β = − 1.23; BCa 95%CI = − 1.72, − 0.72) was negatively associated with HRQOL. After controlling for covariates, nutritional status mediated 41% of the total effect of depression on HRQOL, while depression mediated 6.0% of the total effect of the nutrition on HRQOL.

          Conclusions

          A sizeable proportion of older patients had malnutrition and depression. Given that nutritional status had a significant direct (independently) and indirect (as a mediator) effect on HRQOL, we believe that nutritional screening and optimal nutrition among the older patients can make a significant contribution to the health and well-being of Nepali older patients. Nonetheless, these findings should be replicated in prospective studies before generalization.

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          Most cited references18

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          Social and Emotional Aging

          The past several decades have witnessed unidimensional decline models of aging give way to life-span developmental models that consider how specific processes and strategies facilitate adaptive aging. In part, this shift was provoked by the stark contrast between findings that clearly demonstrate decreased biological, physiological, and cognitive capacity and those suggesting that people are generally satisfied in old age and experience relatively high levels of emotional well-being. In recent years, this supposed “paradox” of aging has been reconciled through careful theoretical analysis and empirical investigation. Viewing aging as adaptation sheds light on resilience, well-being, and emotional distress across adulthood.
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            A systematic look at an old problem.

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              Dietary intake, dietary patterns, and changes with age: an epidemiological perspective.

              Cohort and cross-sectional data were reviewed to describe the changes in dietary intake with age. Total energy intake decreases varied substantially with age, by 1000 to 1200 kcal in men and by 600 to 800 kcal in women. This resulted in concomitant declines in most nutrient intakes. For some nutrients, substantial numbers of older Americans consumed only one fifth to one third of the recommended dietary allowance. For most nutrients, research is lacking with which to judge the health impact of reduced nutrient consumption with age, although there is some evidence of an age-related decline in absorptive and metabolic function. With the aging of the population, more research is needed on nutrient requirements and health outcomes, and public health efforts are needed to increase physical activity and food intake among older people.
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                Author and article information

                Contributors
                sarunaghimire@gmail.com
                binayabaral@gmail.com
                buddhi.pokhrel@gmail.com
                dr.asmita321@gmail.com
                acharya.anushree17@gmail.com
                diptaamatya@gmail.com
                amatyaprabisha@gmail.com
                shivarajmishra@gmail.com
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                24 August 2018
                24 August 2018
                2018
                : 18
                : 191
                Affiliations
                [1 ]Agrata Health and Education (AHEAD)-Nepal, Kathmandu, Nepal
                [2 ]ISNI 0000 0004 0382 0231, GRID grid.416573.2, Department of Biochemistry, , Nepal Medical College and Teaching Hospital, ; Kathmandu, Nepal
                [3 ]ISNI 0000 0000 9021 3093, GRID grid.444739.9, Department of Nutrition and Dietetics, College of Applied Food and Dairy Technology, , Purbanchal University, ; Kathmandu, Nepal
                [4 ]Nepal Development Society, Bharatpur-10, Nepal
                Author information
                http://orcid.org/0000-0002-2662-2006
                Article
                881
                10.1186/s12877-018-0881-5
                6109328
                30143004
                3a77599e-e895-400c-8751-20978cb9e9ad
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 August 2017
                : 15 August 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Geriatric medicine
                nutritional assessment,mna,depression,quality of life,elderly,nepal,mediation,moderation
                Geriatric medicine
                nutritional assessment, mna, depression, quality of life, elderly, nepal, mediation, moderation

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