Edited by: Tecnológico Superior Corporativo
Edwards Deming
January - March Vol. 8 - 1 - 2024
https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
Received: October 07, 2023
Approved: December 06, 2023
Page 125-134
A comprehensive view of the promotion and
prevention of Chronic Non-Communicable
Diseases in older adults at the Clemencia
Foundation and the Sofia Ratinoff Nursing Home
Una visión integral de la promoción y prevención
de Enfermedades Crónicas No Transmisibles en
adultos mayores de la Fundación Clemencia y el
Asilo Sofía Ratinoff
Ángel Antonio Palomino Castillo*
Gabriela Antonieta Saldaña Sánchez*
Jaime Alexandre Rodríguez Peñafiel*
ABSTRACT
Health promotion and disease prevention in older adults
are essential to improve their quality of life and reduce
health care costs in this growing population. A diagnostic
study in this area focuses on identifying specific health
needs, assessing risk factors, and proposing effective
interventions. The objective of this study is to characterize
the current state of health promotion and NCD
prevention in older adults at the Clemencia Foundation and
the Sofia Ratinoff Asylum in the city of Guayaquil. This
research is developed by students and teachers of the
Emergency Medical career of the Instituto Superior
Universitario Espiritu Santo, as part of the project
"Promotion and control of NCDs in older adults". The
study uses a combination of quantitative and qualitative
methods, including surveys, interviews and statistical data
analysis. The population studied includes older adults and
health professionals from the Clemencia Foundation and
the Sofia Ratinoff Asylum, providing a comprehensive view
of their health conditions and needs. The results conclude
* Lic. Instituto Superior Tecnológico Universitario Espíritu Santo, Guayaquil,
Ecuador, https://orcid.org/0009-0007-1213-5518 appalomino@tes.edu.ec
* Lic. Instituto Superior Tecnológico Universitario Espíritu Santo, Guayaquil,
Ecuador gasaldana@tes.edu.ec
* Lic. Instituto Superior Tecnológico Universitario Espíritu Santo, Guayaquil,
Ecuador, jarodriguez5@tes.edu.ec, https://orcid.org/0009-0001-0407-9399
126
126
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
that chronic diseases such as hypertension, diabetes and
arthritis are common in older adults, as are respiratory and
mental health problems. Risk factors identified include
poor dietary habits, lack of physical activity, poor vital sign
monitoring, and limited participation of older adults in
health promotion programs.
Key words: older adults, promotion, prevention, Chronic
Non-Communicable Diseases.
RESUMEN
La promoción de la salud y la prevención de enfermedades
en los adultos mayores son fundamentales para mejorar su
calidad de vida y reducir los costos de atención médica en
esta población en crecimiento. Un estudio diagnóstico en
este ámbito se centra en identificar las necesidades
específicas de salud, evaluar los factores de riesgo y
proponer intervenciones efectivas. El objetivo de este
estudio es caracterizar el estado actual de la promoción de
la salud y la prevención de ECNT en los adultos mayores
de la Fundación Clemencia y el Asilo Sofía Ratinoff de la
Ciudad de Guayaquil. Esta investigación es desarrollada por
estudiantes y docentes de la carrera de Emergencia Médica
del Instituto Superior Universitario Espíritu Santo, como
parte del proyecto "Promoción y control de ECNT en los
adultos mayores". El estudio utiliza una combinación de
métodos cuantitativos y cualitativos, incluyendo encuestas,
entrevistas y análisis de datos estadísticos. La población
estudiada incluye a adultos mayores y profesionales de la
salud de la Fundación Clemencia y el Asilo Sofía Ratinoff,
proporcionando una visión integral de sus condiciones de
salud y necesidades. Los resultados concluyen que las
enfermedades crónicas como la hipertensión, diabetes y
artritis son comunes en los adultos mayores, al igual que
los problemas respiratorios y de salud mental. Los factores
de riesgo identificados incluyen malos hábitos alimenticios,
falta de actividad física, escaso control de los signos vitales
y una limitada participación de los adultos mayores en
programas de promoción de la salud.
Palabras clave: adultos mayores, promoción,
prevención, Enfermedades Crónicas no Transmisibles
127
127
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
INTRODUCTION
The growing incidence and prevalence of Chronic Non-Communicable Diseases (NCDs)
not only represent a significant social harm, especially in the poorest populations, but
also constitute a major obstacle to human development. Attention and concerted action
are essential to address this problem and its socioeconomic implications.
Data obtained from the (World Health Organization, 2023), indicate that:
- Non-communicable diseases (NCDs) kill 41 million people each year, which is
equivalent to 74% of all deaths in the world.
- Seventy-seven percent of all deaths due to NCDs are concentrated in lower middle-
income countries.
- Cardiovascular diseases account for the majority of NCD deaths (17.9 million people
each year), followed by cancer (9.3 million), chronic respiratory diseases (4.1 million)
and diabetes (2.0 million, including deaths from diabetic nephropathy).
To reduce the impact of NCDs on both individuals and society, a comprehensive
approach is needed in which all sectors, including health, finance, transportation,
education, agriculture, planning, and others, work together to reduce the risks
associated with NCDs and promote interventions to prevent and control them (World
Health Organization, 2023).
The adult population is disproportionately affected by NCDs. Lack of access to adequate
health care, together with social determinants of health, housing and food security,
exacerbate the vulnerability of this population to NCDs. The prevalence of risk factors
such as smoking, poor diet, physical inactivity and harmful alcohol consumption is higher
in these populations, thus increasing the incidence of NCDs.
Health promotion and prevention of chronic noncommunicable diseases in older adults
is an imperative need to improve quality of life, reduce the economic and social burden
of disease, and promote health equity. The objective of this research is to characterize
the current state of health promotion and NCD prevention in older adults of the
Clemencia Foundation and the Sofia Ratinoff Asylum in the city of Guayaquil.
Health promotion and prevention of chronic noncommunicable diseases (NCDs) in
older adults is a crucial strategy to improve quality of life and reduce the burden on
health systems and the economy.
In Ecuador, according to data provided by the National Institute of Statistics and Census
of Ecuador (INEC) in 2022, chronic noncommunicable diseases were among the top ten
causes of death in the country; ischemic heart disease is the leading cause of death in
men with 7,224 deaths and women with 5,778, giving a total of 13,13,224 deaths. 778
giving a total of 13,002 deaths corresponding to (12.4%), these data reveal that ischemic
heart disease, diabetes mellitus, hypertensive disease, cerebrovascular disease and
128
128
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
chronic diseases of the lower respiratory tract are among the top ten causes of death
in the country (Azua, Macías, & Ortega, 2023).
Chronic noncommunicable diseases in older adults generate significant costs for health
systems due to the need for continuous medical care, frequent hospitalizations, and
prolonged treatments. In addition, functional disability and dependency resulting from
these diseases affect families and communities, increasing the burden on caregivers and
reducing economic productivity.
Health promotion and effective prevention can help mitigate these effects, allowing older
adults to live longer with a better quality of life. According to the World Health
Organization, health promotion "encompasses learning opportunities aimed at enhancing
health literacy, includes improving the population's knowledge and developing personal
skills that lead to higher levels of individual and collective health" cited by (Ecuador,
Ministry of Public Health, 2019).
For (Aliaga, Cuba, & Meza, 2016), disease promotion and prevention activities should be
addressed considering the macro-social, micro-social, interpersonal and individual
scenario, and should be directed not only to the risk of getting sick, but to the alteration
of the function that produces the disease, and other conditions that may deteriorate the
health of the older adult, such as frailty, falls, and iatrogenic complications. They
emphasize the importance of giving the elderly the necessary guidelines to exercise
better control over their health and improve it, trying to maintain at all times their
autonomy, their quality of life and, above all, always respecting their values and
preferences.
Health promotion and NCD prevention should be accessible to all older adults,
regardless of their socioeconomic level. Health inequalities are more pronounced in
older adults, especially those with low incomes, who often have less access to health
services and face greater barriers to adopting healthy lifestyles. Inclusive and equitable
policies are needed to ensure that all older adults can benefit from preventive
interventions.
MATERIALS AND METHODS
The research follows a polymodal methodology, combining qualitative and quantitative
methods and techniques, which allows the authors not only to obtain a comprehensive
diagnosis of the current situation, but also provides a solid basis for the development of
effective and sustainable interventions in health promotion and disease prevention in
older adults.
The study is exploratory in nature, seeking to discover new factors or relationships that
have not been previously documented in this specific population. This includes identifying
gaps in health services and areas not covered by current programs.
129
129
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
It is a field research, because data collection is carried out directly at the Clemencia
Foundation and the Sofia Ratinoff Asylum, allowing an accurate contextualization and
realistic understanding of the living and health conditions of older adults.
In addition, a hermeneutic methodology is followed, which focuses on the interpretation
of qualitative data to understand the underlying meanings and lived experiences of older
adults.
Among the theoretical methods, the analytical-synthetic and inductive-deductive
methods were used; among the empirical methods, observation, survey and interview
were used; as a mathematical-statistical method, the percentage analysis was used for
the statistical processing of the surveys applied to the older adults.
The study population consisted of 22 older adults and three health professionals from
the Clemencia Foundation and the Sofia Ratinoff Asylum in the city of Guayaquil. The
Clemencia Foundation and the Sofia Ratinoff de Solimano Asylum are dedicated to the
integral care of the elderly in a state of abandonment, indigence, disability, high grade
Alzheimer's and low economic resources who live and sleep in the streets of the
country; hence the importance of this study.
Interventions.
To diagnose the promotion and prevention of chronic noncommunicable diseases
(NCDs) in older adults, it was necessary to determine indicators covering aspects of
health, behavior, access to services, and patient satisfaction. The research instruments
were developed on the basis of these indicators. The dimensions and indicators to be
evaluated are:
Health Indicators.
- Levels of control of blood pressure, blood glucose, cholesterol and other key
biomedical markers in older adults.
- Health complications: frequency of NCD-related complications, such as cardiovascular
events, strokes, amputations due to diabetes, etc.
- Nutritional status: nutritional deficiencies, such as body mass index (BMI), vitamin and
mineral levels, and other nutritional markers.
Prevention and Lifestyle Indicators.
- Physical activity: percentage of older adults who engage in regular physical activity,
including types and frequency of exercise.
- Dietary habits: assessment of diet, including consumption of fruits, vegetables,
processed foods, sugar and salt.
- Smoking and alcohol consumption: prevalence of smoking and alcohol consumption
among older adults, and participation in cessation programs.
- Medication adherence: level of adherence of older adults to their prescribed
medication regimens.
130
130
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
Health promotion indicator.
- Participation in health promotion programs: participation in educational programs,
workshops, and health promotion activities.
- Program coverage: percentage of older adults covered by NCD promotion and
prevention programs.
- Program effectiveness: evaluation of the impact of interventions in reducing the
prevalence and complications of NCDs.
Satisfaction and Quality of Life indicators.
- Patient satisfaction: level of satisfaction of older adults with the health services and
health promotion programs received.
- Quality of life: measurement of older adults' perception of their quality of life.
- Emotional well-being: mental health indicators, such as levels of depression, anxiety
and emotional satisfaction.
- Autonomy and functionality: assessment of older adults' ability to perform activities of
daily living (ADLs) and their level of independence.
RESULTS
The question on the frequency of vital sign monitoring in the older adult population
reveals important data on health care in this population (see Figure 1). Forty-five percent
of the older adult population surveyed indicate that they regularly monitor their vital
signs; this data suggests that almost half of older adults receive regular monitoring of
their vital signs, which is critical for early detection of health problems and management
of chronic diseases. Regular monitoring allows for adjustment of treatments and
preventive measures, which is crucial in the care of older adults.
The most troubling finding, however, is that approximately one-third of older adults
(32%) report not receiving any vital sign monitoring; lack of monitoring can lead to late
diagnosis of medical conditions, increased complications and, ultimately, a deterioration
in quality of life.
According to the respondents, the vital signs they check most often are temperature
(45%) and blood pressure levels (36%); with very low values are respiration and pulse;
they argue that they usually do so when they are sick.
Body temperature is a critical vital sign that can indicate the presence of infection or
inflammation. The fact that almost half of the surveyed older adults receive regular
temperature monitoring is positive, as it allows early detection of common diseases,
such as respiratory or urinary tract infections, which are prevalent in this population.
Blood pressure is another crucial vital sign, especially in older adults, given the high risk
of hypertension and cardiovascular disease in this population. Regular blood pressure
monitoring can prevent serious adverse events such as heart attacks and strokes.
However, the percentage obtained in this question is relatively low.
On the other hand, the data indicate that respiration and pulse are the vital signs that
131
131
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
are least monitored; this is of concern because these signs can provide essential
information about lung function and heart health.
The older adults surveyed indicate suffering from chronic diseases such as high blood
pressure (50%), digestive diseases (41%), diabetes (36%), osteoporosis (27%), heart
disease (23%).
Other common health problems of older adults, according to the results of this question,
are respiratory problems such as common flu, pneumonias and bronchopneumonias (See
Figure 3). Respiratory health problems pose a significant threat to older adults. The
survey reveals that these problems are common, underscoring the need to improve
prevention, detection and treatment strategies.
According to the results obtained, only two older adults, representing 9% of the
population, have malnutrition (see Figure 3), mainly related to low levels of some
vitamins and minerals.
With regard to the prevention and lifestyle indicator, the results obtained are as follows:
Physical activity is an essential component for maintaining health and well-being at all
ages, especially in older adults. The survey results provide a clear picture of the
frequency and type of physical activity performed by older adults, revealing trends and
areas of concern that need to be addressed. Only 18% of older adults report always
being physically active, 36% regularly, and 46% report never being physically; the most
common activities are walking and dancing.
The survey highlights an important concern, a large number of older adults do not
participate in physical activity on a regular basis, which is detrimental to their health and
well-being. Walking and dancing, although popular activities among those who exercise,
are not enough to counteract certain health problems.
Regarding eating habits, 51% consider them to be good, 32% indicate that they
sometimes practice good eating habits and 14% agree that they never do so; however,
42% report liking fast foods and carbonated beverages. These data underscore the
complexity of eating habits among older adults and the need for promotional strategies
to promote healthy eating.
Similarly, older adults indicate that they only consume prescribed medications because
they are given to them at the foundation. The provision of medications by the foundation
can help prevent self-medication and inappropriate use of medications. This is crucial, as
self-medication can lead to adverse effects, dangerous drug interactions, and
ineffectiveness of treatment.
Health promotion indicator.
Older adults report never having participated in health promotion programs. The lack
of participation of older adults in health promotion programs is a matter of concern that
has several implications for their well-being and quality of life. Analyzing the reasons and
consequences of this lack of participation, as well as proposing possible solutions, is
crucial to improve the health of this population.
However, 77% of the surveyed older adults consider that health education for older
adults should be a priority for every Health System. Health promotion helps to prevent
132
132
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
chronic diseases through education on healthy habits, promotion of regular exercise,
and proper nutrition.
Satisfaction and Quality of Life Indicators.
The results related to the satisfaction and quality of life of the older adults are as follows:
9% are very satisfied, 36% feel satisfied with the services offered by the foundation, the
rest of the respondents feel little or not at all satisfied. This is of concern, as a lack of
satisfaction may correlate with a low quality of life and poor overall well-being, and may
manifest itself in physical and mental health problems, less participation in social and
recreational activities, and a higher incidence of feelings of isolation and depression.
The results of the survey on the emotional state of older adults reveal a worrisome
situation, with a high percentage of this population experiencing suboptimal levels of
emotional well-being.
Half of the older adults surveyed (50%) report a fair emotional state, suggesting that
although they are not in a state of critical well-being, but neither do they enjoy full
emotional well-being. The emotional state of 27% of the population is good, and 23% of
older adults have a poor emotional state; alarmingly, this group is likely dealing with high
levels of depression and anxiety, which can have a significant impact on their quality of
life and overall well-being.
The ability of older adults to perform activities of daily living (ADLs) autonomously and
independently is a crucial indicator of their overall quality of life and well-being. The
survey results show that only 23% of older adults report performing all of their activities
independently, indicating a significant concern; lack of regular exercise can lead to
decreased muscle strength and mobility, making it more difficult for older adults to
perform ADLs independently.
Results of the interview conducted with the Foundation's Health Professionals.
Regarding the prevalence of NCDs in the Foundation's older adults, the interviewees
indicated that they are hypertension, diabetes, digestive and cardiac diseases. However,
they state that older adults often have multiple comorbidities that require individualized
attention to ensure that all health problems are treated effectively and consistently.
They are also aware of the diversity of health problems that affect older adults and in
particular respiratory problems; therefore, they are always on the lookout for
respiratory or other less common symptoms, take vital signs frequently, and ask specific
questions to identify any health problems.
The information obtained indicates that there is a significant disparity between the
response of the Foundation's health professionals and the older adults who indicated in
the survey that vital signs are checked mainly when they are sick. This is a critical issue
that warrants further analysis; and may be due to a reactive approach, rather than a
preventive one, which limits opportunities for early detection and proactive
management of health problems.
Regarding the importance of physical activity in this population, the interviewees
consider that it is an essential component for maintaining the health and well-being of
older adults; however, they admit that, due to their condition, the frequency and type
133
133
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
of physical activity is very limited. This information highlights an important concern,
because physical inactivity contributes to a higher incidence of chronic diseases,
increases the risk of falls and fractures, and can accelerate the aging process and loss of
independence.
The interviewees accept the fact that they do not have health promotion programs, but
affirm that they do carry out activities with older adults in celebration of the World Day
against Cancer, Hypertension, the fight against Depression, among others.
The lack of health promotion programs can have a negative impact on the quality of life
of older adults, due to the lack of addressing the problems associated with NCDs that
prevail among this population in the Foundation; and to unaddressed emotional
problems such as depression, anxiety, and social isolation.
Both the older adults and the professionals interviewed are aware that health promotion
helps prevent chronic diseases, through education about healthy habits, promotion of
regular exercise, and proper nutrition.
Participating in these programs can significantly improve the quality of life of older adults
by providing tools and knowledge to better manage their health and well-being.
On the ability of older adults to perform activities of daily living autonomously and
independently, interviewees believe that the vast majority of older adults in the
Foundation have some autonomy. According to interviewees, the inability to perform
ADLs independently is related to physical health problems, chronic diseases, muscle
weakness, and cognitive impairment.
DISCUSSION
There is a significant disparity in access to health monitoring among older adults; the
approach taken is not preventive, failing to take advantage of early intervention
opportunities that can prevent disease progression and reduce the need for more
intensive treatment.
The chronic non-communicable diseases (NCDs) that are most prevalent in older adults
include arterial hypertension, diabetes mellitus, digestive, cardiovascular, chronic
respiratory and osteoarticular diseases such as arthritis.
The Foundation develops health promotion actions, but in many cases they do not
respond to the specific needs of older adults and do not consider the physical, cognitive
and emotional limitations of this population, which is why older adults feel that their
participation in this type of program is very limited.
Health promotion and disease prevention in older adults are essential components to
improve quality of life and reduce health care costs in this growing population.
For the Foundation, improving the quality of service, offering enriching activities, and
ensuring effective communication and participation of older adults in decision making
are crucial steps to increase satisfaction and improve the quality of life of this population.
REFERENCES
134
134
Tecnológico Superior Corporativo Edwards Deming – January - June Vol. 8 - 1 - 2024 https://revista-edwardsdeming.com/index.php/es
e-ISSN: 2576-0971
Aliaga, E., Cuba, S., & Meza, M. (2016). Promoción de la salud y prevención de las
enfermedades para un envejecimiento activo y con calidad de vida. Revista Peruana
de Medicina Experimental y Salud Publica. Obtenido de
http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726-
46342016000200017
Azua, M., Macías, M., & Ortega, G. (marzo de 2023). Enfermedades crónicas no
transmisibles y la calidad de vida en el Ecuador. MQRInvestigar, 7(1). Obtenido de
https://doi.org/10.56048/MQR20225.7.1.2023.1592-1612
Ecuador, Ministerio de Salud Pública. (2019). Educación y comunicación para la
promoción de la salud. Manual. Obtenido de Dirección Nacional de
Normatización.MSP: http://salud.gob.ec
Organización Mundial de la Salud. (16 de septiembre de 2023). OMS. Obtenido de
Enfermedades no transmisibles: https://www.who.int/es/news-room/fact-
sheets/detail/noncommunicable-diseases
