Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Factors associated with the Nutritional

Status of Older Adults in Azogues – Ecuador
Rosa Elvira Minchala Urgilés1, María de los Ángeles Estrella González1,
Pedro C. Martínez Suárez2,3, Andrés Alexis Ramírez-Coronel1,3
1
Faculty of Nursing at the Catholic University of Cuenca, Azogues Campus.
2
Faculty of Clinical Psychology, Universidad Católica de Cuenca
3
Psychometry Laboratory of the Center for Research,
Innovation and Technology Transfer (CIITT) of the Catholic University of Cuenca.

Abstract:- Nutrition plays an important role in the it is 7.4%. By the year 2054 it is predicted that, 18% of the
aging process, through changes in the body's functions population. Life expectancy for women is higher at 83.5
and body. Psychological, physical, economic and social years compared to 77.6 years for men [2].
aspects trigger nutritional changes in the elderly. The
main objective was to determine the association of Aging is not the same as being sick; changes are
various factors to the nutritional status of the elderly at taking place in the organs and processes on the way to
the Rosa Elvira Geriatric Center in Leon. A non- aging. Aging increases the risk of acquiring disabilities or
experimental, observational, descriptive and analytical diseases, and with it, the need to set goals for improving the
study was carried out. We worked with a sample of 36 health of the elderly [3]. The assessment of the geriatric
people selected with non-probability sampling, for patient should include 5 fundamental aspects: physical
convenience. Eighty-one per cent were over 71 years of health, mental health, socioeconomic level, environmental
age, 67 per cent were women, 58 per cent were single, circumstances and functional status. With age, all body
and 61 per cent had primary education. They carry out cells change and deteriorate, leading to alterations in the
some type of physical activity p= 0.046 (67%), the structure and vital functioning of organs, systems and
number of daily meals they eat (3 varied meals) p= devices [4].
0.002 (58%), they did not have loss of appetite for food
p= 0.020 (69%), in the form of feeding, they do it alone The geriatric patient has specific characteristics that
without the need for help p= 0.001 (61%), and the time require that, generally used to assess the general adult
they have been in the geriatric center is also associated population. These include not only aspects of physiological
p= 0.001, 61% of the older adults are less than 5 years aging, with a progressive decline in organ and system
old. In conclusion, the highest percentage of older adults functionality, but also a decrease in functional reserve and
in the geriatric center remain within a normal alteration of the body's homeostasis [5].
nutritional state, due to the fact that, according to the
average age, they still satisfy their needs, they feed When talking about malnutrition, especially in the
themselves without the need for help, the three daily elderly, two aspects must be considered: the first, due to
meals and they carry out some type of physical activity, excess or deficit. In terms of excess, people tend to
since they have time available. consume more than the body needs, resulting in an increase
in total fat consumption and central adiposity, reduction in
Keywords:- Older adults, Nutritional status, Geriatric body mass, greater predisposition to the comorbidities
center. associated with obesity and decreased physical activity.

I. INTRODUCTION At the other extreme, malnutrition can be caused by

inadequate access to food, due to the socio-economic
Between 2015 and 2050, the proportion of the world's difficulties of households, lack of awareness and
population over 60 years of age would double. By 2020, the knowledge about people's health. Eating habits and the
number of people aged 60 and over is greater than the same changes experienced by older adults such as problems
number of children under five. Today, there are 125 million with chewing or swallowing, gastrointestinal function,
people aged 80 or over. The rate of population ageing is polypharmacy, etc. [6] [7].
much higher than in the past. All countries face significant
challenges in ensuring that their health and social structures The population of older people is increasing
are equipped to cope with this demographic transition [1]. worldwide and, in many countries, will outnumber younger
people in the near future. Therefore, meeting the food and
The ageing of the world's population is a phenomenon nutritional needs of the elderly is essential to preserve well-
that marks the 21st century. On a global scale, every second being, functional independence and quality of life. [8].
2 people are 60 years old and at the moment there are 810 Extended life expectancy offers opportunities, not only for
million people in the world older than that generation. In older people and their families, but also for societies as a
Ecuador, 1,049,824 people are over 65 years old, whole.
equivalent to 6.5% of the total population. In the year 2020

IJISRT20APR720 www.ijisrt.com 1257

Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
These additional years of life can be used to undertake that it decreases with age, is of great importance in deciding
new activities, such as continuing education, starting a new what the energy requirements are for older people (PM).
profession or taking up old hobbies. In addition, older [12]. Malnutrition is a common concern in older adults due
people contribute in many ways to their families and to changes in ageing, as well as other health, social and
communities. However, the extent of these opportunities economic factors [13].
and contributions depends largely on one factor: health [1].
Nutritional status is measured by calculating a
Unintentional or unintended weight loss and person's weight, height, or volume of fat according to age
malnutrition at this stage of life contribute to progressive and sex. These tests, called anthropometrics, are useful and
decline in health. Nutritional risk increases in the elderly functional and, when compared to a reference model, help
who are ill, poor and those who have limited access to us determine whether an individual has a normal nutritional
medical care. Nutritional assessment in geriatric patients condition (weight based on age and height) or is deficient,
makes it possible to identify people at risk of malnutrition overweight or obese [14].
in order to provide them with nutritional support [9].
Physical activities are also on the same tail as building
As a science, nutrition studies: food, nutrients, their aging, an easier process. Health conditions such as
action, interaction and balance in relation to health and hypertension, cholesterol, kidney failure, joint problems,
disease, the processes by which the body ingests, digests, and heart problems should be considered when initiating
absorbs, transports, uses and excretes food substances, and some type of physical activity [11]. In the case of older
the socioeconomic, cultural and psychological aspects adults, physical activity consists of recreational or leisure
related to food and nutrition. The elderly requires an activities, transportation (walking, walking or cycling),
average diet of 1,700 kcal/day, which should be varied, occupational activities (when the person is still working),
balanced and sufficient, and an average liquid intake of 200 household chores, games, sports or exercises organized in
ml/day [10]. the form of daily, family and community events. In order to
improve cardiorespiratory and muscular functions and bone
[10]. Geriatric nutrition has always been and functional health, and to reduce the risk of disease,
underestimated, although everyone wants to facilitate depression and cognitive impairment When older adults are
senescence. Adequate nutrition is always important for unable to perform the recommended physical activity due
better ageing [11]. To achieve a good food intake, attention to their health status, they shall remain physically active to
must be paid to the preparation of meals, which must be the extent that their condition permits [15].
easy to chew and digest, and taste good due to the dental,
digestive and taste alterations typical of age. A vitamin In the Body Mass Index, physiological and
supplement may be necessary as a dietary supplement [10]. pathological changes are considered, including bone
demineralization, fractures, compression of intervertebral
As an older adult, old age is one of the most discs, dorsal kyphosis, scoliosis, flattening of the plantar
vulnerable and prone stages in terms of health status [11]. arch, among others, that induce a decrease in the
Common problems in old age include hearing loss, measurement of height, overestimation of BMI and
cataracts and refractive errors, back and neck pain and discrepancy in the ranges of malnutrition and overweight in
osteoarthritis, chronic obstructive pulmonary disease, this population group, structural and pathological changes,
diabetes, depression, dementia, urinary incontinence, falls, including bone demineralization, fractures, compression of
delirium and pressure ulcers. There is no doubt that intervertebral discs, thoracic kyphosis, scoliosis, flattening
nutrition is involved in the development of diseases of the plantar arch, among others, are known to cause a
associated with a decreased life expectancy. decrease in size measurement, overestimation of BMI and
disparity in malnutrition and overweight ranges in this
Age is one of the most important factors influencing population community [16]. BMI provides an estimate of
the basal metabolic rate. Since, a person who does not have what a person thinks based on their height. Older adults are
an extreme physical activity as professional athletes. Much more likely to have a body mass index between 25 and 27
of the energy intake is due to the basal metabolism, the fact [10].

BMI = WEIGHT IN KG HEIGHT IN METERS 2

Underweight Less than 18.5

Normal weight 18.5 to 24.9
At risk of obesity or overweight 30 to 34.9
Obesity grade I 35 to 39.9
Obesity grade II 40 to 49.9
Obesity grade III or morbid More than 50
Table 1:- Interpretation of body mass index [10].

IJISRT20APR720 www.ijisrt.com 1258

Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
In the elderly, the BMI may have a lower value due to Health is a priority objective in all age ranges, with
changes in their physical structure, mainly those related to emphasis on older age groups where nutritional status is
changes in the distribution of fat and size; greater one of the key aspects of quality of life. Therefore, the
difficulties in terms of collaboration (for example, it may objective of the study was to determine the factors
be difficult to weigh or carve the patient). However, during associated with the nutritional status of older adults at the
ageing, anthropometric indicators can be important as a Rosa de León Geriatric Center.
guide for medical and nutritional intervention among the
various groups of elderly people. II. METHODOLOGY

Accurate assessment of nutritional status is necessary An observational, descriptive study with an analytical
for early identification of malnutrition, assessment of risk component was conducted. The study population consisted
situations, identification of causes of potential nutritional of 40 adults over 60 years of age, from which a non-
deficits, developing the action plan to improve nutritional probabilistic sample was selected, for convenience, out of
status and evaluating the effectiveness of nutritional 36, who met the inclusion criteria: affordable to control for
interventions [17]. anthropometric measurements, of normal neurological
status and who accepted to be part of the study. It was
Any clinical assessment should begin with an carried out in the Rosa Elvira de Leon Geriatric Center in
appropriate history; however, it should be borne in mind the city of Azogues - Ecuador, during the period March-
that in many cases it may be difficult to gather information July 2019.
due to certain sensory deficit conditions such as: hearing
and visual impairment, impaired comprehension, difficulty A survey was applied, through a questionnaire
in expression, aphasia, cognitive impairment and the ability elaborated by the authors and validated by experts (a
to carry out various activities of daily living [5] [18]. geriatrician and a university professor), where numerical
and categorical variables were measured such as: age, sex,
The assessment of nutritional status is a requirement marital status, level of education, type of physical activity,
for the approach to care and its requirements, which begins degree of nutritional status, through the body mass index,
with the preparation of a dietary history that includes: number of daily meals, form of feeding and time spent in
personal, social, economic, cultural, laboratory and food the Geriatric Center. The body mass index data were
data (type, quantity, quality of food consumed throughout calculated with the measurement of weight and height, for
life), the health of the subject and culinary traditions and which a scale with a measuring rod branded Detecto was
habits. This history is obtained through direct used, properly calibrated and waxed.
communication with the patient [10] [18].
For data analysis, a data matrix was created in the
Geriatric centers offer care services to adults over 65 Excel 2013 program and for results analysis in the SPSS
years of age who require special protection on a temporary version 22 statistical package. Numerical variables with
or permanent basis and cannot be cared for by their percentages and measures of central tendency (mean,
families; older adults who lack a permanent place to live standard deviation and ranges), frequencies and percentages
and are in a situation of abandonment, lack of family in categorical variables and for inferential analysis, Chi-
references, poverty and extreme poverty, and are at high square was used with p-value analysis in the factors
risk and wish to be admitted [2]. associated with nutritional status.

These are organizations that provide housing, social The study was feasible and accessible because there
security and comprehensive care programs for older adults was adequate time of 3 months for data collection, with the
on a permanent or temporary basis [19]. These new necessary human, material and financial resources and the
programmed would require all service providers to have respective authorization of the director of the Institution
basic knowledge of gerontology and geriatrics, as well as and the acceptance and consent of the adults over 60 years
more general skills needed to work in integrated care of age of the Geriatric Center in the participation of the
systems, including strong communication, coordination and study.
information and communication technology management
skills [20].

IJISRT20APR720 www.ijisrt.com 1259

Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
III. RESULTS

Average BMI of 22.82, standard deviation + 3.14, range 17-31.

Characteristics N %
Sex
Male 12 33
Female 24 67
Source
Urban 31 86
Rural 5 14
Marital status
Single 21 58
Free Union 1 3
Married 4 11
Divorced 2 6
Widower 8 22
Schooling
None 9 25
Primary 22 61
Secondary 5 14
Total 36 100
Table 2:- Sociodemographic data of the Elderly, from the Rosa Elvira Geriatric Center in León.

In the Geriatric Center studied the population is 40 older adults, 36 were worked with because they meet the criteria for
inclusion, of which 67% are female, 86% are from urban areas and the largest percentage are retirees, 58% are single, with a
primary education level of 61%.

Variables
N %
Age
61-70 years old 7 19
over 71 years old 29 81
Length of stay
<5 years 22 61
5to1m-10 years 10 28
>10a1m 4 11
Weight classification according to BMI
Less 18.5 bajo peso 2 6
18,5-24,9 Normal 25 69
30-34.9 overweight 8 22
35-39.9 degree I 1 3
Total 36 100
Table 3:- Data by age, length of stay at the Rosa Elvira de León Geriatric Centre and weight classification according to BMI

Table 3 shows that 81% of adults are older than 71 years, of which 61% are less than 5 years in the Geriatric Center and
present a normal nutritional status (MC 18.5 - 24.9) eutrophic patients, 69%, followed by 22% who in relation to weight and
height present overweight (BMI 30-34.9).

IJISRT20APR720 www.ijisrt.com 1260

Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Variables Chi-square p value 95% confidence interval
Lower limit Upper limit
Physical activity 4 ,046 ,056 ,065
No. Of daily meals 12,17 ,002 ,002 ,003
Loss of appetite 5,44 ,020 ,024 ,030
Way of feeding 13,17 ,001 ,000 ,002
Length of stay in
14,00 ,001 ,000 ,002
the Geriatric Center
Table 4:- Factors Associated with the Nutritional Status of Older Adults

With the 95% confidence interval and a margin of primary school. Another study [23] conducted in 12 social
error of 0.05, the factors that are associated with the centers for the elderly showed that the average age of
nutritional status of older adults are presented: they do participants was 74.3 years and 51.67% were female. These
some type of physical activity p= 0.046 (67%), the figures are in proportion to those obtained in the study:
activities are: walking, dance therapy, they play basketball; 67% were female, 81% were over 71 years of age, and 61%
the number of daily meals they consume (3 varied meals) had primary schooling.
p= 0. 002 (58%), did not have loss of appetite for food p=
0.020 (69%), in the way of feeding themselves, they do it Healthy aging is synonymous with aging without
alone without needing help p= 0.001 (61%), and also the disability. While many older adults remain healthy and eat
time they have been in the geriatric center is associated p= well, those in poorer health may experience difficulty
0.001, 61% of the older adults are less than 5 years old and meeting their nutritional needs. Aging presents a number of
most of them are retirees who live in the urban center of the challenges to the maintenance of good nutritional health in
city. older adults [8].

IV. DISCUSSION In nutritional assessment, the highest percentage

(60.1%) is at risk of malnutrition, 31.8% have a normal
Various studies have shown that the nutritional status nutritional status and 8.1% are malnourished [21]. A total
of the population in general, and especially of the elderly, is of 60.1% of older adults were at risk of malnutrition and
an indicator of quality of life. The WHO points out: Older 6.5% were undernourished [13].
people contribute to society in many ways, whether in their
families, in the local community or in society at large. The 97.3% of older adults who are at nutritional risk
However, the extent of these human and social resources fall into the following profile: people who have had acute
and the opportunities we will have as we age will depend illnesses in the last three months, eat less than five times a
largely on one fundamental thing: our health. day and have little or normal appetite [23]. Sixteen percent
of these individuals are dependent on all activities and only
The WHO policy framework recognizes six types of 15% are independent in all areas of life [22].
"key determinants of active ageing: economic, behavioral,
personal, social, health and social systems and physical The present study shows a 6% malnutrition rate, 69%
environment" [20]. of older adults show a normal nutritional status, which is
associated with the type of physical activity p= 0.046
Important biopsychosocial changes occur at this stage (67%), the number of daily meals consumed (3 varied
of life, making the older population particularly vulnerable meals) p= 0.002 (58%), and no loss of appetite for food p=
to dietary changes that have an atramental impact on the 0. 020 (69%), in the form of feeding, they do it alone
course of the disease, both on growth and recovery. [17]. without needing help p= 0.001 (61%), and also associated
the time they have been in the geriatric center p= 0.001,
In the geriatric population, malnutrition and functional 61% of the older adults are less than 5 years old and most
disability are factors that predict mortality and morbidity. It of them are retired people who live in the urban centre of
is estimated that approximately 35-40% of the elderly the city.
present some type of nutritional alteration such as: caloric-
protein malnutrition, selective deficit of vitamins and/or V. CONCLUSIONS
micronutrients, inadequate water intake and obesity [20].
Adults over 60 years of age in this geriatric center still Aging is a stage of life, it does not mean illness and
maintain a healthy lifestyle, with normal nutritional status death, the changes caused must be treated interdisciplinary.
(eutrophic patients). The normal nutritional state of the elderly at the Rosa
Elvira de León Geriatric Centre, Azogues - Ecuador, is
Rosero [21], in a study of 426 older adults in associated with the physical activity they do, the number of
Colombia, found that 61.7% were female, with an average daily meals they eat, the way they eat without the need for
age of 72 years. Riveros [22] 50% female. Giraldo [13], help and the time they stay at the center, which is less than
60.9% of whom were women, approximately 50% were 5 years.
between 65 and 74 years of age, and 68% had completed

IJISRT20APR720 www.ijisrt.com 1261

Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The ageing of the population, without severe [10]. Dulio G. Nursing Manual Theory plus Practice, fourth
complications, can be considered a success of public health edition. Publisher: Akadia, 2012:291-395.
policies and socio-economic development, but it also [11]. Baijens LW, Clave P, Cras P, Ekberg O, Forster A,
constitutes a challenge for society, which must adapt to it in Kolb GF, Smithard DG. European Society for
order to improve the health and functional capacity of the Swallowing Disorders–European Union Geriatric
elderly as much as possible, as well as their social Medicine Society white paper: oropharyngeal
participation and security. dysphagia as a geriatric syndrome. Clinical
interventions in aging, 2016; 11: 1403.
Considering the appropriate social environments [12]. Díaz S. Nutrition treaty. Ediciones Díaz de Santos;
(geriatric centers and family environment) and healthy Madrid,1999.
lifestyles (physical activity and prevention of co- [13]. Giraldo NA, Paredes A, Idarraga Y, Aguirre DC.
morbidities) as determinants of good health in older people, Factors associated with malnutrition or risk of
it is important to carry out research from the perspective of malnutrition in older adults in San Juan de Pasto,
food and nutrition patterns. While many older adults remain Colombia: A cross-sectional study, Rev Esp Nutr
healthy and eat well, those who are not in good health may Hum Diet. 2017; 21(1): 39 – 48.
experience difficulties in meeting their nutritional needs, [14]. FAO, Nutrition and Health, 2015. Disponible:
functional independence, and thus quality of life. http://www.fao.org/3/am401s/am401s04.pdf
[15]. WHO. Global Strategy on Diet, Physical Activity and
 Conflicts of Interest Health; 2019.
The authors do not report conflicts of interest. https://www.who.int/dietphysicalactivity/factsheet_ol
deradults/es/
ACKNOWLEDGEMENT [16]. Gavriilidou NN, Pihlsgard M, Elmstahl S. High
degree of BMI misclassification of malnutrition
To the authorities and senior citizens of the Rosa among Swedish elderly population: Age-adjusted
Elvira Geriatric Centre in León, Azogues-Ecuador, for the height estimation using knee height and demispan.
publication of the study. To the Psychometry Laboratory of European J Clin Nutr, 2010;567-71.
the Center for Research, Innovation and Technology [17]. Camina-Martín MA, Mateo-Silleras B, Malafarina V,
Transfer of the Catholic University of Cuenca (CIITT) and Lopez-Mongil R, Niño-Martín V, López-Trigo JA,
to the Nursing Career of the Catholic University of Cuenca, Redondo-del-Río MP; Assessment of nutritional
Azogues headquarters. status in geriatrics: consensus statement of the
Nutrition Group of the Spanish Society of Geriatrics
 Financing and Gerontology. Rev. Española de Geriat y Gerontol,
This study is self-financed 2016; 51(1): 52-57.
[18]. Ribera-Casado JM. Special Considerations of
REFERENCES Nutrition in the Geriatric Patient; Cap. XIX; p 256.
Spain; 2015.
[1]. WHO, Ageing and Health, 2018 [19]. López M. Process Management in Geriatric Centers;
https://www.who.int/es/news-room/fact- Spain; 2012. Tesis. Disponible:
sheets/detail/envejecimiento-y-salud http://repository.eia.edu.co:8080/bitstream/11190/404/
[2]. Ministry of Social Inclusion, Directorate for the 7/LopezMonica_2012_GestionProcesosCentros.pdf
Elderly 2015. https://www.inclusion.gob.ec/direccion- [20]. WHO, World Report on Ageing and Health; United
poblacion-adulta-mayor/ States; 2015.
[3]. Saenz Carriera R, Cramona M, Jimenez Z. Mouth [21]. Rosero Otero M, Rosas Estrada GM. Nutritional
changes in the elderly. Rev Cub Estomatol. 2007, 44 assessment of people over 60 in the city of Pasto,
(4). Colombia Rev, Cienc y Enferm, 2017; 23 (3): 23-34.
[4]. Francisco Cardoso M. The geriatric patient. Rev [22]. Riveros Ríos M. Assessment of biopsychosocial
Colomb Odontoestomatol 1995; 2(5):8-9. determinants of risk of malnutrition in older adults in
[5]. Domínguez-Ardila A, García JG. Integral Geriatric nursing homes. Rev. An. Fac. Cienc. Méd, 2015;
Evaluation. Aten famil. 2014; 21(1): 20-23. 48(2); 11-26.
[6]. Carriera DR, Carmona DM, Quintana DZ. Alfaro. [23]. Montejano A. Assessment of nutritional risk and
Oral changes in the elderly. Rev Cub Estomatol. 2007, associated factors in non-institutionalized older adults
44(4). in the province of Valencia; University of Alicante.
[7]. Health WHO. Nutritional Assessment of the Elderly, Thesis; Spain, 2012. Disponible:
2019. Disponible en: https://dialnet.unirioja.es/servlet/tesis?codigo=64903
http://www.sld.cu/galerias/pdf/sitios/gericuba/modulo
5.pdf.
[8]. Wilma L, Catherine H, Aging, Nutritional Status and
Health; Rev, J Healthcare,2015, 3(3): 648–658.
[9]. Velásquez MC. Malnutrition in the elderly: the
importance of nutritional assessment and support.
Rev. Sal Públ y Nutr; México, 2011, 2(2).

IJISRT20APR720 www.ijisrt.com 1262