APPENDIX A

TRANSMITTAL LETTER TO THE DEAN OF THE COLLEGE OF NURSING

UNIVERSITY OF CEBU PARDO & TALISAY

COLLEGE OF NURSING
N. Bacalso Ave., Cebu South Road, Brgy. Bulacao Pardo, Cebu City,

MARY JOYCE P. CORVERA, R.N., M.A.N.

Dean, College of Nursing & Midwifery
University of Cebu Pardo & Talisay
N. Bacalso Ave., Cebu South Road, Brgy. Bulacao Pardo, Cebu City

Dear Ma’am Corvera,

We, from B.S.N. 3-C Group 5, are enrolled in the nursing research course. We
plan to conduct a study entitled: "Assessment of Frailty among Older Adults: Basis for
Proposed Action Plan."

We are writing to seek permission to conduct the mentioned study in Barangay Mohon,
Talisay City, Cebu, Philippines. The results gained from this research will contribute valuable
information to enhance the well-being of older adults in the community. We ensure that our
research will conduct itself ethically by closely adhering to the protocols and guidelines
established by the ethics office.

Thank you for your consideration, and we look forward to your response.

Respectfully yours, Recommending Approval:

RACHEL L. GALGO MARIACORAZON LOURDES C. LUCIN, RN, MAN, LPT

Group Leader Research Coordinator

Noted by: Approved By:

MARC RYAN V. PORTUGUEZ, RN, MSN MARY JOYCE P. CORVERA,RN,MAN

Research Adviser Dean, College of Nursing & Midwifery
 APPENDIX B

TRANSMITTAL LETTER TO THE CAMPUS AFFAIRS DIRECTOR

UNIVERSITY OF CEBU PARDO & TALISAY

COLLEGE OF NURSING
N. Bacalso Ave., Cebu South Road, Brgy. Bulacao Pardo, Cebu City

DR. ANNA LIZA B. S.O.N.

Campus Affairs Director
University of Cebu Pardo & Talisay
N. Bacalso Ave., Cebu South Road, Brgy. Bulacao Pardo, Cebu City

Dear Dr. Son,

We, from B.S.N. 3-C Group 5, are enrolled in the nursing research course. We plan
to conduct a study entitled: "Assessment of Frailty among Older Adults: Basis for
Proposed Action Plan."

We are writing to seek permission to conduct the mentioned study in Barangay

Mohon, Talisay City, Cebu, Philippines. The results gained from this research will
contribute valuable information to enhance the well-being of older adults in the
community. We ensure that our research will conduct itself ethically by closely adhering
to the protocols and guidelines established by the ethics office.

Thank you sincerely, and we look forward to your response.

Respectfully yours, Recommending Approval:

RACHEL L. GALGO MARIACORAZON LOURDES C. LUCIN,RN, MAN, LPT

Group Leader Research Coordinator

Noted by: Approved By:

MARC RYAN V. PORTUGUEZ , RN MSN MARY JOYCE P. CORVERA,RN, MAN
Research Adviser: Dean, College of Nursing & Midwifery
 APPENDIX C

TRANSMITTAL LETTER TO THE RESEARCH ADVISER

UNIVERSITY OF CEBU PARDO & TALISAY

COLLEGE OF NURSING
N. Bacalso Ave., Cebu South Road, Brgy. Bulacao Pardo, Cebu City

Ryan Portuguez
Research Adviser, College of Nursing & Midwifery
University of Cebu Pardo & Talisay
N. Bacalso Ave., Cebu South Road, Brgy. Bulacao Pardo, Cebu City

Dear Mr. Portuguez,

We, from B.S.N. 3-C Group 5, are enrolled in the nursing research course. We plan
to conduct a study entitled: "Assessment of Frailty among Older Adults: Basis for
Proposed Action Plan."

We would like your permission and instructions to proceed with the said study,
which we are looking forward to do. Your proficiency and insight will be vital in
ensuring the success of our research study.

Thank you sincerely, and we look forward to your positiveresponse.

Respectfully yours,
Recommending Approval:
RACHEL L. GALGO MARIACORAZON LOURDES C. LUCIN,RN, MAN, LPT
Group Leader Research Coordinator

Noted by: Approved By:

MARC RYANV. PORTUGUEZ, RN, MSN MARY JOYCE P. CORVERA, RN, MAN
Research Adviser Dean, College of Nursing & Midwifery
 APPENDIX D-1
LETTER OF CONSENT

January 2024

Ma’am/Sir:
Maayong adlaw!

Kami, mga estudyante sa Level III Group 5 sa University of Cebu at Pardo and Talisay-
College of Nursing, maghimo og research mahitungod sa mga Katigulangan nga gititulohan ug
‘’Assessment of frailty among Older Adults: Basis for Proposed action Plan’’. Ang among
pagtuon nagtumong sa pagpakatag ug kaamguhan sa mga Katigulangan kabahin sa Kahuyang.

Ug kalinya niini, amo kamong gihangyo sa pagkumpleto sa mga pangutana nga

makatabang kanamo sa pagdeterminar sa kahuyang sa usa katigulang.

The questionnaire is very brief and will take (5) minutes or less to fill out. Instructions for
completing the questionnaire can be found on the form itself. Please be assured that all
information you provide will be kept strictly confidential. We are not requiring you to fill up
your name and contact details. Also, your name or other identifying information will not appear
on any study report- all results from the study will be reported as statistical summaries only.

Ang imong partisipasyon maghatag og dakong kontribusyon sa katilingbanung kahimsug. Kami

mapasalamaton ug dako sa inyong kuoperasyon.

Kanimo matinahuron,

Rachel L. Galgo Noted by:

Group 5 Research Leader Marc Ryan V. Potuguez, RN, MSN
Research Adviser
 APPENDIX D-2

CONSENT FORM

Upon signing this document, I hereby give my consent to participate in the research study

entitled ‘’ Assessment of Frailty among Older Adults: Basis for Proposed Action Plan’’. Having

been informed of the detailed collection procedures, I understand the following agreements:

1. The Level III College of Nursing from the University of Cebu at Pardo and Talisay will
conduct the said study to assess frailty among community-dwelling older adults about a
selected demographic profile.
2. I shall be assured of the rights of privacy, anonymity, and confidentiality throughout the
duration of the study. No information would be revealed to unauthorized individuals.
3. This consent is granted voluntarily with my full knowledge.
4. I understand that all my questions about the study will be answered and that a copy of
the results of the research shall be given to me if I ask Rachel the leader of the group,
with a contact number of 09457824723

IN WITNESS WHEREOF, both parties (respondent and researchers) have been here unto
affixed their signatures on the ____________day of ___________2024 in Barangay Mohon,
Talisay City Cebu Philippines

_____________________________ Age:________________

(Signature of Respondent above Printed Name) Address:____________________

Contact no. ______________

______________________________________

(Signature of Researcher above Printed Name)

 APPENDIX E

RESEARCH QUESTINNAIRE

I. PROFILE

Directions: Put a check (/) on the box below corresponding to your answer.

Age: __________

Gender

 Female

 Male

Educational Attainment

 Elementary Graduate

 Highschool Graduate

 College Graduate

 Other (specify) _____________

Marital Status

 Single

 Married

 Other (specify) _____________

Family Income

 Less than 5,000

 5,000 -10,000

 10,000 - 20,000

 20,000 and above

No. of household members: ____________

II. GRONINGEN FRAILTY INDEX (GFI)

Circle the appropriate answer and add scores

Y N
E O
S
Mobility.
Can the patient perform the following tasks without assistance from another
person ( walking aids such as a can or a wheelchair are allowed)
1. Grocery shopping 0 1
2. Walk outside house ( around house or to neighbour) 0 1
3. Getting (un)dressed 0 1
4. Visiting restroom 0 1
Vision
5. Does the patient encounter problems in daily life because of impaired 1 0
vision?
Hearing
6. Does the patient encounter problems in daily life because of impaired 1 0
hearing?
Nutrition
7. Has the patient unintentionally lost a lot of weight in the past 6 months 1 0
(6kg
in 6 months or 3kg in 3 months)?
Co-morbidity
8. Does the patient use 4 or more different types of medication? 1 0
Y N SOMETIMES
E O
S
Cognition
9. Does the patient have any complaints on his/her memory (or 1 0 0
diagnosed with dementia)?
Psychosocial
10. Does the patient ever experience emptiness around him? 1 0 1
e.g. You feel so sad that you have no interest in your surroundings. Or if
someone you love no longer love you, how do you feel?
11. Does the patient ever miss the presence of other people around him? Or 1 0 1
do
you miss anyone you love?
12. Does the patient ever feel left alone? 1 0 1
e.g. You wish there is someone to go with you for something important.
13. Has the patient been feeling down or depressed lately? 1 0 1
14. Has the patient felt nervous or anxious lately? 1 0 1
Physical Fitness
15. How would the patient rate his/her own physical fitness? 1 0
(0-10 ; 0 is very bad, 10 is very good) 0 – 6 = 1 7 – 10 = 0

TOTAL SCORE GFI

Appendix 6 – PS (Performance Status)

0 Normal activity without restriction.

1 Restricted in physically strenuous activity but ambulatory and able to carry out light
work.
2 Ambulatory and capable for all self-care, unable to carry out any work and about >50%
of waking hours.
3 Capable only limited self-care, confined to bed or chair and about <50% of waking hours.
4 Completely disabled, cannot carry on any self-care, totally confined to bed or chair.
 APPENDIX F

GANTT CHART