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NUTRITIONAL STATUS AND COGNITIVE FUNCTION AMONG URBAN
AND RURAL FILIPINO COMMUNITY-DWELLING ELDERLY
A Thesis Presented to the Faculty of the
Institute of Graduate Studies of the
Far Eastern University
Manila
In Partial Fulfillment of the Requirement
For the Degree of
Master of Arts in Nursing
By
Lucky P. Roaquin, RN
March 2013
Far Eastern University
Institute of Graduate Studies
N. Reyes St., Sampaloc
Manila 1008, Philippines
APPROVAL SHEET
In the fulfillment of the requirements for the degree of MASTER OF ARTS IN NURSING
specialized in MEDICAL-SURGICAL NURSING, this graduate thesis entitled NUTRITIONAL
STATUS AND COGNITIVE FUNCTION AMONG URBAN AND RURAL FILIPINO
COMMUNITY-DWELLING ELDERLY has been prepared and submitted by LUCKY P.
ROAQUIN, RN is hereby recommended for approval.
DR. EUFEMIA OCTAVIANO, RN, MAN
Thesis Adviser
Approved and accepted by the Committee on Oral Examination with as grade of PASSED, on the
12th day of March year of our Lord, 2013.
PANEL OF EXAMINERS
DR. ROSALINDA P. SALUSTIANO, RN, RM, MAN
Chairman
DR. VICTOR T. TABUZO DR. MARILYN COLADILLA Prof. GLORIA YANG
Member Member Member
NUTRITIONAL STATUS AND COGNITIVE FUNCTION AMONG URBAN
AND RURAL FILIPINO COMMUNITY-DWELLING ELDERLY
A Thesis Presented to the Faculty of the
Institute of Graduate Studies of the
Far Eastern University
Manila
In the Fulfillment of the Requirement
For the Degree of
Master of Arts in Nursing
By
Lucky P. Roaquin, RN
March 2013
ABSTRACT
Aim: The objective of this study was to determine nutritional status of urban and rural Filipino
community dwelling elderly and examine its relationship measures of cognitive function.
Methods: A total of 40 elderly who are living in urban and rural community were selected
through non-probability purposive sampling to participate in this study. The Mini Nutritional
Assessment (MNA) tool was used to determine the nutritional status of the UFCoDE and
RFCoDE while the Montreal Cognitive Assessment (MoCA) tool was used to measure the
cognitive function of the UFCoDE and RFCoDE. Data gathered were statistically analyzed using
the parametric inferential statistics. Informed consent was administered prior to the study.
Results: It was found out that most of Filipino elderly who are living in the community was at
risk of malnutrition (50% UFCoDE; 40% RFCoDE) and malnourished (15% RFCoDE). The
cognitive function of the UFCoDE and RFCoDE revealed that 65% had mild cognitive
impairment among the UFCoDE with mean score falling under same indicator, while 60% had
mild impairment among RFCoDE with mean score falling under moderate cognitive impairment.
The nutritional status among the UFCoDE and RFCoDE showed statistically related to their
cognitive function (p values <0.05). In addition, there was no significant difference among the
UFCoDE and RFCoDE in terms of their nutritional status, while there showed a significant
difference on their cognitive function. Conclusion: The nutritional status was significantly
related to the cognitive function among the UFCoDE and RFCoDE. Furthermore, intensive
research focusing on this subject must be done thereafter.
ACKNOWLEDGMENT
“Don’t count what you have for you may find an end. But rather let them count
for you and you will find no end.” Lucky P. Roaquin, RN
The success of this research proposal will not be possible without the few notable people
who supported, inspired, motivated and assisted me all-throughout my journey as I write the
concepts juggling in mind.
I would not come into a realization that this paper was greatly needed in the healthcare
industry without the people who will be part of it. To my elderly family, who had been my
greatest inspiration in the edifice of this research study, who continuously uplift and empower
themselves to be heard.
The teachings and words of encouragement I received from my most beloved mentor, Dr.
Eufemia Octaviano, who helped, is helping and will be helping me to exemplify the apposite
behavior of being a leader of change in our society.
Graduate school wouldn’t be this much fun, adventurous and challenging without my
companions, my friends, and my colleagues in the FEU - Institute of Graduate Studies, who have
been sharing a lot of knowledge and once in a lifetime personal experiences with them. They
have been one of my few inspirations to be more knowledgeable on my chosen field of expertise.
This paper wouldn’t be doable without the outstanding and honorary lecturers of the FEU
– Institute of Graduate Studies, especially to Dr. Rosalinda Salustiano, who made a huge
contribution in the fulfillment of this paper. They had been my ‘amino acids’ that served as the
building blocks of my advocacy to promote and protect our elderly in the community.
The numerous efforts of those people, who helped me with my study, Ms. Macy Monsod
of Nestle Philippines and Ms. Tina Brosseau of CEDRA for assisting in the approval of tools that
the researcher had utilized; and Mr. Roel Golimlim of Brgy. Bagumbuhay, Quezon City and Mr.
Castor Cayaba of Brgy. Dagupan Centro, Tabuk City for their approval in conducting the
researcher’s study.
And most importantly, I praise the Lord our God, the ultimate source of all wisdom, who
is the source of my refuge, my strength, my light, and my guide as I walk along the path of life.
- Lucky P. Roaquin, RN
DEDICATION
To My Dad
&
To My Mom
TABLE OF CONTENTS
Approval Sheet
PRELIMINARIES PAGE
Title Page ………………………………………………………………………………… i
Abstract …………..……………………………………………………………………… ii
Acknowledgement ………………………………………………………………………. iii
Dedication ……………………………………………………………………………….. v
Table of Contents ……………………………………………………………………….. vi
List of Tables ……………………………………………………………………………. viii
List of Figures …………………………………………………………………………… ix
CHAPTER
I THE PROBLEM AND ITS BACKGROUND
Introduction ……………………………………………………………………… 1
Significance of the Study ………………………………………........................... 3
Statement of the Problems ………………………………………………………. 5
Hypothesis ……………………………………………………………………….. 6
Theoretical Framework ………………………………………………………….. 6
Conceptual Paradigm ……………………………………………………………. 10
Scope and Limitation ……………………………………………………………. 12
Definition of Terms ……………………………………………………………… 13
II REVIEW OF LITERATURE
Review of Related Literatures
Facts and Figures about Elderly Nutrition and Cognition ………………. 14
Nutrition Plays a Definite Role …………………………………………. 15
The Culture in Nutrition ………………………………………………… 20
Nutrition on Cognition amongst the Elderly: Studies Revealed ………… 22
Synthesis ………………………………………………………………………… 26
III RESEARCH METHODOLOGY
Research Design ………………………………………………………………… 28
Population and Sample …………………………………………………………. 29
Research Locale ………………………………………………………………… 30
Research Instrument ……………………………………………………………. 31
Data Collection Procedure ………………………………………..…………….. 34
Statistical Treatment ……………………………………………………………. 35
Ethical Consideration …………………………………………………………… 38
IV RESULTS AND DISCUSSION ……………………………………………… 39
V SUMMARY, CONCLUSIONS AND RECOMMENDATION ……............. 50
REFERENCES
APPENDICES
A Letter of Request Seeking Permission to Conduct Study
A.1. Brgy. Bagumbuhay, Quezon City, Philippines
A.2. Brgy. Dagupan Centro, Tabuk City, Kalinga, Philippines
B Letter of Request Seeking Permission to Utilize Research Instruments
B.1. Nestle Philippines
B.2. Center for Diagnosis & Research on Alzheimer’s Disease
C Utilized Research Tools
C.1. Mini Nutritional Assessment (MNA) Tool
C.2. Montreal Cognitive Assessment (MoCA)Tool
D Informed Consent
D.1. For Urban Filipino Community-dwelling Elderly
D.2. For Rural Filipino Community-dwelling Elderly
E Raw Data of Gathered Information
F FCEPE: Focus Care Enhancement Program for Elderly
G Curriculum Vitae
LIST OF TABLES
TABLE PAGE
1 Nutritional Status of Urban Filipino Community ……………………. 39
Dwelling Elderly Based on Mini Nutritional
Assessement
2 Nutritional Status of Rural Filipino Community ……………………. 40
Dwelling Elderly Based on Mini Nutritional
Assessement
3 Detailed Results of Cognitive Function of Urban ……………………. 42
Filipino Community Dwelling Elderly by Areas
Based on Montreal Cognitive Assessment
Philippines (MoCA-P)
4 Summary Results of Cognitive Function of Urban ……………………. 43
Filipino Community Dwelling Elderly Based on
Montreal Cognitive Assessment
Philippines (MoCA-P)
5 Detailed Results of Cognitive Function of Rural ……………………... 43
Filipino Community Dwelling Elderly by Areas
Based on Montreal Cognitive Assessment
Philippines (MoCA-P)
6 Summary Results of Cognitive Function of Rural ……………………. 44
Filipino Community Dwelling Elderly Based on
Montreal Cognitive Assessment
Philippines (MoCA-P)
7 Significant Relationship Between the Nutritional ……………………. 45
Status and Cognitive Function of Urban and
Rural Filipino Community Dwelling Elderly
8 Significant Difference Between the Urban and ………………………. 47
Rural Filipino Community Dwelling Elderly
in terms of Nutritional Status
9 Significant Difference Between the Urban and ………………………. 48
Rural Filipino Community Dwelling Elderly
in terms of Cognitive Function
LIST OF FIGURES
FIGURE PAGE
1 Maslow’s Hierarchy of Needs …………………………………………. 7
2 Leininger’s Sunrise Enabler Model ……………………………………. 8
3 The Relationship of Nutritional Health Status and ……………………. 10
Cognitive Function among Urban and Rural
Filipino Community-dwelling Elderly
4 Process of the Data Gathering Procedure ……………………………... 34
CHAPTER I
THE PROBLEM AND ITS BACKGROUND
Introduction
The creation of this research study had been of influenced by the eagerness of the
researcher to uplift the health and wellness of Filipino elderly who are living in urban and rural
areas. Demographic shifting is dynamic. In this era, the paradigm of population may change and
that, population of the elderly might change its course. Inclusion of the care for our elderly
patients has been left behind, given the least priority and taking much less consideration in the
plan of and delivery of care.
As part of being a Filipino, it has been instilled in the society the importance of respect to
the elderly population. This trait had been an inspiration of the researcher to conduct such study.
The importance of nutrition among the elderly has been given emphasis by the researcher to
enhance the well-being of the elderly in the Philippines whether they are living in the urban areas
or the rural community.
To enhance the welfare the elderly in the society, the government had planned and
promulgated the so-called Republic Act 9994 or the “Expanded Senior Citizens Act of 2010”.
This Act includes benefits targeted not only to basic commodities which include availment of
food to sustain health and well-being but also educational assistance, as mandated on the law.
And from the 1987 Philippine Constitution, it was stated on Article XIII, Section 2 on
Health/Social Services likewise mandates: “The State shall adopt an integrated and
comprehensive approach to health development which shall endeavor to make essential goods,
health and other social services available to all people at affordable cost. There shall be priority
for the needs of the underprivileged sick, elderly, disabled, women and children.”
Furthermore, it has been of great importance that the researcher had chosen this topic to
promote additional working research on this field of expertise. Thus, there were little or less
studies that were established in the country especially with regards to the health and welfare of
the elderly population. There was a high prevalence of malnutrition among our elderly
population (BAPEN, 2007) and yet, awareness on this specific health issue in this population
was low (ENHA, 2005). In the Philippines alone, there was high prevalence of underweight as
well as overweight among Filipino elderly where undernutrition was a major problem among
elderly at 27.0% of the 70 years old and over and 17.7% of the 60 - 69 years old (Capanzana, et.
al., 2008).
Malnutrition has been associated with compromised cognitive capacity in the elderly
(Wells, et. al., 2006). According to Jernigan (2012), without the proper food, one’s biosystem
will become listless and disinterested, thus, elderly person suffering from malnutrition may
develop memory decline and answering simple questions will be impossible. Early detection of
malnutrition is important since it has been associated with diminished cognitive function,
mobility, and a diminished ability to care for one's self (Eriksson, et. al., 2005).
The elderly in our society, being one of the many recipients of care, attends to or holds to
different cultural practices acquired from his or her roots of generation. Thereby, including
culture care in the interventions rendered by professional caregivers is essential in order to
alleviate sufferings – disease-caused illnesses or psychological imbalances – thus, preserving,
maintaining and enhancing their way of living that includes health practices and self-care
regimens.
Significance of the Study
The study was conducted because the researcher wanted to investigate the relationship of
nutritional status and cognitive function of elderly as well as their differences among urban and
rural Filipino community-dwelling elderly. This will serve as a medium or a reference for
appropriate interventions in the nutritional and cognitive care for the elderly in the Philippines.
Nursing Practice
This study emphasized on the impact of nutrition to the cognition of the elderly. It will
provide details on how to give necessary plan of actions, series of interventions and the inclusion
of cultural care in the management of well and sick elderly. It will also give birth to different
strategic approach of nutritional care in the universality and diversity of gerontology nursing.
Furthermore, the study will strengthen and enhance the nutritional development programs
necessary to the promotion and support of the elderly well-being.
Nursing Service & Administration
On the other hand, the results of the study will hasten new and effective practice that will
help the entire healthcare team in the procurement of the delivery of care for the elderly. As
nurses and leaders, it is another responsibility to look for new and useful ways of intervening
care to our elderly patients with the integration of culture in our plan of care.
Nursing Education
This study will develop new and effective contribution to the body of knowledge that can
be taught to future leaders of the healthcare system. The information embodied in this research
will supplement students’ critical thinking, analysis, and adaptation of trans-cultural nursing in
the field of their practices. This study will abet the students to be more diligent, knowledge-
equipped and value-driven nurses towards the care for the elderly. Thus, improving the quality of
care rendered and the standards of practice encapsulated in the nursing curriculum and practice.
Nursing Research
The study will encourage other healthcare professionals in the investigation of culturally
competent care rendered to every individual across each nation. It will develop further
understanding on the concepts of care and culture in a multifarious society. This will widen the
horizon of evidence-based nursing research in the field of trans-cultural and gerontology nursing.
It will aide in the formation of effective and efficient tools in measuring cultural competencies of
nurses specifically in the care for the elderly.
Society
This study will give realization to the existence of the “known-yet-unknown” quandary
encountered by the elderly population. This study will give importance on the empowerment of
this vulnerable population through nutritional interventions, such as autonomy on food
preferences and choices, for sustainability and functionality. Moreover, this study will enable the
society to act as protectors of the elderly especially in terms of their right to adequate
nourishment and enhancement of optimum level of wellness.
Statement of the Problem
The study intended to investigate the relationship of nutritional status and cognitive
function of elderly as well as their differences among the urban and rural Filipino elderly who
are living within the community. Specifically, this study sought to answer the following
inquiries:
1. What is the nutritional status of urban and rural Filipino community-dwelling
elderly?
2. What is the cognitive function of urban and rural Filipino community-dwelling
elderly?
3. Is there a significant relationship between nutritional status and cognitive function
among urban and rural Filipino community-dwelling elderly?
4. Is there a significant difference in the nutritional status between urban and rural
Filipino community-dwelling elderly?
5. Is there a significant difference in the cognitive function between urban and rural
Filipino community-dwelling elderly?
6. Based on the study, what care enhancement program can be developed for the
elderly?
Hypothesis
From the problems of the study, the researcher’s assumptions are based on the following
hypotheses:
H01: There is no significant relationship between the nutritional status and cognitive
function of urban Filipino community-dwelling elderly.
H02: There is no significant relationship between the nutritional status and cognitive
function of rural Filipino community-dwelling elderly.
H03: There is no significant difference between urban and rural Filipino community-
dwelling elderly in terms of nutritional status.
H04: There is no significant difference between urban and rural Filipino community-
dwelling elderly in terms of cognitive function.
Theoretical Framework
The researcher based this study on two theories regarding nutrition and culture care.
These theories were Maslow’s Hierarchy of Human Needs and Leininger’s Theory of Culture
Care, Diversity and Universality.
Maslow’s Hierarchy of Human Needs
When physiologic and psychosocial changes among elderly are not appropriately
addressed, errors in management and poor
outcomes may ensue (Geist & Kahveci, 2012).
According to Smeltzer & Bare (2006),
human needs are addressed on the basis of priority that once essential needs are met, the person
experiences a need on a higher level. As explained further by Cherryb (2012), physiologic needs
such as nutrition, hydration, oxygenation, and sleep are the most basic and instinctive needs in
the hierarch; hence, it is essential for survival and growth.
Figure 1:
Maslow’s Hierarchy of Needs* *source:http://www.consciousaging.com/Transpersonal%20Psychology/Conscious%20Aging%20-
%20Maslow's%20Hierarchy%20of%20Needs.aspx
Maslow (Maslow, 1943) conceptualized human needs as a five-dimensioned pyramid that
is aligned according to its intrinsic and extrinsic human necessity. He explained that humans
need to attain all his basic requirements at the base level before attending to the higher form of
human fundamental needs. Age, being a part of human existence, does not influence the cyclical
nature of this theory. Physiologic needs, when met, unmet, or partially met, motivate all people,
regardless of age, gender, social and civic status, in aiming to meet basic necessities of vitality.
Leininger’s Theory of Culture Care, Diversity and Universality
The elderly in our society, being one of the many recipients of care, attends to or holds to
different cultural practices acquired from his or her roots of generation. Thereby, including
culture care in the interventions rendered by professional caregivers is essential in order to
alleviate sufferings – disease-caused illnesses or psychological imbalances – thus, preserving,
maintaining and enhancing their way of living that includes health practices and self-care
regimens.
Figure 2:
Leininger’s Sunrise Enabler Model* *source: http://leiningertheory.blogspot.com/2010/07/sunrise-enabler-l-eininger-developed.html
Nursing limited its scope into four metaparadigms: the concepts of person, environment,
nursing, and health. Leininger enhanced further the governing ideas that shape the practice of
nursing thus, not limiting only to the four metaparadigms of nursing. This then, gave birth to the
Theory of Culture Care, Diversity, and Universality. Furthermore, this theory is of great
importance as Leininger (2010) embedded in her theory that in order for a care to be competent,
she [the nurse] must take into account the cultural beliefs, caring behaviors, and values of
individuals, families, and groups. Nevertheless, environmental context was also defined as one of
her metaparadigms to be the “totality of an event, situation or particular interactions that give
meanings to human experiences, interpretations and social interactions in particular physical,
ecological, sociopolitical, and/or cultural settings (Leininger, 1991, as cited by Leininger &
McFarland, 2010). Therefore, the integration of culture as part of the environment in caring for
the elderly is necessary in order to render a proficient nursing care.
Kalinga is a vast area filled with hills, valleys, mountains and rice terraces. More than
half of the province’s area is suitable for agriculture and produces a bounty of rice, corn, cassava,
coffee, mangoes, pineapples, and legumes. Primarily, the people of Kalinga were farmers thus;
farming is the most common livelihood of the province. Rice is the main food staple among the
Kalingas. Most of the elderly were living with their respective families and their main source of
income mostly comes from agricultural business such as farming. There were only few Kalinga
elderly who were educated through college level. Most of the Kalinga elderly were high school
graduates and undergraduates.
Being the second largest city in Philippines, Quezon City has been a center for commerce
and industry. It has a large population of elderly. This urban area has a lot of infrastructures such
as shopping malls and amusement parks. The economy is greatly developed unlike in Kalinga
where it strives to be more developed. Most of the elderly were with their families and the main
source of their income comes from their children’s financial assistance or monthly premiums of
their retirement. They are more engaged to business like small sari-sari store. Elderly in this
urban area were well- educated comprising from college undergraduate to post-graduate level.
Conceptual Paradigm
The relationship of the concepts of the study can be further explained on Figure 3 as
depicted below.
Figure 3:
Assessment of Nutritional Status and Cognitive Function among
Urban and Rural Filipino Community-dwelling Elderly:
Basis for the development of
Focus Care Enhancement Program for Elderly
The fundamentals of this research study was deeply rooted in the concepts and ideas
made upon on the theory of Maslow and Leininger. As discussed earlier, a person should sustain
and fulfill the deficiency on the lower level before he or she attains his or her higher level of
need. And according to Leininger, healthcare professional should be known of the cultural
background and presentation of the population. The way people deal with their everyday struggle
is affected by the culture rooted in their existence.
The study was related in such a way that the research to be conduct will be based in the
nutritional and cognitive aspects of health, as it was discussed in the Hierarchy of Needs, and the
similarities and differences of cultural practices of the elderly in terms of their nutrition. In
addendum, the researcher will be conducting this research to investigate the relationship of
nutrition to the cognition of elderly, as well as the differences and similarities of nutritional
status of urban and rural Filipino community-dwelling elderly.
Adequate intake of nutrients and good hydration maintains and improves optimum well-
being, which includes enhanced cognitive functioning, of the elderly population. On the contrary,
deficiency of appropriate nutrients and minimal hydration of our elderly may impose great effect
on the mental health of this population, which includes mild cognitive impairment (MCI).
As part of human practices and way of living, nutrition has been actualized on the culture
of every individual in the society. Nutrition is greatly influenced by the cultural environment of
the elderly. Their nutritional preferences had been affected by the socioeconomic factors, social
norms and standards, and health-related beliefs.
Furthermore, the comparison of the urban and rural communities will then be the basis
for more culturally competent nursing skills on the nutritional aspect of the elderly. In addition,
the theory of Leininger was further elaborated in this study and not just encapsulated its
paradigms on the universality and diversity of the theory but, on the similarities and differences
of elderly on the same country but of different community.
The results of the study will then be centered on the enhancement of elderly nutrition and
cognition through different recommendations as further discussed on Chapter V of this study.
Scope and Limitations of the Study
The study focused on the relationship of nutritional status to cognitive function in the
elderly and the differences of urban and rural Filipino community-dwelling elderly. This study
aimed to explore the impact of nutrition to the cognition of elderly from both different
environments. Moreover, the study was confined on the nutritional health aspect of the elderly in
relation to their cognitive functioning. Well-being and fraility among the elderly are not included
in the scope of this study. In addition, elderly who were institutionalized or hospitalized situated
in the community was not included in the study, henceforth; those elderly who are engage in a
residential home care activity were not be included.
Definition of Terms
The following terms were operationally defined by the researcher in the intention to use it
according to the processes of the study.
Cognitive Function (CF) refers to the intellectual processes which involve memory, speech,
creativity, reasoning, analysis, and decision making. It is the ability of the elderly to perceive,
comprehend, and scrutinize concepts into a formation of pertinent ideas.
Community-dwelling Elderly (CoDE) refers to those old adults aging 60 and above who are
living in the community independently or with their respective families. They are not confined in
any geriatric facility or institutions.
Nutritional Status (NS) refers to the state of health among the elderly which involves dietary
intake, hydration and consumption of nutrients desirable for well-being and functioning.
Rural Filipino Community-dwelling Elderly (RFCoDE) refers to the old adults of 60 years
old and above who are naturally born citizen from the Philippines. At the same time, they are
living in the rural or municipality areas of the Philippines.
Urban Filipino Community-dwelling Elderly (UFCoDE) refers to the old adults of 60 years
old and above who are naturally born citizen from the Philippines. At the same time, they are
living in the urban or city areas of the Philippines.
CHAPTER II
REVIEW OF LITERATURE
This chapter presents the abundance of literature and research studies that were gathered
and collated from book, journals and articles, pertinent to the study. It has been categorized on
three interrelated concepts. First, it will give a brief and accurate summary on the concepts about
the role of nutrition, its source and importance among the elderly population. Second, it will give
a precise overview on the cultural aspect of nutrition based on the two distinct environments.
Third, it will give robust information about the relationship of nutrition to the cognition among
the elderly. And lastly, it will give a synthesis that will give explanation on the important factors
of this study as compared to other researches.
Facts and Figures about Elderly Nutrition & Cognition
Malnutrition is a state of nutrition (under or overnutrition) in which a lack of protein,
energy and other nutrients causes measurable adverse effects on tissue and/or body form,
composition, function or clinical outcome (Nestlé Health Science, 2012). Furthermore, Saava, et.
al. (2006) defined malnutrition as “an inadequate nutritional status or under-nourishment
characterized by insufficient dietary intake, muscle wasting and the weight loss leading to poor
health and the decreased quality of life, it might be precipitated by the loss of appetite,
loneliness, the chronic illness, physical and psychological elements that all together potentially
impact morbidity, mortality and the quality of life in the older age.”
There was a high prevalence of malnutrition among our elderly population (BAPEN,
2007). Of all the elderly aging 80 years and over, 35 percent of them were malnourished; 25 to
35 percent was 60 to 80 years of age; 25 percent of them were below 60 years of age.
Malnutrition is not just a problem among elderly in an institution – whether hospital or home
care (ENHA, 2005). It was also prominent among older people treated in the community. In the
conference paper of Wait (2005), 15 to 40 percent of older adults living in the community are
malnourished.
With the high prevalence of malnutrition among our elderly in the community, awareness
on this specific health issue in this population was low (ENHA, 2005). According to Bacon
(2005), a survey about the awareness of malnutrition among UK family doctors showed that 88
percent of the respondents were not aware of any nutritional screening tool designed to identify
patients at risk of malnutrition and 40 percent never provided dietary advice to patients at risk of
malnutrition prior to an elective admission to hospital (Nutricia Clinical Care/doctors.net.uk:
2005).
Nutrition Plays a Definite Role
As we age, there are changes within our body that occur inevitably. Ageing process
(Kirkwood, 2006 as cited by Denny, 2008) is the biological changes that result from a lifelong
accumulation of molecular damage in the cells and organs that constitute the human body,
eventually disrupting the cell’s ability to make the energy they need to function. According to
Brunner (2008), cellular changes of old age cause an alteration in the physical appearance and
functional decline. The body’s ability to maintain homeostasis becomes increasingly diminished
with cellular ageing, and organ systems cannot function at full efficiency because of cellular and
tissue deficits. These changes may lead to reduced appetite, body weight loss, malnutrition, and a
compromised immune system (Lichtenberg, 2010).
Dudek (2007) described that food nourishes the mind as well as the body broadens
nutrition to an art as well as a science. For most people, nutrition is not simply as food but rather
the quality, frequency and amount of food intake. Moreover, good eating habits established early
in life promote health maintenance throughout adulthood. And the development and progression
of degenerative diseases are influenced by lifelong eating habits.
Adequacy in the nutrient intake of the elderly has been in the topmost priority in the plan
of care; yet nutritional deficiencies and malnutrition occur frequently and are an area of major
concern (Ebersole, et. al., 2005). Malnutrition (Maher, et. al., 2012) is defined as an imbalance of
nutrients caused by either an excess intake of nutrients of nutritional deficits which causes ill-
effect on the health and well-being of an older adult and (Wells, et. al. 2006) has been associated
with compromised cognitive capacity of the elderly.
Nutrition, as other physiologic needs, is of great importance in every individual’s vitality.
According to Nordqvist (2009), nutrition is the supply of materials – food – required by
organisms to stay alive. It also focuses on how diseases, condition, and problems can be
prevented or lessened with a healthy diet. Therefore, nutrition status is fundamental to the quality
of life in the ageing person as it is closely associated with an older person’s functionality and
ability to remain independent (Lichtenberg, 2010).
According to Resnick (2007), nutrition is important among elderly because it has an
impact on their functional performance, thus, inadequacy of food intake can result to weight loss
and loss of muscle mass interfering mobility and ambulation.
Having enough amount of nutrient intake is essential at any age population especially our
vulnerable residents in our society, the older adults. From the article of Beattie (2012), a 1990
survey by Ross Laboratories found that 30 percent of seniors skip at least one meal a day, while
another study found that 16 percent of seniors consume fewer than 1000 calories a day, which is
insufficient to maintain adequate nutrition. There are many reasons why a senior may skip a
meal, from forgetfulness to financial burden, depression to dental problems, and loneliness to
frailty.
For the older adults in our society, nutrition is of great beneficial in their vitality. In the
article of Segal & Kemp (2012), the benefits of healthy eating include increased mental alertness,
resistance to illness and disease, higher energy levels, faster recuperation times, and better
management of chronic health problems.
According to Baker (2007), there are at least 45 chemical compounds and elements found
in foods that are essential to human cells. They were classified into five main groups:
carbohydrates, proteins, fats, minerals, and vitamins. These nutrients have their specific roles in
maintaining a healthy body among the elderly. Carbohydrate (Rutherford, 2011) serves as the
source of energy for the body through the conversion of sugar into glucose. Protein (Paddon-
Jones & Rasmussen, 2009) is important in the diet of the elderly since it preserves the skeletal
mass in ageing. Aside from storing energy, fat (Tchkonia, et. al., 2010) is important in immune
and endocrine function, thermoregulation, mechanical protection, and tissue regeneration.
Vitamins and minerals (Saibil, 2011) are essential among the elderly since they keep the bones
and teeth strong, promote health blood circulation and wound healing, maintains the function of
the kidney, preserve normal skin integrity, and provides adequate immunity.
Nutrition is a broad concept especially that it is not focused on what food we eat but
rather what we eat aside from food. According to Cartz, et. al. (2012), water is essential to health
but is often overlooked. This can result to inadequate level of hydration among the elderly
population. Inadequate hydration (Byles, et. al., 2009) is associated with many adverse
consequences including poor oral health, poor skin integrity, constipation, urinary tract infection,
and confusion, and may contribute to reduced food intake and malnutrition. Furthermore,
sufficient hydration may bring well-being, better quality of life, and improved outcomes for
every older adult (Cartz, et. al., 2012).
According to Jéquier & Constant (2010), water, a vital nutrient, has numerous critical
roles in the human body such that it acts as a building material; as a solvent, reaction medium,
reactant and reaction product; as a carrier for nutrients and waste products; in thermoregulation
and as a lubricant and shock absorber. Consequently, the optimal functioning of our body
requires a good hydration level. The regulation of water balance is very precise and is essential
for the maintenance of health and life.
According to Benton, et. al. (2012), the brain requires adequate nutrition for optimum
growth, development and maturation. Protein, fatty acids (specifically, long-chain fatty acids)
and many micronutrients are essential for the proper structure of brain tissue, healthy
neurochemistry, and the overall growth and maturation of the brain.
On the other hands, oral nutritional supplementation (Milne, Avenell & Potter, 2006) can
improve nutritional status and seem to reduce mortality and complications for under-nourished
elderly. It has been used widely prescribed for older adults both in the hospital and community
settings. Supplements can improve the nutritional status of older people resulting to small but
consistent weight gain. According to Suter (2006), an adequate intake of different vitamins is not
only of importance for the prevention of the development of deficiencies, but also the control of
chronic disease risk. Vitamins may play a role in prevention of the pathogenesis of most chronic
diseases of aging such as decreased cognitive function, cardiovascular diseases, and cancer.
Pharmacology is another factor that influences the intake of necessary nutrients needed
by the optimal functioning of the body, as we reach the age of 65 and older. According to Biggs
(2007), medications play a role in poor nutrition causing anorexia and after taste sensation,
making food tastes bitter, metallic, or sour. The adverse consequences of drug-nutrient
interactions in elderly people can include nutritional deficiency, drug toxicity, loss of drug
efficacy and disease control, and unwanted changes in body weight (Couris, et. al., 2006).
Nutrition greatly affects the functionality of our life especially as we get older. Good and
adequate nutrient intake may improved bone density thus decreasing falls (Bischoff-Ferrari, 2009
through ESPEN Congress), increased muscular strength with exercise (van Loon, 2009 through
ESPEN Congress), and stimulate immune system and sustain mental health (Traister, 2011).
The Culture in Nutrition
Nutrition plays a great role in the society especially in the elderly. And as part of the
health care team, it is our duty to fulfill a role that manages the nutritional intake of every elderly
in the society. As culture influences the nutritional intake of the elderly, every individual who
takes the responsibility in the care for our elderly should have social awareness in this field of
the heath care industry. The holistic approach in the care for the elderly involves the culture care
encapsulated in the paradigms of nursing. The amount of food needed by our elderly is
influenced by how the way of their living, beliefs, practices, and customs.
Physiological changes may be the common denominator of every elderly in the society
across the globe but the uniqueness in their needs, especially in terms of their nutritional health,
made them different from every old ager in the world.
According to Grodner, et.al. (2012), lifestyle and behavior are central to the maintenance
of health and wellness. In order to influence the way of one’s living, healthcare professional
should take into account the values, attitudes, culture, and life circumstances of every individual.
This is then will affect the nutrition and diet intake of every individual especially the elder
populations. Thus, diet and nutrition assessment is imperative to provide culturally competent
care.
As further explained by Giger (2013), nutritional preferences include habits and patterns
that were develop during the childhood as a result of family lifestyle, and ethnic or cultural,
social, religious, geographical, economic, and psychological components. Food also has
symbolic meaning, in some cultures, that has nothing to do with nutritional value. In these
cultures eating becomes associated with sentiments and assumptions about oneself and the
world. In addition food becomes symbolic to people because it can be used as a reward.
Eating habits (Luggen, Bernstein & Touhy, 2008) are influenced by ethnicity which
determines if traditional foods are preserved, and religion where it affects possible food choices.
A variety of reasons including taste, convenience, cost, weight management, disease prevention,
culture, religion, food contents, food accessibility and many more contribute to food selection
(Ree, et. al., 2008). Furthermore, Ree, et.al. (2008) identified that individuals with higher literacy
and income levels were expected to make healthier food choices as compared to their lower
counterparts.
The intake of food has been influenced by the culture that was originated in the roots of
our existence. The selection of what food to eat is governed by forces which include preferences,
choices and likings (Grodner, 2012). As further explained by Grodner (2012), food preferences
are foods we choose to eat when all foods are available at the same time and in the same amount.
Environment greatly affects the preferences of food intake that is usually the result of cultural
and socioeconomic influences. We often adjust our choices to match those that are around us.
Food choices (Grodner, 2012) concern the specific foods that are convenient to choose
when we are actually ready to eat. It is confined by convenience and nutritional value may not be
a prime concern that affects food choice. On the other hand, food liking (Grodner, 2012)
considers which foods we really like to eat.
Food habits in elderly people are not only influenced by the lifetime preferences and by
physiological changes according to aging but also by social aspects such as loneliness, economic
situations or living conditions and disability (Saeidlou, 2011). Furthermore, according to Tomé
(2011), socioeconomic status affects food choices and dietary quality. Food price is among the
many factors that influence old people's food choices. Consequently, it affects energy intake and
nutrient quality of diets.
According to the study of Tanchoco (2011), distinction to the general pattern on food
pattern, consumption, preferences, and preparation had been brought about by the augmentation
of diverse ethnic groups in the different parts of the Philippines. On the other hand, the use of
rice is still the major staple across the land. Vegetables had been in a scant amount in servings, as
well as fruits and dairy products due to their high cost.
Nutrition on Cognition Amongst the Elderly: Studies Revealed
Malnutrition has been associated with compromised cognitive capacity in the elderly
(Wells, et. al., 2006). According to Jernigan (2012), without the proper food, one’s biosystem
will become listless and disinterested, thus, elderly person suffering from malnutrition may
develop memory decline and answering simple questions will be impossible. Early detection of
malnutrition is important since it has been associated with diminished cognitive function,
mobility, and a diminished ability to care for one's self (Eriksson, et. al., 2005).
Nutrition plays a very important role in the promotion of well-defined cognitive
functioning of the elderly. Studies on the effect of nutrients had been established that there is a
connection between the nutritional status and cognitive function among the elderly population.
The intake of nutrients is greatly affected by the culture of every elderly. The dietary intake and
food choices are influenced by historical and cultural factors which include dietary habits, food
preparations and cooking methods (James, 2004).
As the brain is dependent upon a constant supply of nutrients and oxygen for optimum
function, it is not surprising that poor nutrition can be linked with disturbances in the blood
supply to the brain, and hence neurological impairment (Clark, in press as cited by Denny,
2008). Adequate nutrition is critical to preserving the health of older people and an integral part
of health, happiness, independence, quality of life, and physical and mental functioning
(Ebersole, et. al., 2005).
According to Benton, et. al. (2012), cognitive decline and functional disability are clinical
symptoms of dementia, a series of syndromes that reflect damaged and malfunctioning neurons.
There are as many as fifty other causes that include head injury, drugs, alcohol, and specific
nutritional deficiencies. Nutrition may modulate cognitive processing. For example, nutrients
such as folate and vitamin B-12 are required for genome maintenance, and iron or copper
overload can exacerbate homeostatic imbalance in redox pathways.
Adequate water intake (Holdsworth, 2012) is a fundamental part of a balanced diet and in
addition to its importance for physical performance and mental function. Dehydration affects
health, wellbeing and performance, which includes cognitive function and motor control, as well
as contributing to morbidity in several chronic disease processes.
As part of nutrition, hydration is vital in the cognitive functioning of the brain. According
to the article of Norman (2012), nutrition and hydration are part of a foundation for healthy
learning. Water is essential for optimal brain health and function. It enhances circulation and aids
in removing wastes. Water keeps the brain from overheating, which can cause cognitive decline
and even damage.
From the study of Seamans, et. al. (2010), women were appearing to be at a higher risk of
vitamin D insufficiency than men thus, it was associated with reduced capacity of spatial
working memory.
The evidence reviewed suggests that, whereas studies involving supplementation with
single vitamins, or restricted ranges of vitamins, have demonstrated equivocal results, evidence
from studies involving the administration of broader ranges of vitamins, or multivitamins,
suggest potential efficacy in terms of cognitive and psychological functioning (Kennedy &
Haskell, 2011).
According to the study made by Vizuete, et. al. (2010), the greater consumption of
cereals, vegetables, eggs, and fish would certainly supply essential nutrients that might facilitate
the maintenance of cognitive capacity.
From the study of Morley & Banks (2010), lipids may affect cognition in a number of
diseases and conditions but the effect of cholesterol and triglycerides were negative. On the
contrary omega-3 fatty acids such as DHA were supportive with the cognition among elderly.
Therefore, cholesterol, omega-3 fatty acids and triglycerides have implications for Alzheimer’s
disease and conditions associated with dyslipidemia and cognitive impairments such as obesity.
Roberts, et. al. (2010) discussed that higher intake of mono- and polyunsaturated fats
were associated with a reduced likelihood of mild cognitive impairment among elderly persons
in the population-based setting. Furthemore, Roberts, et. al. (2010) stated that polyunsaturated
fats may reduce the risk of thrombosis, cardiovascular risk, and stroke, and may also inhibit
inflammation.
There are associations between nutrition and dementia disorders but they are complex
(Irving, 2003). A few intervention studies with liquid supplements in demented elderly people
resulted in improved nutritional status. More studies are needed to evaluate not only the effects
on nutritional parameters, but also the effects on cognitive performance, ADL functions and
quality of life.
Synthesis
Malnutrition among the elderly population had been prevalent yet; assessment and
interventions centered on nutrition had been in the least priority of the health care professionals.
Malnutrition may cause detrimental effects on the wellbeing of the elderly. Such outcomes may
interfere directly on the functionality of the elderly particularly the cognitive aspect of health.
Nutrition is important across lifespan. But the greater amount of it demands on the needs
of the unborn as well as the elderly. Adequacy on diet intake and hydration is important as we
age. Enough supplementation of essential vitamins and minerals may aid in maintaining a
healthy body of an elderly. Furthermore, as we age, certain degenerative diseases may arise due
to insufficiency of nutrient intake.
Factors affecting decrease intake of nutrient and hydration may include pharmacology
(certain medications that may suppress appetite), socio-economic status (deficient sources of
income), educational attainment (lacking information about nutrition), and cultural determinants.
Personal factors may also affect intake of nutrients such as food preferences, food choices and
food likings.
Furthermore, studies revealed that there is a relationship of inadequate nutrient intake on
the cognitive functioning among elderly. Cognitive dysfunction such as mild cognitive
impairment, dementia, and Alzheimer’s disease may take place if there is an evident
insufficiency on the levels of certain compounds in our body that regulates the brain functioning.
In addition, an increase of harmful substances in our body such as triglycerides and cholesterol
may initiate the progress of cognitive impairment among the elderly.
CHAPTER III
RESEARCH METHODOLOGY
This chapter discusses the research methods used by the researcher. It talks about the
design utilized by the researcher, the selection of participants and locale, the instruments that was
employed to the participants, and the how data collection and statistical treatment. It also
includes a discussion on ethical principles.
Research Design
The researcher will be using a descriptive-correlational-comparative non-experimental
research design. Here, the researcher intends to describe and compare the relationship of
nutritional health status and the cognitive function of Filipino and Indonesian community-
dwelling elderly. According to Nieswiadomy (2008), descriptive-correlational-comparative
studies enable the researcher to describe or explain the relationship between variables in a given
phenomena and examines the strength of relationships between variables by determining how
changes in one variable are associated with changes in another variable at the same time,
scrutinizes the differences between intact groups on some dependent variable of interest. As
further explained by Sousa, Driessnack & Mendes (2007), the researcher observes, describes,
and documents various aspects of a phenomenon. There is no manipulation of variables or search
for cause and effect related to the phenomenon. From Baac (2010), descriptive research design
provides further insight into the research problem by describing the variables of interest of the
research. From an anonymous document, competent description can challenge accepted
assumptions about the way things are and can provoke action. On the contrary, correlational
studies can suggest that there is a relationship between two variables but they cannot prove that
one variable causes a change in another variable. In other words, correlation does not equal
causation (Cherryb, 2012). It is then, therefore that a comparative research is important in this
study to allow the researcher employ research in an objective and statistical valid way (Verial,
2012).
Population and Sample
The participants of this research were male and female Filipino elderly who are living
within the community (urban and rural) with their families. The elderly were 60 years old and
above and were not clinically diagnosed with depression, dementia and Alzheimer’s disease
before the research. Exclusion criteria includes were those elderly who were hospitalized or
underwent any major surgery of the lower gastrointestinal tract for the past 12 months, who were
taking medications (e.g. chemotherapeutic drugs) that may suppress appetite, who are enrolled in
any fitness management sessions, who have diseases that may affect their amount of food intake
(e.g. neoplasms, liver and kidney disease, biliary diseases, gastrointestinal diseases), who were
currently joining activities in a residential care facility, and who were currently institutionalized
or hospitalized.
The participants were selected through a non-probability purposive sampling technique.
This method is based on the assumption that the researcher or the chosen expert has enough
knowledge about the population of interest to select specific subjects for the study
(Nieswaidomy, 2008). Furthermore, the participants were chosen that the researcher believes are
typical, or representative, of the accessible population, or someone who is believed to be an
expert may be asked to select the subject. In addition, purposive sampling (Wadsworth Cengage
Learning, 2005) targets a particular group of people. The major problem with purposive
sampling was that the type of people who are available for study may be different from those in
the population who can't be located and this might introduce a source of bias. On the other hand,
according to Trochim (2006), the researcher samples with a purpose in mind. This technique is
useful for situations where you need to reach a targeted sample quickly and where sampling for
proportionality is not the primary concern. With a purposive sample, you are likely to get the
opinions of your target population, but you are also likely to overweight subgroups in your
population that are more readily accessible.
Research Locale
The researcher conducted the study in Metro Manila and the Cordillera Administrative
Region, Philippines. According to Ericta (2012), 6.76 percent or 6.23 million comprises of
elderly aging from 60 and above, and 10.9 percent of which are elderly of the Metro Manila and
6.9 percent of which are elderly of the Cordillera Administrative Region. In addition, the
researcher had chosen these two regions due to availability and richness of urban and rural
community-dwelling elderly.
Research Instrument
According to Nieswiadomy (2008), research instruments are the devices used to collect
data that will facilitate observation and measurement of the variables of interest. For this study,
the researcher utilized the Mini Nutritional Assessment (MNA) tool from Nestle Health Institute
and Montreal Cognitive Assessment (MoCA) tool from Center for Diagnosis & Research on
Alzheimer’s Disease.
Nutritional Status
Nutritional status of the elderly will be assessed by the Mini Nutritional Assessment
(MNA) tool that comprises 18 items that were grouped into four rubrics: anthropometric
assessment (BMI calculated from weight and height, weight loss, and arm and calf
circumferences; items B, F, Q and R) general assessment (lifestyle, medication, mobility and
presence of signs of depression or dementia; items C, D, E, G, H and I); short dietary assessment
(number of meals, food and fluid intake, and autonomy of feeding; items A, J, K, L, M and N);
and subjective assessment (self perception of health and nutrition; items O and P) (Guigoz,
2006).
Scores of 24-30 (none decrease in food intake, none weight loss, none restricted mobility,
none psychological stress or acute disease in the past three months, none neuropsychological
problems, BMI of 23 or greater, lives independently, doesn’t take more than 3 prescribed drugs,
no pressure sore, eats three meals, consumes one serving of dairy product, two or more servings
of legumes or egg per week and eats fish, meat or poultry everyday, consumes two ore more
servings of fruits and vegetables per day, drinks more than 5 cups of water in a day, self-fed
without problem, views self with no nutritional problem, has better health status than same age
group, MAC of 22 or greater and CC of 31 or greater) are considered normal nutritional status;
17-23.5 (moderate decrease in food intake, weight loss between one and three kilograms, can go
out to bed or chair but does not go out, none psychological stress or acute disease in the past
three months, with mild dementia, BMI of 19 to less than 23, lives in nursing home or hospital,
takes more than three prescribed drugs, has pressure ulcer or skin ulcer, eats two meals per day,
consumes at least two of the protein intake markers, doesn’t consume fruit, or vegetable in a day,
drinks 3-5 cups per day, self-fed with some difficulty, uncertain of nutritional status, views
health status as good or doesn’t know of the same age group, MAC of 21 to 22, and CC less than
31) indicate at risk of malnutrition; 0-17 (severe decrease of food intake, weight loss of greater
than three kilograms or does not know if there was weight loss, none ambulatory, with severe
dementia or depression, BMI of less than 19, lives in nursing home or hospital, takes more than
three prescribed drugs, has pressure ulcer or skin ulcer, eats one meal per day, consumes one of
the protein intake markers, doesn’t consume fruit, or vegetable in a day, drinks less than three
cups per day, self-fed with difficulty, views self as being malnourished, views health status as
not good of the same age group, MAC of less than 21, and CC less than 31) indicates
malnutrition. An advantage of the tool is that no laboratory data are needed (Guigoz, 2006).
An in-depth assessment and physical exam should be performed when patients are
identified to be malnourished or at nutritional risk. A review of symptoms and objective clinical
findings should be assessed in addition to the patient’s cultural factors, preferences, social
needs/desires surrounding meals (DiMaria-Ghalili, et. al., 2012). Older adults who are residing in
the community are at risk of malnutrition and represent a group that should be targeted for
nutrition screening, thus MNA-SF is necessary following a full MNA if score is ≤11 on the short
form (Charlton, 2010). The sensitivity, specificity and positive predictive values according to the
clinical status were 96%, 98% and 97%.
Cognitive Function
Cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA)
(Nasreddine, et. al., 2005). It is a brief 30-item questionnaire use to assess the cognitive ability of
the elderly which includes orientation, short-term memory, executive function, language ability,
and visuospatial ability. Scores of ≥26 indicates normal cognitive function while ≤25 indicates
mild cognitive impairment. The MoCA is a relatively simple, brief test that helps health
professionals determine quickly whether a person has abnormal cognitive function and may need
a more thorough diagnostic work-up for Alzheimer's disease though the disadvantage of using
MoCA is that conclusions regarding its validity can only be made in memory clinic settings
(Rosenzweig, 2010). Nasreddine, et.al. (2005) tested the reliability examining the internal
consistency (Cronbach’s alpha = 0.83) and the test-retest reliability (r = 0.9) which indicates
excellent result. Validity of MoCA was measured correlating to Mini Mental Status Examination
(MMSE) yielding to excellent (r = 0.87) result.
Data Collection Procedure
The research study will be undergoing five steps for the data collection procedure. The
process will be based on the concepts that are described and further be explained on Figure 2 as
shown below.
Figure 4:
Process of the Data Gathering Procedure
Prior to the data collection, the researcher gave a letter to the Barangay Captain of the
two locales asking permission to conduct the study.
The researcher did a house-to-house visit for the possible participants who will join the
research. In-depth explanation of the study was conducted for both the participants and his/her
next to kin.
After an in-depth explanation about the research, the researcher then gave an informed
consent to the research participants stating the purpose of the study as well as the confidentiality
of all the details submitted by the participants.
After the administration of informed consent to the research participants, the researcher
utilized the Mini Nutritional Assessment (MNA®) tool (Guigoz, et. al. 2006). The researcher
Step 1:
Identification of Research
Participants
Step 2:
Informed Consent
Step 3:
Untilization of MNA® tool
Step 4:
Utilization of MoCA® tool
Step 5:
Collation and Evaluation
took the body mass index (BMI) using a bathroom scale to determine the weight of the
participants which was measured by kilograms (kg), and a tape measure to determine the height
of the participants which was measured in centimeters (cm) then converted to meter-square (m2).
After taking the BMI of the participants, the researcher proceeded with the interview using the
MNA® tool (Guigoz, et. al. 2006). This is a 30-item questionnaire that lasted for five to 10
minutes. This tool helped the researcher to determine the nutritional status of urban and rural
Filipino community dwelling elderly.
After taking the nutritional status of the elderly, the researcher utilized the Montreal
Cognitive Assessment (MoCA®) tool (Nasreddine, 2005). This is a 30-item questionnaire that
lasted for 10 to 15 minutes. This tool helped the researcher to determine the cognitive function of
Filipino urban and rural community dwelling elderly.
After taking the nutritional status and cognitive function of both urban and rural elderly,
the researcher collated all the information provided by the participants and evaluated further for
missing data. After didactic collation and evaluation of the information laid by the participants,
this then gave lee-way for the statistical analysis needed in order to test the hypothesis.
Statistical Treatment
All data was computed and analyzed using the parametric inferential statistics wherein
the information gathered from the sample will be used to estimate the corresponding figures for a
population and make comparisons between samples and population, stating the level of
confidence in each result (Watson, et. al., 2006). To determine to the nutritional health status of
UFCoDE and RFCoDE, the researcher used the frequency distribution. Frequency distribution
(Jackson, 2012) is a table in which all scores are listed along with the frequency with which each
occurs.
To determine the cognitive function of UFCoDE and RFCoDE, the researcher had chosen
to use the mean. According to Jackson (2012), mean is the most commonly used measure of
central tendency; the arithmetic average of a group of scores. Most important, the mean
(Steinberg, 2012) is the place where the numerical distances of scores on one side of the mean
balance the numerical distance of scores on the other side of the mean. This is mathematically
represented by:
where
μ represents population mean;
Σ represents the sum;
X represents the individual score; and,
N represents the number of scores in the distribution.
To calculate the mean (μ), we sum up (Σ) all the scores of the individuals (X) and divide
by the total number (N) of scores in the distribution.
To determine the relationship of nutritional health status and cognitive function among
UFCoDE and RFCoDE, the researcher used Pearson’s Product Moment Correlation (represented
by rho, ρ). This is used to determine if there is a linear relationship between two continuous
variables (Evans & Rooney, 2011). Pearson’s ρ is the most commonly used correlation
coefficient when both variables are measured on an interval or ratio scale (Jackson, 2012).
To determine if there are differences between UFCoDE and RFCoDE in terms of their
nutritional health status and cognitive function, the researcher utilized the z-test. According to
Steinberg (2011), z-test is used to determine the probability of obtaining a sample mean that is
known to the population. This is then represented by:
where
represents the sample mean;
μ represents the population mean; and,
represents the standard error of the mean.
Ethical Consideration
The researcher observed the different ethical code during the course of the study. These
include the following as enumerated and further explained below:
Informed Consent. The participants of the study were given informed consent stating the
purpose, procedure and intension of the study. The researcher discussed the intent of the study
thoroughly to the participants and their next of kin. Inquiries were answered with full knowledge
by the researcher.
Confidentiality. Given with all the information as submitted by the participant of the study, the
researcher treated all facts with utmost confidentiality. Important information from the
participants, such as name, was not exposed to other participant. Participants’ anonymity was
preserved by the researcher. Tools that had information of the participants were kept securely by
the researcher.
Respect & Non-malificence. Since the participants of this study were elderly and was included as
vulnerable population, the researcher treated the participants with due respect. The researcher
avoided embarrassing, offensive, and foul words. During the data gathering, the researcher
looked into the safety of the participants. Such safety measures include quiet environment, use of
lay-man’s terms and assistance during the data gathering.
Honesty. The researcher properly cited articles, journals, and books from all related researches
used in this study. In addition, permission to use tools and to conduct study was addressed by the
researcher.
CHAPTER IV
RESULTS AND DISCUSSION
This chapter shows the presentation, analysis and interpretation of data gathered
according to the sequence of problems as stated on Chapter I. Furthermore, the study intends to
investigate the relationship of nutritional health status to the cognitive function as well as their
differences among the Filipino elderly who are living in an urban and rural community.
Presentation is according to the specific problems of the study.
Specific Problem
Problem No. 1. What is the nutritional status of urban and rural Filipino community
dwelling elderly?
Table 1
Nutritional Status of Urban Filipino Community Dwelling Elderly Based on
Mini Nutritional Assessment (MNA)
Screening
Score
N % Assessment
Score
N % Total
Assessment
N % Malnutrition
Indicator
Score
12 – 14 10 50% 13 – 16 4 20% 24 – 30 10 50% Normal
Nutritional
Status
8 – 11 10 50% 10 – 12.5 14 70% 17 – 23.5 10 50% At Risk of
Malnutrition
0 – 7 < 10 2 10% < 17 Malnourished
Total 20 100 Total 20 100 Total 20 100
Table 1.1 shows the result of the nutritional status (NS) of urban Filipino community
dwelling elderly as based on the Mini Nutritional Assessment (MNA) tool. As shown above, the
result of the MNA of the participants (N=20) fell under normal nutritional status and at risk of
malnutrition where N=10 or 50% were normal nutritional status and N=10 or 50% were at risk of
malnutrition. In addition, the screening scores of the participants (N=20) fell under normal
nutritional status and at risk of malnutrition where N=10 or 50% were normal nutritional status
and N=10 or 50% were at risk of malnutrition. On the other hand, the assessment scores of the
participants (N=20) were distributed in the indicators. N=4 or 20% of the participants had normal
nutritional status, N=14 or 70% were at risk of malnutrition, and N=2 or 10% were
malnourished.
Table 2
Nutritional Status of Rural Filipino community Dwelling Elderly Based on
Mini Nutritional Assessment (MNA)
Screening
Score
N % Assessment
Score
N % Total
Assessment
N % Malnutrition
Indicator
Score
12 – 14 10 50% 13 – 16 3 15% 24 – 30 9 45% Normal
Nutritional
Status
8 – 11 8 40% 10 – 12.5 13 65% 17 – 23.5 8 40% At Risk of
Malnutrition
0 – 7 2 10% < 10 4 20% < 17 3 15% Malnourished
Total 20 100 Total 20 100 Total 20 100
Table 1.2 shows the result of the nutritional status (NS) of rural Filipino community
dwelling elderly as based on the Mini Nutritional Assessment (MNA) tool. As shown above, the
result of the MNA of the participants (N=20) were distributed in all the indicators where N=9 or
45% were normal nutritional status, N=8 or 40% were at risk of malnutrition, and N=3 or 15%
were malnourished. In addition, the screening scores of the participants (N=20) fell in all the
indicators where N=10 or 50% were normal nutritional status, N=8 or 40% were at risk of
malnutrition, and N=2 or 10% were malnourished. On the other hand, the assessment scores of
the participants (N=20) were distributed in the indicators. N=3 or 15% of the participants had
normal nutritional status, N=13 or 65% were at risk of malnutrition, and N=4 or 20% were
malnourished.
From the study of Capanzana, et. al. (2008), there was high prevalence of underweight as
well as overweight among Filipino elderly. Body Mass Index (BMI) values indicated that
undernutrition was a major problem among elderly at 27.0% of the 70 years old and over and
17.7% of the 60 - 69 years old. On the other hand, overweight was also prevalent among 60-69
years old and 70 years old and over at 20.0% and 14.0%, respectively. In addition, Jenkins, et. al.
(2007) reported that 30% of the elderly were underweight and is more common people over 70.
According to the 2008 National Nutrition Survey, 21.1% of adults age 60 and above have BMI
of less than 18.5 while 18.0% and 3.8% were overweight and obese respectively. On the other
hand, 57% of adults age 60 and above have a normal BMI(18.5 to <25.0).
Problem No. 2. What is the cognitive function of urban and rural Filipino community
dwelling elderly?
Table 3
Detailed Results of Cognitive Function of Urban Filipino Community Dwelling Elderly by Areas
Based on Montreal Cognitive Assessment Philippines (MOCA-P)
Visouspatial
(5)
Naming
(3)
Attention
(6)
Language
(3)
Abstraction
(2)
Recall
(5)
Orientation
(6)
S* N % S* N % S* N % S* N % S* N % S* N % S* N %
5 10 50 3 17 85 5 7 35 3 1 5 2 4 20 5 1 5 6 15 75
4 6 30 2 3 5 4 9 45 2 7 35 1 10 50 4 8 40 5 5 25
3 3 15 3 3 15 1 12 60 0 6 30 3 6 30
1 1 5 1 1 5 2 4 20
1 1 5
AVERAGE SCORE
4.2 2.85 4.05 1.45 0.9 3.2 5.75 *S=score
Table 2.1 shows the percentage and mean score results of the cognitive function (CF)
among the UFCoDE as based on the seven areas of the Montreal Cognitive Assessment-
Philippines (MoCA-P) tool. As shown on the table, 50% or N=10 had the highest score in
visuospatial/executive ability and the mean score was 4.2 where 5 being the highest score and 0
being the lowest. 85% or N=17 had the highest score in naming and the mean score was 2.85
where 3 being the highest and 0 being the lowest. 45% or N=9 had score of 4 in attention and the
mean score was 4.05 where 5 being the highest and 0 being the lowest. 60% or N=12 had score
of 1 in language and the mean score was 1.45 where 3 being the highest and 0 being the lowest.
50% or N=10 had score of 1 in abstraction and the mean score was 0.9 where 2 being the highest
and 0 being the lowest. 40% or N=8 had score of 4 in delayed recall and the mean score was 3.2
where 5 being the highest and 0 being the lowest. 75% or N=15 had the highest score in
orientation and the mean score was 5.75 where 6 being the highest and 0 being the lowest.
Table 4
Summary Results of Cognitive Function of Urban Filipino Community Dwelling Elderly
Based on Montreal Cognitive Assessment Philippines (MOCA-P)
Total Score N % Interpretation
26 – 30 6 30% Normal Cognitive Function
18 – 25 13 65% Mild Cognitive Impairment
10 – 17 1 5% Moderately Cognitive Impairment
<10 Severe Cognitive Impairment
Total 20 100
Table 2.1.1 shows the frequency of the summary results of the cognitive function (CF)
among the UFCoDE based on Montreal Cognitive Assessment-Philippine (MoCA-P) tool. As
shown above, 65% or N=13 had mild cognitive impairment while 30% or N=6 had normal
cognitive function and 5% or N=1 had moderate cognitive impairment. The total mean score of
the UFCoDE as shown on Table 2.1 was 22.4 with verbal interpretation of mild cognitive
impairment according to MoCA-P tool.
Table 5
Detailed Results of Cognitive Function of Rural Filipino Community Dwelling Elderly by Areas
Based on Montreal Cognitive Assessment Philippines (MOCA-P)
Visouspatial
(5)
Naming
(3)
Attention
(6)
Language
(3)
Abstraction
(2)
Recall
(5)
Orientation
(6)
S* N % S* N % S* N % S* N % S* N % S* N % S* N %
5 9 45 3 14 70 4 5 25 2 1 5 2 1 5 4 2 10 6 15 75
4 1 5 2 6 30 3 8 40 1 16 80 1 6 30 3 7 35 5 3 15
3 5 25 2 2 10 0 3 15 0 13 65 2 3 15 4 2 10
2 2 10 1 3 15 1 4 20
0 3 15 0 2 10 0 4 20
AVERAGE SCORE
3.4 2.7 2.55 0.9 0.4 1.95 5.65 *S=score
Table 2.2 shows the percentage and mean score results of the cognitive function (CF)
among the RFCoDE as based on the seven areas of the Montreal Cognitive Assessment-
Philippines (MoCA-P) tool. As shown on the table, 45% or N=9 had the highest score in
visuospatial/executive ability and the mean score was 3.4 where 5 being the highest score and 0
being the lowest. 70% or N=14 had the highest score in naming and the mean score was 2.7
where 3 being the highest and 0 being the lowest. 40% or N=8 had score of 3 in attention and the
mean score was 2.55 where 5 being the highest and 0 being the lowest. 80% or N=16 had score
of 1 in language and the mean score was 0.9 where 3 being the highest and 0 being the lowest.
65% or N=13 had the lowest in abstraction and the mean score was 0.4 where 2 being the highest
and 0 being the lowest. 35% or N=7 had score of 3 in delayed recall and the mean score was 1.95
where 5 being the highest and 0 being the lowest. 75% or N=15 had the highest score in
orientation and the mean score was 5.65 where 6 being the highest and 0 being the lowest.
Table 6
Summary Results of Cognitive Function of Rural Filipino Community Dwelling Elderly
Based on Montreal Cognitive Assessment Philippines (MOCA-P)
Total Score N % Interpretation
26 – 30 Normal Cognitive Function
18 – 25 12 60% Mild Cognitive Impairment
10 – 17 5 25% Moderately Cognitive Impairment
< 10 3 15% Severe Cognitive Impairment
Total 20 100
Table 2.2.1 shows the frequency of the summary results of the cognitive function (CF)
among the UFCoDE based on Montreal Cognitive Assessment-Philippine (MoCA-P) tool. As
shown above, 60% or N=12 had mild cognitive impairment while 25% or N=5 had moderate
cognitive function and 15% or N=3 had severe cognitive impairment. The total mean score of the
UFCoDE as shown on Table 2.1 was 17.55 with indicator of moderate cognitive impairment
according to MoCA-P tool.
According to Glisky (2007), older adults show significant impairments on attentional
tasks that require dividing or switching of attention among multiple inputs or tasks. Many older
adults complain of increased memory lapses as they age although they believe that their
memories for remote events are better than their memories for recent events. From Deary, et. al.
(2009), there is little age-associated decline in some mental functions—such as verbal ability,
some numerical abilities and general knowledge—but other mental capabilities decline from
middle age onwards, or even earlier. The latter include aspects of memory, executive functions,
processing speed and reasoning. Morganti & Riva (2011) explained further that the ability to
orient in space declining with age and it constitute one of the main signs of cognitive impairment
in neurological patients.
Problem No. 3. Is there a significant relationship between the nutritional status and
cognitive function among the urban and rural Filipino community dwelling elderly?
Table 7
Significant Relationship between the Nutritional Status and the Cognitive Function of
Urban and Rural Filipino Community Dwelling Elderly
Variable
Computed
Value
(Urban)
Computed
Value
(Rural)
Tabular
Value at 0.05 Decision Interpretation
Nutritional
Status and
Cognitive
Function
ρ = 0.4320 ρ = 0.50 ρ = 0.2573
Reject the
Null
Hypothesis
Significant
*ρ=Pearson rho
Table 3.1 presents the significant relationship between the nutritional status and cognitive
function of urban and rural Filipino community-dwelling elderly. Based on the table, the
computed Pearson r value for urban and rural elderly was 0.4320 and 0.50 respectively and the
tabular Pearson r value at 0.05 level of significance was 0.2573. Since the computed values were
greater than the tabular value, therefore the null hypothesis, that there is no significant
relationship between the nutritional status and cognitive function of urban and rural Filipino
community-dwelling elderly, therefore was rejected. It means that the nutritional status and
cognitive function of urban and rural Filipino community-dwelling elderly was interrelated or
interconnected. It concludes further that the nutritional status was affected or related to the
cognitive function or vice versa.
According to Denny (2008), diet plays a key role in the development of cognitive decline
in older age. Furthermore, Benton (2012) stated that specific nutritional deficiencies may cause
cognitive decline among the elderly. In addition to nutrition, adequate hydration (Holdsworth,
2012; Norman, 2012; Jéquier & Constant, 2010) is fundamental in diet and it is important in
optimal brain health. From the study of Roberts, et. al. (2010), mono- and polyunsaturated fatty
acids may be beneficial the promotion on healthy brain function thus, reducing the risk of
thrombosis, cardiovascular risk, and stroke that may lead to cognitive impairment. Vizuete, et. al.
(2010) further concluded that greater consumption of cereals, vegetables, eggs, and fish would
certainly supply essential nutrients that might facilitate the maintenance of cognitive capacity.
Vitamin B12 (Bozoglu, et. al., 2010) may also help improve the cognitive status and maintain the
functional status among the geriatric population.
Problem No. 4. Is there a significant difference in the nutritional status between the urban
and rural Filipino community dwelling elderly?
Table 8
Significant Difference between the Urban and Rural Filipino Community Dwelling Elderly in
terms of Nutritional Status
Variable Computed
Value
Tabular Value
at 0.05 Decision Interpretation
Urban and Rural
Community
Elderly
z = 1.14 z = 1.96 Accept the Null
Hypothesis Not Significant
*z=z-test value
Table 4.1 presents the significant difference between the urban and rural Filipino
community-dwelling elderly in terms of nutritional status. Based on the table, the computed
Pearson r value for urban and rural Filipino community-dwelling elderly was 1.14 and the
tabular z-test value at 0.05 level of significance was 1.96. Since the computed value was lesser
than the tabular value, therefore the null hypothesis, that there is no significant relationship
between the nutritional status and cognitive function of urban and rural Filipino community-
dwelling elderly, therefore was accepted. It means that the nutritional status of urban and rural
Filipino community-dwelling elderly was not diverse form each other. It concludes further that
the nutritional status of urban and rural Filipino community-dwelling elderly was similar and has
no distinct differences.
From the study of Risonar, et. al. (2009), community living elderly suffer from lack of
both macronutrient intake as compared with energy requirements, and micronutrient intake as
compared with the standard dietary recommendations. Their energy intakes are ~65% of the
amounts required based on their total energy expenditure. Though their intakes decrease with
increasing age, so do their energy expenditure, making their relative insufficiency of food intake
stable with age.
Problem No. 5. Is there a significant difference in the cognitive function between the urban
and rural Filipino community dwelling elderly?
Table 9
Significant Difference between the Urban and Rural Filipino Community Dwelling Elderly in
terms of Cognitive Function
Variable Computed
Value
Tabular Value
at 0.05
Decision Interpretation
Urban and Rural
Community
Elderly
z = 3.28 z = 1.96 Reject the Null
Hypothesis Significant
*z=z-test value
Table 4.2 presents the significant difference between the urban and rural Filipino
community-dwelling elderly in terms of cognitive function (CF). Based on the table, the
computed z-test value for urban and rural Filipino community-dwelling elderly was 3.28 and the
tabular z-test value at 0.05 level of significance was 1.96. Since the computed value was greater
than the tabular value, therefore the null hypothesis, that there is no significant relationship
between the nutritional status and cognitive function of urban and rural Filipino community-
dwelling elderly, therefore was rejected. It means that the cognitive function of urban and rural
Filipino community-dwelling elderly differs from each other.
From the study, 55% or N=11 of the UFCoDE had more than 11 years of education while
30% or N=6 of the RFCoDE had more than 11 years of education. Since there was higher rate of
literacy among the UFCoDE than of the RFCoDE, higher educational attainment is associated
with greater levels of cognitive performance as well as with a reduced risk of dementia and
Alzheimer’s disease (Parisi, et. al., 2012). From the study of Alley, et. al. (2007), years of
education were positively related to higher baseline scores on each of the cognitive tests; the
effect of an additional year of education was large, particularly relative to the effect of an
additional year of age.
CHAPTER V
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Summary
This research study was conducted to determine the relationship of nutritional status and
cognitive function among urban and rural Filipino community-dwelling elderly. This study was
rooted on two important theories in Nursing: (1) Maslow’s Hierarchy of Human Needs where it
identified that nutrition and cognition are part of human needs in order to survive; and (2)
Leininger’s Theory of Culture Care, Diversity, and Universality where it discusses the
importance of culture as part of nursing care. In addition, this study explored the differences of
urban and rural Filipino community-dwelling elderly in terms of their nutritional status and
cognitive function.
The total population of this study was forty (40) elderly which was divided equally
according to their locale – twenty elderly for urban and twenty elderly for rural. The participants
were chosen based on the criteria set by the researcher using non-probability purposive sampling.
The data needed for the study were obtained through the use of Mini Nutritional Assessment
(MNA®) tool to determine the nutritional status of the elderly which was adapted from the
Nestle Nutrition Institute, and the use of Montreal Cognitive Assessment (MoCA®) tool to
determine the cognitive function of the elderly which was adapted from Montreal Cognitive
Assessment organization. The collection of data was done from December 2012 to January 2013.
The data gathered was statistically computed analyzed using inferential non-parametric
statistics. Frequency distribution was used to determine the nutritional status and cognitive
function of urban and rural Filipino community-dwelling elderly. Pearson’s Product Moment
Correlation was utilized to determine the relationship of nutritional status and cognitive function
among urban and rural Filipino community-dwelling elderly. Z-test was used to determine the
difference between the UFCoDE and RFCoDE in terms of their nutritional status and cognitive
function.
Findings
The findings of the study revealed the following:
1. The nutritional status of the UFCoDE gathered from the results of the MNA® according
to the indicators as follows:
1.1. The screening score indicated that 50% or N=10 had normal
nutritional status and 50% or N=10 were at risk of malnutrition.
1.2. The assessment scored indicated that 20% or N=4 had normal
nutritional status, 70% or N=14 were at risk of malnutrition, and 10% or
N=2 were malnourished.
1.3 The total assessment score indicated that 50% or N=10 had normal
nutritional status and 50% or N=10 were at risk of malnutrition.
2. The nutritional status of the RFCoDE gathered from the results of the MNA® according
to the indicators as follows:
2.1. The screening score indicated that 50% or N=10 had normal
nutritional status, 40% or N=8 were at risk of malnutrition, and 10% or
N=2 were malnourished.
2.2. The assessment scored indicated that 15% or N=3 had normal
nutritional status, 65% or N=13 were at risk of malnutrition, and 20% or
N=4 were malnourished.
2.3. The total assessment score indicated that 45% or N=9 had normal
nutritional status, 40% or N=8 were at risk of malnutrition, and 15% or
N=3 were malnourished.
3. The cognitive function of the UFCoDE gathered from the results of the MoCA®
according to the indicators as follows:
3.1. The total score indicated that 30% or N=6 had normal cognitive
function, 65% or N=13 had mild cognitive impairment, and 5% or N=1
had moderate cognitive impairment.
3.2. The mean scores per areas were 4.2 for visuospatial/executive ability
(0-5), 2.85 for naming (0-3), 4.05 for attention (0-6), 1.45 for language (0-3),
0.9 for abstraction (0-2), 3.2 for delayed recall (0-5) and 5.75 for orientation
(0-6).
4. The cognitive function of the RFCoDE gathered from the results of the MoCA®
according to the indicators as follows:
4.1. The total score indicated that 60% or N=12 had mild cognitive
impairment, 25% or N=5 had moderate cognitive impairment, and 15% or
N=3 had severe cognitive impairment.
4.2. The mean scores per areas were 3.4 for visuospatial/executive ability
(0-5), 2.7 for naming (0-3), 2.55 for attention (0-6), 0.9 for language (0-3), 0.4
for abstraction (0-2), 1.95 for delayed recall (0- 5) and 5.65 for orientation (0-
6).
5. The result on the relationship of nutritional status and cognitive function among UFCoDE
and RFCoDE as follows:
5.1. That the computed ρ-values for UFCoDE and RFCoDE were 0.4320
and 0.50 respectively.
5.2. That the computed ρ-valued for UFCoDE and RFCoDE was higher
than the tabular ρ-value at 0.05 level of significance where ρ was 0.2573.
6. The result on the difference in the nutritional status between the UFCoDE and RFCoDE
where the tabular z-test value at 0.05 level of significance is 1.96 as follows:
6.1. That the computed z-test value for nutritional status among the
UFCoDE and RFCoDE was 1.14.
6.2. That the computed z-test value of the UFCoDE and RFCoDE in terms
of their nutritional status was lower than the tabular z-test value at 0.05 level of
significance where z was 1.96.
7. The result on the difference in the cognitive function between the UFCoDE and RFCoDE
where the tabular z-test value at 0.05 level of significance is 1.96 as follows:
7.1. That the computed z-test value was for cognitive function among the
UFCoDE and RFCoDE was 3.28.
7.2. That the computed z-test value of the UFCoDE and RFCoDE in terms
of their cognitive function was higher than the tabular z-test value at 0.05
level of significance where z was 1.96.
Conclusions
On the basis of findings of the study, the following conclusions are drawn:
1. That fifty percent of the UFCoDE population was either at risk of malnutrition or
have a normal nutritional status.
2. That the population of RFCoDE falls under normal nutritional status or at risk of
malnutrition since the percentage is not far from each other.
3. That the majority of UFCoDE and RFCoDE population had mild cognitive
impairment.
4. That the mean score of UFCoDE according to the different areas of the MoCA®
tool was 22.4 indicating that there is an incidence of mild cognitive impairment
among the elderly who are residing in an urban community.
5. That the mean score of RFCoDE according to the different areas of the MoCA®
tool was 17.55 indicating that there is an incidence of moderate cognitive
impairment among the elderly who are residing in an rural community.
6. That there is a significant relationship of nutritional status and cognitive function
among the UFCoDE and RFCoDE.
7. That there is no significant difference between the UFCoDE and RFCoDE in
terms of their nutritional status.
8. That there is significant difference between the UFCoDE and RFCoDE in terms
of their cognitive function.
Recommendations
The results of this study highlighted the relationship between nutritional status and
cognitive function among urban and rural community-dwelling elderly as well as their
differences. From the findings and conclusions drawn from this study, the following
recommendations are given by the researcher:
1. Nursing Practice, Educations, Service & Administration
1.1. Nurses who practice in the community should do a nutritional health
screening and assessment every six months to determine the status of those
elderly who are living in urban and rural community.
1.2 Nurses should create a nutritional teaching module for Filipino elderly
that focuses on the nutritional needs, food preferences, cooking methods and
food preparation.
1.3 Nurses should include culture in their plan of care as nutrition is greatly
affected by the way of living, beliefs, practices, and traditions.
1.4 Nurses should have social awareness on this field of nursing in order
to deliver an effective nursing care across different cultural orientation.
2. Nursing Research
2.1 Future nurse researcher should conduct a study comparing Filipino
elderly and other elderly in a worldwide perspective.
2.2 Nurses should develop tools to determine the nutritional status and
cognitive function of Filipino elderly.
2.3 Nurses should do didactic researches on elderly nutrition and
cognitive function on a worldwide perspective with the inclusion of
culture as basis of the study.
2.4 Future researcher should include 24-hour diet recall that includes intake
of medical supplements and alcoholic beverages to assess further the nutritional
status of the elderly.
3. Society
3.1 The growing number of elderly in the country reminds the population
about demographic shifting of the society. It is imperative that this
population is in need of quality care. Government implements the provision of
the Senior Citizens Act to enhance the quality of life among our urban and
rural community-dwelling elderly. The government should create
programs for the elderly that focuses on nutrition and cognition
enhancement.
3.2 Family of an elderly should respect and accept the nutritional
preferences and food choices of their elderly as it is rooted in their
culture. Families should serve healthy and complete meals for the elderly
focusing on nutritional needs.
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Appendix A
Letter of Request Seeking Permission to Conduct Study
FAR EASTERN UNIVERSITY Institute of Nursing Graduate Studies
N. Reyes, Sr. St., Sampaloc
Manila 1008, Philippines
4 December 2012
Hon. ROEL T.GOLIMLIM
Brgy. Captain
Brgy. Bagumbuhay, Proj. 4
Quezon City, Philippines
LETTER OF REQUEST SEEKING PERMISSION TO CONDUCT STUDY
Dear Hon. Golimlim:
My name is Lucky P. Roaquin, and I am a graduate student at the Far Eastern University –
Institute of Graduate Studies. I wish to conduct a research for my graduate thesis which involves
the relationship of nutritional status and cognitive function among Filipino urban and rural
community-dwelling elderly. This study will be conducted under the supervision of Dr. Eufemia
Octaviano, a faculty of the aforementioned University.
I am hereby seeking your consent to approach a number of elderly people (aging ≥60 years) who
are currently residing within the area of your jurisdiction particularly in Barangay Bagumbuhay,
Project 4, Quezon City.
If you require any further information, please do not hesitate to contact me. Thank you for your
time and consideration in this matter.
Yours sincerely,
Lucky P. Roaquin, RN
FEU - Institute of Nursing Graduate Studies
Cell. No.: +63 9163593508
E-mail: k.roaquin@hotmail.com
Supervised by:
Dr. Eufemia Octaviano, RN, MAN
Adviser, FEU – IN Graduate Studies
FAR EASTERN UNIVERSITY Institute of Nursing Graduate Studies
N. Reyes, Sr. St., Sampaloc
Manila 1008, Philippines
14 January 2013
Hon. CASTOR CAYABA
Brgy. Captain
Brgy. Dagupan Centro
Tabuk City, Kalinga, Philippines
LETTER OF REQUEST SEEKING PERMISSION TO CONDUCT STUDY
Dear Hon. Cayaba:
My name is Lucky P. Roaquin, and I am a graduate student at the Far Eastern University –
Institute of Graduate Studies. I wish to conduct a research for my graduate thesis which involves
the relationship of nutritional status and cognitive function among Filipino urban and rural
community-dwelling elderly. This study will be conducted under the supervision of Dr. Eufemia
Octaviano, a faculty of the aforementioned University.
I am hereby seeking your consent to approach a number of elderly people (aging ≥60 years) who
are currently residing within the area of your jurisdiction particularly in Barangay Dagupan
Centro, Tabuk City, Kalinga.
If you require any further information, please do not hesitate to contact me. Thank you for your
time and consideration in this matter.
Yours sincerely,
Lucky P. Roaquin, RN
FEU - Institute of Nursing Graduate Studies
Cell. No.: +63 9163593508
E-mail: k.roaquin@hotmail.com
Supervised by:
Dr. Eufemia Octaviano, RN, MAN
Adviser, FEU – IN Graduate Studies
Appendix B
Letter of Request Seeking Permission to Utilize Research Instruments
APPENDIX B.1.
Letter of Request Seeking Permission to Utilize Research Instrument – Nestle Philippines
From: kit roaquin [mailto:k.roaquin@hotmail.com]
Sent: Tuesday, September 25, 2012 12:31 PM
To: Monsod,MaCristina,MAKATI,HEALTHCARE NUTRITION
Cc: Malimet,Jewel,MAKATI,HCN / BTNMS - Contractual
Subject: Re: Permission to Borrow MNA® Tool for Research
Good day!
Thanks for letting me use your tool. Thi will be of great help on me. And as soon as I will finish
this study, I will send you a copy of it.
Best Regads
Lucky P. Roaquin, RN, MANc
Institute of Graduate Studies
Far Eastern University
Manila City, 1008 Philippines
On Sep 25, 2012, at 10:00 AM, "Monsod,MaCristina,MAKATI,HEALTHCARE NUTRITION"
<MaCristina.Monsod@PH.nestle.com> wrote:
Dear Lucky,
Thank you for your interest in Nestlé Nutrition’s MNA. We are willing to give you some forms for your
use. Please send us your mailing address.
In case you have inquiries, please do not hesitate to get in touch with me.
Regards,
Macy
Macy Ochoa Monsod
Nutrition Marketing Manager
<image001.jpg>
Email: macristina.monsod@ph.nestle.com
Add: #31 Plaza Drive, Rockwell Center
Makati City, Philippines 1200
Tel: +632 8980001 loc 7512
From: Cheung,Lorena,HONGKONG,HealthCare Nutrition
Sent: Tuesday, September 25, 2012 12:43 AM
To: Monsod,MaCristina,MAKATI,HEALTHCARE NUTRITION
Subject: Fwd: Permission to Borrow MNA® Tool for Research
Hi Macy,
FYI.
Regards,
Lorena
Begin forwarded message:
From: Janet Skates <janetskates@charter.net>
Date: 2012年9月25日GMT+08:00上午12時32分07秒
To: 'kit roaquin' <k.roaquin@hotmail.com>
Cc: "Cheung,Lorena,HONGKONG,HealthCare Nutrition" <Lorena.Cheung@HK.nestle.com>
Subject: RE: Permission to Borrow MNA® Tool for Research
Dear Lucky,
Thank you for your interest in Nestlé’s Mini Nutritional Assessment (MNA®). No special permission is
required to use the MNA® in your graduate research and thesis - Nutritional Health Status and Cognitive
Function of Filipino and Indonesian Community-Dwelling Elderly. If you decide later to publish your
research, you will need to request permission to reprint the MNA® when you submit your manuscript
for publication. You may send the request toinfo@mna-elderly.com.
Good luck in your studies and research. Please let me know if you have further questions.
Kind regards,
Janet Skates
Nestlé Health Sciences Consultant
MNA® Mini Nutritional Assessment Application
1 (423) 239-7176
janetskates@yahoo.com
From: kit roaquin [mailto:k.roaquin@hotmail.com]
Sent: Wednesday, September 19, 2012 2:50 AM
To: info@mna-elderly.com
Subject: Permission to Borrow MNA® Tool for Research
Importance: High
To Whom It May Concern:
Sir/Madam,
Good day!
As a part of the health care professionals that endeavors in the care for the population especially our
older adults, I came into a realization that the world is inevitably changing thus, it affects the trends
within our society. Due to the effect of rapid advancement in the modern technologies, it has uplifted the
value of health in terms of medicine and nutrition. Our elderly in our society is as vulnerable as the
unborn that needed to be given immediate interventions to promote health and wellness at the same
time prevent occurrences of illnesses and diseases.
Nutrition plays the most important role in this venture of success of every health care professional. The
proper and accurate assessment of elderly especially with regards to their nutritional status is very much
important in the establishment of an effective and efficient plan of care. Furthermore, as a nurse, it is my
duly responsibility to maintain the integrity of every elderly across the globe.
Thereby, I would to ask for your permission to allow use your comprehensive assessment tool for elderly
nutrition - the Mini Nutritional Assessment (MNA) tool. This is in regards to my graduate thesis -
Nutritional Health Status and Cognitive Function of Filipino and Indonesian Community-Dwelling Elderly.
Your tool, just like the success of every research I have read, has been of great help in clarifying the
relationship of nutrition in the holistic domain of the elderly.
And as a return of your greatness, I will be sending you a copy of the outcomes from this research study.
I am Lucky P. Roaquin, a registered nurse and advocate of the elderly. Currently, I am enrolled in a
Master's Degree Program from the Far Eastern University - Manila, Philippines.
Thank you very much and I am looking forward for your favorable response.
Respectfully yours,
Lucky P. Roaquin, RN, MANc
Institute of Graduate Studies
Far Eastern University
Manila City, Philippines
APPENDIX B.2.
Letter of Request Seeking Permission to Utilize Research Instruments –
Center for Diagnosis & Research on Alzheimer’s Disease (CEDRA)
From: Info-MoCA (info@mocatest.org)
Sent: Monday, September 17, 2012 3:29:27 PM
To: 'kit roaquin' (k.roaquin@hotmail.com)
Cc: info@mocatest.org
Good morning,
All available languages are posted on the website www.mocatest.org
Tina Brosseau Projects & Development Manager Center for Diagnosis & Research on Alzheimer's disease (CEDRA) Phone: (450) 672-9637 / Fax: (450) 672-1443 www.cedra.ca
From: kit roaquin [mailto:k.roaquin@hotmail.com] Sent: 13 septembre 2012 7:14
To: info@mocatest.org
Subject: Re: Permission to Borrow MoCA
Thanks a lot, Tina.
And lastly, do you have any Bahasa (Indonesian) version of your MoCA?
Lucky P. Roaquin, RN, MANc Institute of Graduate Studies Far Eastern University Manila City, Philippines
On Sep 13, 2012, at 11:22 PM, "Info-MoCA" <info@mocatest.org> wrote: You are welcome to use the MoCA in your study as described below with no further permission requirements if it is not industry funded. Any modification to the MoCA ©/ Instructions, requires prior written approval by copyright owner. Shall any industry funding become available, a licencing agreement to use the MoCA will be required. All the best, Tina
From: kit roaquin [mailto:k.roaquin@hotmail.com] Sent: 12 septembre 2012 12:09
To: info@mocatest.org Subject: RE: Permission to Borrow MoCA
Hi Tina, Good day! Thank you for the quick positive response. With regards to the queries below, here are my response: - 'Nutritional Health Status and Cognitive Function of Filipino and Indonesian Community-dwelling Elderly' - I don't have numbers yet of the participants since I will using a purposive sampling design (50 Filipino & 50 Indonesian-tentative number) - My study is not funded by any institution. This is a self-initiative study for my graduate thesis. Hopefully I provided you with enough information. For further clarifications, you may ask me in your convenience. Thank you so much! Lucky P. Roaquin, RN, MANc Institute of Graduate Studies Far Eastern University Manila City, Philippines
From: info@mocatest.org
To: k.roaquin@hotmail.com CC: info@mocatest.org
Subject: RE: Permission to Borrow MoCA Date: Mon, 10 Sep 2012 10:38:06 -0400
Good morning, Thank you for your interest in the MoCA. In order to grant permission to use the MoCA test, we need more information.
- What is the title of your study? - How many subjects will participate in the study and how many times will the MoCA be
administered? - Is the study industry funded? If so, a licensing agreement must be completed.
Thank you, Tina Brosseau Projects & Development Manager Center for Diagnosis & Research on Alzheimer's disease (CEDRA) Phone: (450) 672-9637 / Fax: (450) 672-1443 www.cedra.ca / www.mocatest.org
From: kit roaquin [mailto:k.roaquin@hotmail.com] Sent: 10 septembre 2012 1:32
To: info@mocatest.org
Subject: Permission to Borrow MoCA
Importance: High
To Whom It May Concern:
Sir/Madam:
Good day!
As a part of the health care professionals that endeavors in the care for the population especially our older adults, I came into a realization that the world is inevitably changing thus, it affects the trends within our society. Due to the effect of rapid advancement in the modern technologies, it has uplifted the
value of health in terms of medicine and nutrition. Our elderly in our society is as vulnerable as the
unborn that needed to be given immediate interventions to promote health and wellness at the same time prevent occurrences of illnesses and diseases.
Cognitive function plays the most important role in this venture of success of every health care professional. The proper and accurate assessment of elderly especially with regards to their cognitive
function is very much important in the establishment of an effective and efficient plan of care. Furthermore, as a nurse, it is my duly responsibility to maintain the integrity of every elderly across the
globe.
Thereby, I would to ask for your permission to allow use your comprehensive assessment tool for elderly
nutrition - the Montreal Cognitive Assessment (MoCA) tool. This is in regards to my graduate thesis - Nutritional Health Status and Cognitive Function of Filipino and Indonesian Community-Dwelling Elderly.
Your tool, just like the success of every research I have read, has been of great help in clarifying the relationship of nutrition in the holistic domain of the elderly.
And as a return of your greatness, I will be sending you a copy of the outcomes from this research study.
I am Lucky P. Roaquin, a registered nurse and advocate of the elderly. Currently, I am enrolled in a Master's Degree Program from the Far Eastern University - Manila, Philippines.
Thank you very much and I am looking forward for your favorable response.
Respectfully yours, Lucky P. Roaquin, RN, MANc Institute of Graduate Studies Far Eastern University Manila City, Philippines
Appendix C
Utilized Research Tools
Appendix D
Informed Consent
APPENDIX D.1.
Informed Consent for Urban Filipino Community-dwelling Elderly
FAR EASTERN UNIVERSITY Institute of Nursing Graduate Studies
N. Reyes, Sr. St., Sampaloc
Manila 1008, Philippines
Informed Consent Form for Filipino Urban Community-Dwelling Elderly
Date:
Dear Mr/Mrs. ,
Greetings of peace and joy!
I am Lucky P. Roaquin, a graduate student of the Far Eastern University – Institute of Graduate
Studies. I am doing a research on the relationship of nutritional and cognitive function among
urban and rural Filipino community-dwelling elderly.
Please ask me to clarify about the information and I will take time to explain.
The purpose of this study is to improve nursing profession and to serve the Filipino people
especially the elderly population. Rest assured that the results of this study will be treated with
utmost confidentiality.
Very truly yours,
Lucky P. Roaquin, RN
I, , understand fully the purpose of this study and that all of my
questions were answered. Therefore, I am willing to participate in this study with my full
knowledge and cooperation.
Name:
Signature:
Date:
APPENDIX D.2.
Informed Consent for Rural Filipino Community-dwelling Elderly
FAR EASTERN UNIVERSITY
Institute of Nursing Graduate Studies
N. Reyes, Sr. St., Sampaloc
Manila 1008, Philippines
Informed Consent Form for Rural Filipino Community-Dwelling Elderly
Date:
Dear Mr/Mrs. ,
Greetings of peace and joy!
I am Lucky P. Roaquin, a graduate student of the Far Eastern University – Institute of Graduate
Studies. I am doing a research on the relationship of nutritional and cognitive function among
urban and rural Filipino community-dwelling elderly.
Please ask me to clarify about the information and I will take time to explain.
The purpose of this study is to improve nursing profession and to serve the Filipino people
especially the elderly population. Rest assured that the results of this study will be treated with
utmost confidentiality.
Very truly yours,
Lucky P. Roaquin, RN
I, , understand fully the purpose of this study and that all of my
questions were answered. Therefore, I am willing to participate in this study with my full
knowledge and cooperation.
Name:
Signature:
Date:
Appendix E
Raw Data of Gathered Information
Appendix E
Raw Data on Gathered Information
A. Demographic Profile
Urban Rural
Age Gender Years of Education Age Gender Years of Education
63 M 11-14 years 73 F 0-6 years
66 M 11-14 years 65 F 11-14 years
62 F 11-14 years 60 M 11-14 years
68 F More than 14 years 65 F 0-6 years
60 M 11-14 years 71 F 7-10 years
71 M 7-10 years 85 F 7-10 years
66 F 11-14 years 86 M 7-10 years
77 M 0-6 years 61 F 11-14 years
80 M 7-10 years 67 M 7-10 years
60 F 11-14 years 64 M 0-6 years
68 M 0-6 years 60 F 7-10 years
70 M 7-10 years 76 M 11-14 years
74 M More than 14 years 62 F 11-14 years
79 F More than 14 years 63 M 0-6 years
60 F 11-14 years 68 M 7-10 years
60 F 7-10 years 71 M 0-6 years
69 M 7-10 years 76 M 7-10 years
65 F 0-6 years 69 F 7-10 years
63 F 7-10 years 80 M 11-14 years
70 F 11-14 years 60 M 7-10 years
Appendix E
Raw Data on Gathered Information
B. Mini Nutritional Assessment (MNA) Tool
Urban Rural
TOTAL
(30)
Screening
(14)
Assessment
(16)
TOTAL
(30)
Screening
(14)
Assessment
(16)
28 13 15 24 12 12
17.5 10 7.5 25 13 12
19 10 9 27.5 14 13.5
24 11 13 24.5 14 10.5
26 14 12 17 10 7
22 11 11 24.5 13 11.5
22 10 12 13.5 6 7.5
20 10 10 19 9 10
20.5 9 11.5 28 14 14
24 12 12 21.5 11 10.5
26 14 12 27.5 13 14.5
24 13 11 22 11 11
22 12 10 23 12 11
22 11 11 26 14 12
28 14 14 18 8 10
24.5 13 11.5 16 8 8
26 12 14 22.5 10 12.5
23.5 11 12.5 20 10 10
26.5 14 12.5 12.5 7 5.5
21 11 10 26.5 14 12.5
Appendix E
Raw Data on Gathered Information
C.1. Montreal Cognitive Assessment (MoCA) Tool – Urban
TOTAL
(30)
Visuo
(5)
Naming
(3)
Attention
(6)
Language
(3)
Abstraction
(2)
Recall
(5)
Orientation
(6)
25 5 3 5 1 1 4 6
21 5 3 4 1 0 2 6
20 3 3 3 1 1 3 6
24 5 3 4 1 2 3 6
26 5 3 4 2 2 4 6
18 3 3 3 1 0 3 5
24 4 3 5 2 0 4 6
19 4 3 3 1 0 2 6
11 1 2 1 1 0 1 5
27 5 3 5 3 1 4 6
26 5 3 5 1 1 5 6
22 4 3 4 2 0 3 6
26 5 3 5 2 1 4 6
27 5 3 5 2 2 4 6
26 5 3 4 2 2 4 6
20 4 3 4 1 1 2 5
20 3 2 4 2 1 3 5
19 4 2 4 1 1 2 5
23 5 3 4 1 1 3 6
24 4 3 5 1 1 4 6
Appendix E
Raw Data on Gathered Information
C.2. Montreal Cognitive Assessment (MoCA) Tool – Rural
TOTAL
(30)
Visuo
(5)
Naming
(3)
Attention
(6)
Language
(3)
Abstraction
(2)
Recall
(5)
Orientation
(6)
16 3 2 3 1 0 1 6
21 4 3 4 1 2 1 6
21 5 3 3 1 0 3 6
14 2 2 4 1 0 0 5
17 2 3 2 1 0 3 6
8 0 2 1 1 0 0 4
13 3 2 2 1 0 1 4
20 5 3 3 1 0 2 6
22 5 3 4 1 0 3 6
7 0 2 0 0 0 0 5
22 5 3 3 1 1 3 6
18 3 3 4 1 0 2 5
22 5 3 3 1 1 3 6
24 5 3 4 1 1 4 6
22 5 3 3 1 1 3 6
13 3 3 1 0 0 0 6
20 5 3 1 1 1 3 6
18 3 3 3 1 0 2 6
9 0 2 0 0 0 1 6
24 5 3 3 2 1 4 6
Appendix F
FCEPE: Focus Care Enhancement Program for Elderly
APPENDIX F:
FCEPE: Focus Care Enhancement Program for Elderly
FAR EASTERN UNIVERSITY INSTITUTE OF NURSING
GRADUATE STUDIES
FCEPE: Focus Care Enhancement Program for Elderly
By: Lucky P. Roaquin, RN
Title : “Kumain ng Masustansya para Pagtanda’y ay Sumigla”
Description : Focus Care Enhancement Program for Elderly (FCEPE) is
designed to promote the well-being of elderly in the Philippines
particularly on their nutritional health and cognitive functioning.
Malnutrition has been a great quandary among the elderly
population. The enhancement of proper nutrition among the
elderly population is essential in the promotion of a better cognitive functioning in
the later life. It is said to be that cognitive impairment is affected by poor
intake of nutrients. This program will help the elderly to
prepare healthy and affordable meals that will improve not only their
cognitive capacity but also to their total well-being. With good nutritional status, elderly
will be able to perform activities of daily living independently.
Benefits : The elderly will gain knowledge, skills, and attitude towards
healthy ageing with respect to:
1. The understanding of malnutrition, its incidence, risk
factors and effects to health;
2. The importance of good and proper nutrition, its sources
and role to elderly well-being; and
3. The value of cooking methods, food preparation and
healthy meal planning.
General Objectives : After two days of didactic health teaching and motivational
activities, the elderly will be able to :
1. Comprehend the meaning of malnutrition and its
detrimental effect to ageing;
2. Appreciate the essence of having a good and proper
nutrition; and,
3. Create a functional and complete meal plan at affordable
among the elderly.
Learning Objectives Learning Topics Motivational Activities Evaluation
After the end of the
lecture, the elderly
are expected to:
Day 1: 9 AM - 12
PM
Know the
information about
malnutrition, its
incidence, the
different risk
factors, and its
effect to the
elderly.
State the meaning
of good nutrition
and its importance
to healthy ageing.
Enumerate the
different
techniques in food
preparation and
cooking methods.
Develop a
personalized one-
day complete
meal plan
enumerating the
different food
groups
Day 2: 9 AM – 12
PM
Definition of
malnutrition,
incidence of
malnutrition, risk
factors, effect of
malnutrition to
elderly
Definition of good
nutrition,
importance of good
nutrition, major
food groups,
importance &
sources of vitamins
and minerals
Importance of food
preparation,
techniques on good
food handling,
different cooking
methods, tips on
food storage and
refrigeration
Discussion of the
Food Guide
Pyramid
Recommended for
Filipino Elderly,
sample meal
planning
techniques
Participative
learning discussion
Participative
learning discussion
Demonstration,
video playing
Participative
discussion,
demonstration
Demonstration
Recitation
Pen and paper
Return
demonstration,
recitation
Pen & paper,
return
demonstration
Follow-up
nutritional
screening and
assessment
Follow-up
nutritional
screening and
assessment
Create meals
focusing on the
nutrients, proper
cooking
techniques and
resourcefulness of
available food
sources
Sample cooking
demonstration
(malunggay
porridge, hi-protein
ampalaya mix)
Appendix G
Curriculum Vitae
Lucky P. Roaquin
#4 North Sikap St., Brgy. Plainview,
Mandaluyong City, Philippines
Contact numbers: (+63) 915 359 3508; (+63) 932 208 9922 E-mail address: k.roaquin@hotmail.com
Personal Profile Highly astute, energetic, and team-spirited with a strong work ethics to fill numerous general roles. Accurate, precise and highly ethical in all work-related assignments. Comprehensive experience in environments with problem resolution and business function, all in time-critical, fast-paced and high-volume settings. Fast learner with high energy and a drive to exceed expectation, in the management of a private investment portfolio. Outstanding comprehension on health assessment & management, reports analysis, leadership management and staff development. Summary of Qualifications
Experienced in balancing priorities for a short-term and long-range goals
Able to coordinate multiple projects and meet deadlines under pressure
A strong history of completing projects on time
Equally effective working in self-managed projects or as a team member
Ability to adapt quickly to challenges and challenging environments
Energetic, optimistic, and self-motivated
Enthusiastic, resourceful, and willing to assume increase responsibility Professional Experience 2011 HR Manager / Education Business Manager GROP International Services, Inc.
Manages people in the company
Handling recruitment process and representative of English tutors
Provides educational and self-enhancement training to newly hired English tutors
Prepares efficient topics given to Chinese students for learning and capacity building
2011 English as Spoken Language Tutor Korean Private English Tutor – Antipolo City
Teaches English to Koreans and helps them to speak English fluently, construct sentences accurately, and create high-quality English essays.
Helps builds and boosts confidence of Korean students in a competitive way.
Prepares functional lesson plans and time sheets for the students.
Creates a conducive learning environment for the students
Provides necessary activities for the improvement of learning capacity of the students.
2008-2010 Account Receivables Analyst
Accenture, Inc., Makati City
Reconcile, researches and resolves discrepancies between payments and
customer invoice.
Solves problems largely by precedent with referral to detailed instructions/procedures.
Interacts largely with own workgroup but may interact with users around first line queries/requests for information.
Communicates & coordinates discrepancies to onshore counterparts to resolve outstanding issues.
Shares knowledge and experience with either members of team.
May assist less experience or temporary staff where appropriate
Sufficient familiarity with/exposure to a number of straightforward processes and standardized work routines to execute them.
Professional Development
Trainings Attended 2011 Nurse Associate Home Health Care – Quezon City October 17, 2011 – January 20, 2012
Responsible for overall health assessment of patients.
Assists colleagues in the accomplishment of some nursing tasks.
In-charge in the plan of care of patients
Accountable in the implementation of plan of care to patients towards wellness.
Provides assistance to patients in the performance of activities of daily living.
Documents profound reports and findings. Seminars Attended 2012 Resource Speaker “Care of the Chronically Ill and the Older Person” St. Paul University – Quezon City January 17, 2012 2011 Resource Speaker “In the Limelight: Nurses Amidst Modernity” Colegio de San Juan de Letran – Calamba City October 4, 2011 2011 Attendee “Palliative Care Symposium on Symptom Management” UP-Philippine General Hospital – Manila City November 4, 2011 2011 Attendee “Essentials of Dementia Care” Manila Doctors Hospital – Manila City October 20, 2011 2011 Attendee “Wound Care Management” Home Health Care – Quezon City August 24, 2011 2011 Attendee “Care of Terminally Ill”
Home Health Care – Quezon City August 13, 2011 2011 Attendee “Taking Care of Lola and Lola Congress” Home Health Care – Quezon City July 29, 2011 Areas of Strength
Strong communication skills, analytical problem solver and proficient in financial analysis.
Time management skills and driven to learn-apply new ideas
Dedicated, self-motivated, highly professional and proven leadership capabilities
Complete command of:
Excel
PowerPoint
Word Formal Education 2010 to present Master of Arts Nursing major in Medical-Surgical Graduate Student Far Eastern University – Manila City 2008 Bachelor of Science Nursing Graduate Far Eastern University – Manila City 2004 High School Graduate St. Theresita’s School – Tabuk City Character References Mariebel Doris Camagay, MD, FPGM Medical Director Home Health Care – Quezon City Tel# (+632) 920 1445 Stephen Borrega, RN Unit Head Nurse Home Health Care – Quezon City Tel# (+632) 433 1715 I hereby certify that all information above is based on my knowledge.
Respectfully yours,
_____________________ Lucky P. Roaquin, RN
Lic#506882