Health and nutritional status of elderly Greek migrants to Melbourne, Australia

Age and Ageing, May, 1996 by Antigone Kouris-Blazos, Mark L. Wahlqvist, Antonia Trichopoulou, Evangelos Polychronopoulos, Dimitrios Trichopoulos

Introduction

According to 1982 mortality data [1], Greeks in Australia were deemed the 'second longest lived population in the world', after the Japanese in Hawaii [2] and followed closely by Greeks in Greece [3]. This mortality advantage was mainly due to low rates of coronary heart disease and colonic cancer [4-7]. In contrast, 1989 morbidity data [8] suggest that the health of Greek Australians may have deteriorated since 1982. The prevalence of heart disease, hypertension and hypercholesterolaemia was equal to or higher than Australian-born in all age groups. Interestingly, however, the prevalence of cancer remained lower in Greek Australians in all age groups. Studies on small samples of elderly migrants in Australia [9-11] also report that Southern Europeans have worse health and well-being than Australian-born and have a higher prevalence of obesity. It has been suggested that retention of some 'protective' elements of the traditional Greek diet, such as plant food and olive oil, may protect health [2] and reduce mortality rates in elderly age groups [12]. Even though there has been increasing interest in the traditional Greek diet as a health-promoting nutritional pattern, there have been few attempts to define food and nutrient composition of the Greek diet in Greece [12-17] and Australia [18-20] and identify changes upon migration and with increasing length of stay [6]. Such changes may shed light on possible causes for the deteriorating health of Greek Australians. Most of the studies on Greek Australians provide inadequate and incomplete data on their absolute intake of foods and nutrients and none has included elderly subjects. Elderly people are more likely to adhere to traditional cuisine and thus may provide more useful information on the protective components of such a diet. Greece provides an unusual opportunity because rural regions, such as Spata, still follow a more traditional Greek diet than city regions [17, 21] and can act as a 'surrogate' measure of diets prevalent in the 1950-60s, when mass migration to Australia took place. When a longitudinal study is not possible, comparisons of migrant diets with such 'surrogate' measures may provide insight into dietary trends and their potential impact on health status. This paper describes and compares the health status (self-reported health conditions) and nutritional status (food and nutrient intake, nutritional biochemistry, anthropometry) of elderly Greeks living in Melbourne and Spata. Data on Anglo-Celtic Australians were used for comparative purposes [22].

Methods

Sample selection: The study of elderly Greeks in Greece and Australia and of Anglo-Celtic Australians is part of a wider international study of elderly people [22-24]. This study was approved by the Monash University ethics committee. The telephone directory has been successfully used to obtain a representative sample of Greek Australians [18] and this method was employed in Australia to recruit elderly Greeks. In countries with low telephone usage, such as Greece, it is preferable to use electoral rolls, and these were therefore used in Spata. All study subjects were interviewed in their homes using an interviewer-administered questionnaire [22, 25-28]. All interviews and measurements were performed by a single observer, fluent in Greek. Residents in psychogeriatric homes were excluded. The total population in Spata in 1988 was about 10000, of whom 6.4% were aged 70 . These subjects formed the sampling base. A total of 104 (M 51, F 53) subjects were included in the study (mean age 77 years; 60% 70-79; 40% 80 ). The response rate was high at 89% and the sample did not differ in sex and age group distribution from the wider elderly community in Spata. In Melbourne, the study was conducted between 1990 and 1992. At the 1986 census in Victoria, 130 553 persons claimed to be of Greek ancestry, of whom 65 515 had been born in Greece [29]. Only 2% (2686 persons) were aged 70 . About 30 000 telephone connections were identified as belonging to Greek families, and these formed the sampling base of the study. A total of 189 (M 94, F95) subjects were included in the study (mean age 78 years; 65% 70-79; 35% 80 ). The response rate was 84% and the sample did not differ significantly in sex or age group distribution from the wider elderly Greek community in Melbourne (1986 Victoria census) except for women aged 70-79 (p = 0.05). Geographic distribution (percentage living in various suburbs in Melbourne) was not significantly different from the wider elderly Greek community in Melbourne. The mean length of residence in Australia was 30 years.

Health status: This study employed the Multi-level Assessment Instrument [30] which has been recommended as one of the most valid and reliable measures of the health status of elderly people [31]. It includes a 30-item check-list of common self-reported health conditions (see Table I). Health complaints reported were cross-checked by the interviewer with prescribed medications to ensure that complaints were not merely self-perceived but had been diagnosed by a doctor, a consideration particularly relevant for heart disease, cancer and hypertension. This check may not work for conditions that can be treated with diet alone (e.g. diabetes, constipation).