The ageing process is a biological reality which has its own dynamic, largely beyond human control (WHO, 2002). However, it is also depended on how each society makes sense of old age. Most elderly people in the current study were falling within the age range 60–69 years may reflect the picture of elderly in SA. The Older Persons Act 13 of 2006 in South Africa provides that an older person is a person who is 60 years old or older (Constitution of the Republic of South Africa, 1996). In African, elderly person is defined as age between 50 to 65 years, depending on the setting, the region and the country (Agbozo et al., 2018).
Our study examined the nutritional Status and dietary pattern of the elderly in Tshiulungoma village. We found low prevalence of underweight among elderly people, which was similar to previous study conducted in South Africa and other parts of Sub-Saharan countries (Kimokoti & Hamer, 2008; Van der Sande et al., 2001). This study support Mahan and Escott-Stump (2012), the actual prevalence of underweight among older adults is quite low, many adults are at risk for undernutrition and malnutrition. Underweight among elderly people may be due to poor mobility, inability to purchase and prepare food (Aganiba et al., 2015). Our data found that 34% of elderly people were overweight while 16.7% were obese. These findings are congruent with previous study that indicated that South Africa had the highest rate of overweight and obesity (Van der Sande et al., 2001). The prevalence was of overweight was slightly higher in elderly women (18.7%) as compare to 15.3% of elderly men while obesity was higher in elderly women (11.7%) as compared to 5% of elderly men. Similar findings were observed in sub-Saharan countries like South Africa, Ghana, Kenya, Senegal, Uganda, Botswana and Cameroon (Kimokoti & Hamer, 2008; Van der Sande et al., 2001; Cheserek et al., 2012; Agbozo et al., 2018). The findings of this study support Mahan and Escott-Stump (2012), prevalence of obesity has increased in all ages, older adults are no exception, obesity rates are greater among those ages 65 to 74 than among those ages 75 and over and over and obesity is associated with increase in mortality and contribute to many chronic diseases. Prevalence of obesity and overweight could be due to the fact that aging is associated with a decrease in total energy expenditure, and if this coincides with a maintained or increased energy intake, overweight/obesity may develop (Edfors & Westergren, 2012). However, the socioeconomic disparities, poor nutritional qualities of traditional diets in many rural communities could not be ruled as they might have contributed to malnutrition among elderly people. Under and overnutrition among elderly coexist in the current study like many Sub-Saharan countries (Alao, Akinola & Ojofeitimie, 2015; Maila, Audain & Marinda, 2019). The prevalence of obesity was high among 13% female as compared to their male 4% counterparts (Mittal & Srivastava, 2006). This may be due to the fact that women are heavier than males while males are taller than females and in South Africa overweight and obesity is associated with “wealth and healthy” but the perception has drastically changed on the basis that overweight and obesity are associated with many non-communicable diseases (Motadi et al., 2015)
The nutrition and health of the elderly is often neglected. Most nutritional intervention programs are directed toward infants, young children, adolescents, and pregnant and lactating mothers (Agarwalla, Saikia & Baruah, 2015). Every community has its own pattern and practices, with ideas as to which foods are good for the people at different ages and which one are not. What people think about food is also affected by what is available. Most of the elderly people know the nutritional values of the foods they eat. Some avoid certain foods because of personal dislike, social and cultural practices and religion. The dietary pattern of the participants shows that most of them ate three main meals a day which is necessary for good health. This is similar to findings from a study carried out among elderly in rural Southern African countries (Lee et al., 1996). As shown by Shahar et al. (2003) the older population tends to continue the more traditional eating pattern of three meals a day. However, minority of them either skip breakfast or eat in- between meals. Minority of the participants sometimes skip breakfast or dinner. Skipping of meals is a very common practice among elderly people in the rural areas (Lee, Templeton & Wang, 1996). Minority of the participants in the current study snacked in between meals possibly to enable them cope with the energy needs of the body as they go about their daily activities. However, Lee et al. (1996) reported low intake of nutrient among elderly people who snacked frequently. The pattern also shows a low intake of snacks, alcohol and tobacco use among them.
The findings on food consumption revealed that many participants in the current study consumed food from different food groups. However, most of the participants consumed fruits, vegetables and cereals. Protein food sources were rarely consumed except that participants consumed legumes, nuts and seeds 2–3 times per week. These findings are congruent with previous studies that reported high intake of vegetables and cereals among older persons in South Africa (Govender, 2011) and Zambia (Maila et al., 2019). Additionally, maize meal porridge is one of the staple foods in the South African diet and is usually consumed with green leafy vegetables and a small amount of animal-derived food (Labadarios et al., 2005). The rarely consumption of this animal derived food sources could be due their high cost, limited supply and in some cases, due to religious or cultural practices. Insufficient consumption of these animal food source leads to low intake of important micronutrients among this age group (Roohani et al., 2013).
Our study showed low consumption of milk and milk product among the participants. Perhaps this can be attributed to the fact that milk is perceived as tasteless by most elderly people due to deterioration of taste buds. Between 75 and 85 years, the taste buds’ deterioration is 65% reduction of sensitivity to sweet and salty taste. One of the well-established factors that affect food choice is the sensory perceptions to food stimuli. Chemical and physical properties of the food are perceived by the individual in terms of sensory attributes. These sensory attributes of foods can be categorized, in broad terms, as appearance, texture, trigeminal mouth feel, odour and taste (Shepherd, 1999; Alao et al., 2015). The ability to perceive these sensory attributes in addition to liking them determines whether an individual consumes a food (Shepherd, 1999; Mahan & Escott-Stump, 2012). The low consumption of milk and dairy product can explain the reason why participants didn’t meet their dietary intake of calcium. Congruently, in Zambia Maila et al. (2011) reported low consumption of milk and milk product. In Kenya Munoru (2018) reported high consumption of milk among elderly people. In addition, Chollet et al. (2014) reported higher percentage of 96% in the consumption of dairy products in Switzerland.
About (38%) of the study participants had the highest dietary diversity score. This may be due to the fact that almost all participants received social grant. A social grant is given to qualifying poor households as an important contributor in reducing poverty and food insecurity in South Africa. Socioeconomic status plays a vital role in quality of life, including the food choices that these elderlies can make (Mkhize, Napier & Oldewage-Theron, 2013). However, Study conducted by Chakona and Shackleton (2019) in South Africa revealed that grant recipients do not use the money for food only but also on other household necessities instead of taking care of the beneficiaries’ own needs. Alao et al. (2015) revealed that income remains a strong determinant in the choice of food consumed by the elderly people. Furthermore, highest dietary score may be linked to overnutrition observed among study participants as indicated by the prevalence of overweight and obesity.
Almost half of the participants didn’t meet their energy intake in the current study. Alao et al. (2015) reported that older who may not eat enough to meet energy needs which can results in increases the risk of nutrition related illness. Our study revealed that even though many participants consumed food from different food groups, it is also noticed from the result of the study that participants didn’t meet the dietary intake of iron, zinc, calcium, vitamin B1, B2 and vitamin C. These may be attributed to the age-related alterations to the sense of taste which is closely linked to poor appetite, inappropriate food choices, and lower nutrient intake. This insufficient intake of micronutrients may be due to the fact that the participants reported low intake of protein. Protein share the same food sources with zinc, iron, vitamin B1 and B2 (Mahan & Escott-Stump, 2012).
The limitation of the present study was that the information on dietary intake relied on the ability of the participants to recall, which might have resulted in under and overreporting. The study was conducted in two villages which cannot be generalized to Thulamela municipality.