Nutritional Needs Surveys Among the Elderly -- Russia and Armenia, 1992

The ongoing social, political, and economic changes in the 15 republics of the former Soviet Union have resulted in hyperinflation of the Soviet Union ruble (SUR), regional conflicts, and other hardships for the populations of these republics (1). In January 1992, a public health assessment in Russia indicated that the elderly -- most of whom subsist on fixed incomes and among whom the prevalences of decreased mobility or chronic illnesses may be substantial -- are at greatest risk because of declining social support (1). During March-May 1992, CARE, in collaboration with CDC, conducted three surveys in Russia and Armenia to assist in targeting the delivery of food and medical humanitarian aid to the most needy among the elderly. This report summarizes findings from these surveys.

The surveys were designed to collect baseline information on indicators of nutritional risk among elderly populations and to identify subpopulations most in need of relief services. Population-based household surveys of persons aged greater than or equal to 70 years * were conducted in three cities: Moscow (population: 9 million) and Ekaterinburg (population: 1.1 million [Western Siberia]), Russia, and Yerevan (population: 1.2 million), Armenia. Participants for the systematic probability sampling were drawn from local listings of persons receiving government pensions. Virtually all of the elderly in the sites were on these listings; however, prisoners and approximately 3000 refugee pensioners in Yerevan were excluded from the lists.

In each city, interview teams were trained locally. Teams visited each participating household and administered questionnaires regarding demographic information, living situations, self-reported medical and dental conditions, home stores of food, economic status, aid received from various sources, and diet and other practices related to nutrition. Interviews were completed for 259 (88%) of 296 persons in Moscow, 215 (74%) of 290 in Ekaterinburg, and 381 (84%) of 456 in Yerevan. Up to three visits were made to obtain interviews. However, 2% of persons on the survey lists who were located declined to participate; the remainder of persons not surveyed had died, moved, were not home, or otherwise could not be located. While in the field, investigators used computers for data entry and analysis to generate a report within 1 week from the completion of each survey.

Most (65%-74%) of the elderly surveyed were women (Table 1); one third were married, and nearly two thirds were widowed or divorced. Most (84%-92%) lived in private homes, usually with at least one other person (20%-37%); few (1%-2%) lived in institutions. Median pension ranged from 348 SUR to 448 SUR (the World Bank estimated that minimal nutritional support for one person in Russia is 522 SURs per month [World Bank, personal communication, April 3, 1992] and the Armenian government established an income of 2000 SUR per month as the poverty level [Minister of Social Protection, personal communication, April 15, 1992]. At the time of these surveys, the exchange rate was approximately 100 SUR=$1 U.S.) Savings were low; 41%-74% had less than 500 SURs in savings. A large proportion of the elderly reported chronic illnesses (57%-67%) or dental problems (e.g., missing teeth) (37%-70%) that impaired eating.

Reported by: S Laumark, PhD, K Welch, CARE, New York City. Div of Field Epidemiology, Epidemiology Program Office; Div of International Liaison, International Health Program Office; Div of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings from these surveys have assisted CARE in targeting its humanitarian relief efforts in relation to three factors. First, by targeting assistance only to elderly in institutions, which had initially been done, most elderly and others at highest risk might be excluded from aid. Second, medical and dental assistance is crucial because medical and dental conditions may be important contributors to nutritional risk. Finally, commodity aid (e.g., rice, wheat, butter oil, sugar, beans, and milk powder) may be more beneficial than monetary aid for those elderly persons with limited ability to leave their homes to shop.

CARE is using this survey methodology every 4-6 months in other sites in the former Soviet Union to assess nutritional status and to target delivery of commodities and humanitarian assistance for elderly persons in need. For example, the baseline data were used to assess and compare the existing distribution of aid at different locations within Russia (e.g., Moscow and Ekaterinburg). In addition, CARE is using market data (i.e., product availability and price) to clarify survey results. For example, market data can be used to assess distribution and price of milk and preference of the elderly for milk.

CARE, in collaboration with government programs in these republics, has provided these baseline findings to other agencies and humanitarian-aid organizations to improve the overall targeting of aid. Follow-up surveys in these cities are planned for January- March 1993 to evaluate the impact of the humanitarian interventions. Rapid nutritional-assessment surveys of this type are important in determining the health status of refugees and other displaced populations (2). This report underscores the utility of such surveys in also supporting international assistance efforts for nonrefugee populations.

References

1. CDC. Public health assessment -- Russian Federation, 1992. MMWR 1992;41:89-91.

2. CDC. Famine-affected, refugee, and displaced populations: recommendations for public health issues. MMWR 1992;41(no. RR-13).

• Persons aged greater than or equal to 70 years were surveyed in Russia; persons aged greater than or equal to 60 years were surveyed in Armenia. For this analysis, data presented for Armenia were limited to persons aged greater than or equal to 70 years.

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