aCHAPTER I Introduction The nutritional intake of the elderly is one of the vital factors for their well-being.

On the other hand, oral health ensures that the nutrients needed by the elderly will not be compromised as when contaminated by harmful bacteria which can be attributed to poor oral hygiene. Most elderly, because of their lifestyle, may engage in smoking, drinking alcoholic beverages and or eating street foods which were not properly prepared. Likewise, as part of the aging process, teeth also degenerate. One of the effects of aging may include loosening of teeth which later on results to being edentulous, then to cope with that loss they may be advised to use dentures. In addition, greater risk to oral health problems such as related to gum and periodontal diseases may also be experienced by the elderly. Artificial teeth or the so called dentures may also affect their oral health in connection to nutritional intake. They may also have loss of appetite as an effect of oral problems. While the link between oral and systemic health is complex, it is easier to understand how poor oral health substantially influences ones overall quality of life as the ability to enjoy food and speak properly as well as social confidence can be grossly affected by oral diseases. A British national nutrition survey showed that the intake of most nutrients, such as non-starch polysaccharides, protein, calcium, iron, niacin, and vitamin C, was lower in edentate than dentate subjects. The survey also revealed that

subjects with 21 or more teeth consumed more of most nutrients, especially the nonstarch polysaccharides. Indeed, oral health is an integral and important part of ones overall hea lth but it is often neglected due to prevailing misconceptions which include a general apathy towards oral health since many conditions affecting the oral cavity are non-life threatening. Therefore, while people are willing to attend annual health checks for their blood pressure, blood sugar, height and weight; the same interest for dental check-ups is generally lacking. Maintaining oral health in elderly individuals is essential to ensure comfort, health, and well-being. Poor oral health in geriatric populations can lead to lifethreatening conditions, including malnutrition and dehydration, brain abscesses, valvular heart disease, joint infections, cardiovascular disease, and pneumonia. Epidemiologic prevalence studies, however, reveal that the oral health status of the institutionalized elderly is poor. Studies in the United States, Canada, Great Britain, and Europe have demonstrated high prevalence rates of caries, poor oral hygiene and denture care, gingival inflammation, dry mouth, bleeding gums, and periodontal disease among nursing home elders. Moreover, a survey of 1063 residents in 31 nursing homes throughout Washington indicated that the greatest single need among the dentate elderly was routine oral hygiene. The seriousness of poor oral health in institutionalized elders is not generally recognized by nursing home staff, and thus attention to oral hygiene is afforded low priority by nurses.

In connection with that, the researchers found it interesting and significant to study the impact of oral problems on the nutritional status of geriatric clients. This study may be a reference in devising a program for health education to be conducted among elderly population specifically those in Barangay Marowoy, Lipa City where there is the greatest number of geriatric population and they are the ones the researchers think should be given special attention.

Theoretical Framework The researchers found the following concepts and theories of great importance as a guide and reference of the study. Virginia Henderson stated that the individuals are not healthy without good oral health, because oral health can affect general health in different ways. Furthermore, she conceptualized the 14 Fundamental Needs of humans. These needs are: 1. Breathing normally, 2. Eating and Drinking adequately, 3. Eliminating body wastes, 4. Moving and maintaining a desirable position, 5. Sleeping and resting, 6. Selecting suitable clothes, 7. Maintaining normal body temperature by adjusting clothing and modifying the environment, 8. Keeping the body clean and well-groomed to promote integument, 9. Avoiding dangers in the environment and avoiding injuring others, 10. Communicating with others in expressing emotions, needs, fears, or opinions, 11. Worshipping according to ones faith, 12. Working in such a way that one feels a sense of accomplishment, 13. Playing or participating in various forms of recreation, and 14. Learning, discovering or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Based on this, one cannot achieve total well-being without satisfying or attaining good oral health.

Theoretical Paradigm

Demographic Profile Oral Health Assessment Nutritional Status

Health Education Program

Geriatric Clients Total Health

In the above, it includes the identification of geriatrics demographic profile, in terms of their age, gender, weight, height, body mass index, and oral status categories. It also includes determining the oral problems and its relationship to the nutritional status of the geriatric clients. Then, the results will be used to devise a health education program that will contribute to the geriatric clients total health.

Statement of the Problem This study aimed to determine the impact of oral problems on the nutritional status of geriatric clients as a basis for health education program. Specifically, this sought answers to the following: 1. What is the demographic profile of the respondents in terms of: 1.1 Age, 1.2 Gender, 1.3 Weight, 1.4 Height, 1.5 BMI, and 1.6 Oral Status Categories? 2. What is the extent of oral health assessment on geriatric clients? 3. What is the extent of nutritional status among geriatric clients? 4. Is there significant relationship between oral problems and nutritional status of the respondents?

Null Hypothesis There is no significant relationship between oral problems and nutritional status of geriatric clients.

Significance of the Study The researchers found this study of valuable significance to the following: To the Nurses, since they are the ones who take care of the clients, so that they will be aware of the possible impact of oral problems on the nutritional status of their clients and address it appropriately. To the Barangay Officials, because they are the people who are responsible for the health of their community which includes the elderly and should be given additional concern and care. So that they will be aware of the possible adverse effects of oral health problems especially to the old. To the Local Health Officers, they are involved in identifying the health issues and concerns of each and every community within the scope of the City. For them to be able to understand the impact of oral health to the nutritional status of the vulnerable persons in the community, the elderly and to address it immediately. To the Geriatric Clients, since they will benefit most from this study, for them to be aware of the possible oral problems that they may experience and its relation to their nutritional status, in order for them to decrease the risk of developing nutritional problems. To the Family of Geriatric Clients, because they are directly dealing with the concerns of their geriatric family member, therefore they must be aware of the relationship of the oral health to the nutritional status of geriatric clients. They can protect their old family members from oral problems that may lead to complications such

as gastrointestinal illnesses. Aside from avoiding oral problems to develop, also to prevent progression if there is any and to immediately consult expert regarding their oral health for a good nutrition which will result to a healthy living. To the Future Researchers, this can be used as a reference in conducting similar and related studies to further support their data. This can be of great value for them if they want to conduct this study in other areas and will have broader scope.

Scope and Limitations This study focused on the impact of oral problems on the nutritional status of geriatric clients as basis for health education program. The total respondents of this study were 100 elderly clients. This covered those who are aged 60 years old and above. In addition, the respondents included were both males and females. This study was limited to those residing only at Barangay Marawoy since there is the highest statistics of geriatric population in that area in the City of Lipa.

Definition of Terms As used in this study, the following terms are defined technically and operationally. Body mass index a formula for determining if a person is overweight or underweight

Geriatric client refers to old people from 60 years of age and above Health a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity (World Health Organization) Oral health health status of the oral cavity which includes the mouth, teeth, gums, periodontal structures, tongue, tonsils, chewing muscles and throat Oral Problems may pertain to diseases of the mouth, teeth, periodontal structures, tongue, tonsils, chewing muscles and throat Nutritional status the state of persons nutritional intake, whether poor, at moderate or high risks to nutritional problems

CHAPTER III Research Methodology This chapter presents the research locale and design, respondents of the study, sampling procedure, research instrument, validation and reliability of the research instrument, data gathering procedure and statistical treatment of data that were employed in the conducting of this study. Research Design This study used descriptive method of research. Descriptive research collects data in order to answer questions about the current status of the subject or topic of study and it uses formal instruments to study preferences, attitudes, practices, concerns, or interests of a sample. (Jacobs, 2011) Sampling Method The respondents of the study were considered using random sampling. Random sampling is Research Locale This study was conducted in Barangay Marawoy, Lipa City where the geriatric population is highest. According to Lipa City Federation of Senior Citizens Association President, Mr. Frank Fajutagana, Barangay Marawoy has the biggest geriatric population.

Research Instrument This study used survey questionnaire as the main data gathering instrument. The survey questionnaire is a checklist type, since this may be considered a convenient way of collecting needed information from the target respondents regarding the impact of oral problems on their nutritional status. The questionnaire is composed of three parts: Part I dealt with demographic profile of the respondents, Part II dealt with geriatric oral assessment which is composed of 12 items and Part III is composed of 10 items to assess the geriatric nutritional status. Informal interview was also utilized to supplement the data that was collated through questionnaire. Data Gathering Procedure Letter of permission was delivered personally to the target institution and sought approval to the concerned personnel. Then, upon approval of the permission to distribute questionnaire and conduct informal interview to the target respondents, survey questionnaires were distributed to 100 geriatric clients of Marawoy, Lipa City. Informal interview was conducted during the distribution of questionnaire. Afterwards, it was collected, then tallied and finally, interpreted.