Health promotionHealth promotion

Prepared by:Prepared by:

Dr. Soad HassanDr. Soad Hassan

Lecturer of Gerontological Lecturer of Gerontological Nursing Nursing

Health promotion of the elderlyHealth promotion of the elderly

Health promotionHealth promotion is the process of is the process of

enabling people to increase control enabling people to increase control

over & improve their health by over & improve their health by

developing their resources to maintain developing their resources to maintain

or enhance well being.or enhance well being.

Health promotingHealth promoting is an action for is an action for

health using knowledge, communication health using knowledge, communication

& understanding& understanding

Objectives of health promotionObjectives of health promotion Increase quality and years of Increase quality and years of

healthy life healthy life Maintain functionMaintain function Eliminate health disparities and Eliminate health disparities and

independency independency Improve (enhance) quality of lifeImprove (enhance) quality of life Extend life expectancy → ↓ Extend life expectancy → ↓

premature mortality caused by premature mortality caused by chronic& acute diseaseschronic& acute diseases

Component of health promotionComponent of health promotion

1.1. Exercise Exercise

2.2. NutritionNutrition

3.3. Rest & sleepRest & sleep

4.4. Periodic medical check upPeriodic medical check up

5.5. High risk behaviorHigh risk behavior

6.6. Spiritual well-being Spiritual well-being

7.7. Psychosocial well-beingPsychosocial well-being

1- Exercise1- Exercise

Physical Social

Psychological

Benefits ofBenefits of exerciseexercise

Physical benefits of exercise1)1) Consumption of body fatConsumption of body fat2)2) Improve cardio-vascular capacity( Improve cardio-vascular capacity( byby↑↑

blood flow----- keep tissue healthyblood flow----- keep tissue healthy3)3) Control hypertension& blood sugarControl hypertension& blood sugar4)4) Improve respiratory function Improve respiratory function 5)5) Improve joint flexibilityImprove joint flexibility6)6) Improve pattern of sleep & restImprove pattern of sleep & rest7)7) ↑ ↑ independency independency 8)8) Improve sense of well –being & relaxationImprove sense of well –being & relaxation9)9) Maintain mind’s function Maintain mind’s function 10)10) Promote sense of normalityPromote sense of normality11)11) Peristaltic movementPeristaltic movement

Psychological benefits of exercise

1.1. Improve mood stateImprove mood state

2.2. Improve self-imageImprove self-image

3.3. Reduce stressReduce stress

4.4. Enhance sleepEnhance sleep

5.5. Improve depressive state of elderlyImprove depressive state of elderly

Social benefits of exercise

Improve social interaction & relation Improve social interaction & relation with otherwith other

Types of

exercise

Isotonic Isometric

Role of the nurse during Role of the nurse during exercise exercise

I- Assessment done at the beginning of I- Assessment done at the beginning of exercise program include:exercise program include:

1.1. History & physical examination (CVS, History & physical examination (CVS, resp, musculoskeletal & neurological resp, musculoskeletal & neurological system)system)

2.2. Renal & liver function testsRenal & liver function tests3.3. ECG,& exercise stress testECG,& exercise stress test4.4. Assess range of motion & use of Assess range of motion & use of

assistive devices.assistive devices.5.5. Assess environmental hazardsAssess environmental hazardsII-Set a regular time to exercise each day II-Set a regular time to exercise each day

III- Before starting exercise the nurse should advice the III- Before starting exercise the nurse should advice the elderly aboutelderly about::

1. Document baseline resting function status (ht &resp rate, bl.sugar)

2. 10 minutes warms up stretching exercise

3. Drink water before and after exercise is important as water will be lost during exercise

4. Clothes worn during exercise should allow for easy movement and perspiration.

5. Athletic shoes provide both support and protection

6. Outdoor exercise should be avoided in extremely hot or cold weather.

1.1. Enclosed shopping malls are sheltered Enclosed shopping malls are sheltered places for walking during the extreme places for walking during the extreme weather or when there are concerns weather or when there are concerns about neighborhood safety.about neighborhood safety.

2.2. Exercising with a partner provides Exercising with a partner provides both encouragement to continue both encouragement to continue exercising and safety. exercising and safety.

3.3. Nurse should advice the older adults Nurse should advice the older adults to stop exercising and seek help if they to stop exercising and seek help if they experiences chest pain or tightness, experiences chest pain or tightness, shortness of breath, dizziness, or shortness of breath, dizziness, or palpitation during exercise. palpitation during exercise.

During exerciseDuring exercise Monitor heart & resp. rateMonitor heart & resp. rate Stop exercise if elderly has fatigue , Stop exercise if elderly has fatigue ,

chest pain or chest pain or ↑↑heart & resp. rateheart & resp. rate

After exercise:After exercise: 10 minutes cooling up at end of 10 minutes cooling up at end of

exercise exercise Monitor pulse rate during cooling Monitor pulse rate during cooling

for returning to resting ht. ratefor returning to resting ht. rate

22 - -NutritionNutrition

It is neglected especially those It is neglected especially those living alone or with low income.living alone or with low income.

Factors affecting nutritional status:Factors affecting nutritional status:

1)1) Age related changesAge related changes

2)2) Psychosocial factorsPsychosocial factors

3)3) Economic factorsEconomic factors

4)4) Cultural factorsCultural factors

Age related changesAge related changes ↓↓ Taste & smellTaste & smell ↓↓ Visual acuityVisual acuity Loss of teeth & poor fitting dentureLoss of teeth & poor fitting denture ↓↓ Gastric secretion→ influence in Gastric secretion→ influence in

absorption of B12, folic acid& iron. absorption of B12, folic acid& iron.

Food remain longer time in Food remain longer time in stomach + stomach + ↓↓ gastric secretion will gastric secretion will lead to indigestion &feeling of lead to indigestion &feeling of fullness. fullness.

Psychosocial factorsPsychosocial factors Depression is common ( losses, death, Depression is common ( losses, death,

retirement, change of body appearance, retirement, change of body appearance, impaired vision &poor physical fitness) this impaired vision &poor physical fitness) this will lead to lack of interest in eating& will lead to lack of interest in eating& anorexia and anorexia and ↓↓ food intake. food intake.

Living alone also will lead to lack of Living alone also will lead to lack of incentive to cook &eat.incentive to cook &eat.

Economic FactorsEconomic Factors Low income Low income Limited access to food and food Limited access to food and food

choiceschoices Inadequate facilities to food storage Inadequate facilities to food storage

and preparation and preparation

Cultural factorsCultural factors

Eating habits may miss certain food group Eating habits may miss certain food group as vegetarians.as vegetarians.

Nutritional requirement of Nutritional requirement of elderlyelderly

1- Calories1- Calories Caloric requirement diminished by Caloric requirement diminished by

10% in age 51-75 years and by 20-10% in age 51-75 years and by 20-25% in age more than 75 years.25% in age more than 75 years.

N.B: Fat yield 9 cal/gram, CHO and N.B: Fat yield 9 cal/gram, CHO and protein yield 4 cal/gram, mineral protein yield 4 cal/gram, mineral and water yield no caloriesand water yield no calories

2- Protein requirement2- Protein requirement

0.8 g/kg body wt 0.8 g/kg body wt

A balanced diet of a healthy A balanced diet of a healthy

elderly should contain 12-14% of elderly should contain 12-14% of

total caloric intake.total caloric intake.

During infection, stress, trauma During infection, stress, trauma

protein protein ↑ to 1.6 or 1.5 ↑ to 1.6 or 1.5 g/kg body wt g/kg body wt

33--Fat requirementFat requirement

Fat either saturated or Fat either saturated or unsaturated unsaturated

Total fat intake limited to 30 % Total fat intake limited to 30 % or less of total energy intakeor less of total energy intake

Saturated fat limited to 10-15% Saturated fat limited to 10-15% of total energy intakeof total energy intake

Dietary cholesterol intake Dietary cholesterol intake limited to 300mg/ day or lesslimited to 300mg/ day or less

44 - -Carbohydrates requirementCarbohydrates requirement

CHO is essential for maintaining CHO is essential for maintaining normal bl. glucose level & preventing normal bl. glucose level & preventing protein break down.protein break down.

50% of total calories---- CHO 50% of total calories---- CHO Simple CHO as sugar, honey ( avoided)Simple CHO as sugar, honey ( avoided) Complex CHO as vegetables, grains, Complex CHO as vegetables, grains,

fruitsfruits Complex CHO has vit, minerals, fibers Complex CHO has vit, minerals, fibers

which help in bowel elimination& which help in bowel elimination& ↓↓ bl. bl. cholesterol level.cholesterol level.

55--FluidFluid intake intakeElderly at high risk for dehydration due to:Elderly at high risk for dehydration due to:1.1. ↓↓ Thirst sensationThirst sensation2.2. Inadequate fluid intake (2000-3000 cc/day) requiredInadequate fluid intake (2000-3000 cc/day) required3.3. Some medications, such as for high blood pressure or Some medications, such as for high blood pressure or

anti-depressants, and diureticanti-depressants, and diuretic4.4. Some medications may cause patients to sweat moreSome medications may cause patients to sweat more5.5. Frail seniors have a harder time getting up to get a Frail seniors have a harder time getting up to get a

drink when they’re thirsty, or they rely on caregivers drink when they’re thirsty, or they rely on caregivers who can’t sense that they need fluidswho can’t sense that they need fluids

6.6. As we age our bodies lose kidney function and are less As we age our bodies lose kidney function and are less able to conserve fluid (this is progressive from around able to conserve fluid (this is progressive from around the age of 50, but becomes more acute and noticeable the age of 50, but becomes more acute and noticeable over the age of 70)over the age of 70)

7.7. Illness, especially one that causes vomiting and/or Illness, especially one that causes vomiting and/or diarrhea, also can cause elderly dehydrationdiarrhea, also can cause elderly dehydration

66 - -Vitamins & mineral Vitamins & mineral requirementsrequirements

CalciumCalcium:---for mineralization of bone :---for mineralization of bone &has a role in blood & cardiac function.&has a role in blood & cardiac function.

Daily requirement 1200 mg./day if Daily requirement 1200 mg./day if there is no contraindicationsthere is no contraindications

Vitamin D :------ needed for calcium Vitamin D :------ needed for calcium absorption& metabolism.absorption& metabolism.

Exposure 15 minutes/day to sun is Exposure 15 minutes/day to sun is enoughenough

Nurse RoleNurse Role

Assessment involves: nutritional Assessment involves: nutritional history, physical examination, history, physical examination, anthropometric measurements, anthropometric measurements, biochemical evaluation, cognitive & biochemical evaluation, cognitive & mood evaluationmood evaluation

Health history related to nutritionHealth history related to nutrition Anthropometric measurementAnthropometric measurement Client and family education Client and family education

Dietary guideline for old Dietary guideline for old personspersons

Eat a variety of foodEat a variety of food Maintain a healthy wtMaintain a healthy wt Choose a diet low in fat,Choose a diet low in fat,

saturated & cholesterol saturated & cholesterol Choose a diet plenty of Choose a diet plenty of

vegetables, fruits & vegetables, fruits & grain productsgrain products

Use sugar & salts in Use sugar & salts in moderatemoderate

Drink 200-3000cc/dailyDrink 200-3000cc/daily

33 - -Rest& sleepRest& sleep Person spend 1/3 of his life in sleepPerson spend 1/3 of his life in sleep Sleep is time for cell growth& repairSleep is time for cell growth& repair Elderly need 5-7 hrs at nightElderly need 5-7 hrs at night

Importance of Rest& sleep:Importance of Rest& sleep:

1)1) Conserve energyConserve energy

2)2) Provide organ respite (rest)Provide organ respite (rest)

3)3) Restore the mental alertness& Restore the mental alertness& neurological efficiency neurological efficiency

4)4) Relieve tensionRelieve tension

5)5) Emerge feeling of well beingEmerge feeling of well being

Factors affecting sleeping Factors affecting sleeping patternspatterns

Age related changes in sleep Age related changes in sleep patternspatterns

Internal factorsInternal factors External factorsExternal factors

Nursing measures adopted to promote Nursing measures adopted to promote sleepsleep

1. Engage in exercise program 2. Avoid exercise within 3-4 hr. of bedtime.3. Spend time out door in the sunlight each day but avoid

period between 12 Md to 3 PM sunshine exposure.4. Engage in relaxing activities near bedtime. 5. Avoid tobacco at bedtime6. Avoid drink any caffeinated beverages before mid

afternoon.7. Limit fluid intake after the dinner hour if nocturia is a

problem.8. Limit daytime naps to 30 minutes or less.9. Avoid using the bed for watching TV, writing bills,

and reading.

44 - -Periodic medical Periodic medical examinationexamination

Importance of Periodic medical Importance of Periodic medical examination:examination:

1.1. Assess elderly level of well-beingAssess elderly level of well-being2.2. Detect early signs of diseaseDetect early signs of disease3.3. Educate client how to promote his Educate client how to promote his

healthhealth4.4. Reinforce + ve promoting & Reinforce + ve promoting &

protecting behaviorsprotecting behaviors5.5. If examination done at home, it If examination done at home, it

permit evaluation of environment permit evaluation of environment ( hazards care giver…)( hazards care giver…)

Types of health screeningTypes of health screeningHealth screeningHealth screeningPeriodPeriod

Bl. pBl. pEach Dr. visit or 3-6 Each Dr. visit or 3-6 monthsmonths

Ht & wtHt & wtPeriodically as part of Periodically as part of comprehensive comprehensive

physical examinationphysical examination

Dental check upDental check upOnce / year( annually)Once / year( annually)

Fecal occult blood& Fecal occult blood& sigmoidoscopysigmoidoscopy

( (annuallyannually))

Vision including Vision including glaucoma testglaucoma test

Every 2 yearsEvery 2 years

Health screeningHealth screeningPeriodPeriod

HearingHearingEvaluate Evaluate periodicallyperiodically

Cholesterol levelCholesterol level Every 5 yearsEvery 5 years

Cancer screeningCancer screeningAnnuallyAnnually

Mammography for Mammography for women under 70 ywomen under 70 y

1-21-2 yearsyears

Digital rectal Digital rectal examinationexamination

AnnuallyAnnually

ImmunizationsImmunizations

VaccinationVaccinationPeriodPeriod

Influenza (over Influenza (over 65y)65y)

Annually (mid Annually (mid October to mid October to mid

November)November)

Tetanus & Tetanus & diphtheriadiphtheria

Every 10 yearsEvery 10 years

Pneumococcal Pneumococcal vaccinationvaccination

Once at age 65y, Once at age 65y, revaccination for revaccination for

high risk fatal high risk fatal pneumonia/6 ypneumonia/6 y

55 - -High Risk BehaviorHigh Risk Behavior It is behavior that damage physical It is behavior that damage physical

healthhealth..

It includes: It includes: Over the counter medication (multiple Over the counter medication (multiple

medications )medications ) Smoking Smoking Caffeine Caffeine

Smoking Nicotine & toxic substances in cigarette Nicotine & toxic substances in cigarette

has impact on detoxication process in has impact on detoxication process in

the body------- cell damage& variety of the body------- cell damage& variety of

diseases as cancer, respiratory, CVD, ↑ diseases as cancer, respiratory, CVD, ↑

risk of osteoporosisrisk of osteoporosis

Cessation of smoking improves cerebral Cessation of smoking improves cerebral

blood flow& ↑ pulmonary functionblood flow& ↑ pulmonary function

Multiple medication

Older people consume many Older people consume many medication--------medication--------↑↑adverse drug adverse drug reaction reaction

The most common over the counter The most common over the counter medication: Analgesics, laxatives& medication: Analgesics, laxatives& antacids followed by cough antacids followed by cough products, eye wash& vitamins.products, eye wash& vitamins.

Caffeine

Found in coffee, tea, soft drinks, Found in coffee, tea, soft drinks, chocolatechocolate

It is mood elevatorIt is mood elevator It stimulates sympathetic nervous It stimulates sympathetic nervous

systemsystem ↑motor activitymotor activity ↑ ↑ muscle capacity & alertnessmuscle capacity & alertness ↑ ↑ Rapid pulseRapid pulse ↑ ↑ calcium excretioncalcium excretion

66 - -Spiritual Well- beingSpiritual Well- being Spiritual well-beingSpiritual well-being is the practice and is the practice and

philosophy of the integral aspects of philosophy of the integral aspects of mental, emotional and overall mental, emotional and overall wellbeing.wellbeing.

Spiritual well-beingSpiritual well-being is a state in is a state in which the positive aspects of which the positive aspects of spiritualityspirituality are experienced, are experienced, incorporated and lived by the individual incorporated and lived by the individual and reflected into ones environment. and reflected into ones environment.

Signs of spiritual distress: Signs of spiritual distress: Doubt Doubt DespairDespair Guilt Guilt BoredomBoredom Expression of anger toward god Expression of anger toward god

BenefitsBenefits

The practice and incorporation of The practice and incorporation of Spiritual Wellbeing into one’s life Spiritual Wellbeing into one’s life influences and includes benefits for influences and includes benefits for ones; ones; Emotional WellbeingEmotional Wellbeing, , Physical WellbeingPhysical Wellbeing, and , and Mental WellbeingMental Wellbeing. .

Some of the measurable benefits that people experience Some of the measurable benefits that people experience from spiritual wellbeing counseling and groups from spiritual wellbeing counseling and groups include:include:

A feeling of being more contented with their life’s A feeling of being more contented with their life’s situation situation

Greater enjoyment of self time, finding an inner Greater enjoyment of self time, finding an inner peace peace

Greater ability to take control of and resolve their Greater ability to take control of and resolve their life’s issues life’s issues

A greater sense of satisfaction in their activities and A greater sense of satisfaction in their activities and life situations life situations

Ability to take a more active part in life rather than Ability to take a more active part in life rather than standing still and watching it pass by standing still and watching it pass by

Ability to build more intimate, loving and lasting Ability to build more intimate, loving and lasting relationships relationships

A greater feeling of purpose and meaning in their lifeA greater feeling of purpose and meaning in their life

Measures to increase Spiritual Measures to increase Spiritual well beingwell being

Identify ways that believes give meaning to Identify ways that believes give meaning to lifelife

Use problem solving to solve any conflict Use problem solving to solve any conflict related to spiritualityrelated to spirituality

Meeting with religious man at regular Meeting with religious man at regular intervalsintervals

Presence of religious literatures in the Presence of religious literatures in the immediate environment such as Quran on immediate environment such as Quran on beside tablebeside table

Reading in religious books & prayingReading in religious books & praying Discuss role of spirituality in one’s lifeDiscuss role of spirituality in one’s life

77 - -Psychosocial Well- Psychosocial Well- beingbeing

Psychosocial changes may alter an Psychosocial changes may alter an individual relationship with others. individual relationship with others.

Physical wellbeing depend on:Physical wellbeing depend on: Psychosocial wellbeingPsychosocial wellbeing Social structureSocial structure Personal relationshipsPersonal relationships

In Later years many adjustment are In Later years many adjustment are necessary necessary

Role of the nurse in health Role of the nurse in health promotionpromotion

Assessment to his physical health, Assessment to his physical health, Psychosocial Well- being, lifestyle pattern, Psychosocial Well- being, lifestyle pattern, hobbies, high risk behaviors, knowledge, hobbies, high risk behaviors, knowledge, believes& attitudes that affect health & believes& attitudes that affect health & wellbeing.wellbeing.

Assess health needs Assess health needs Assess social , environmental & cultural Assess social , environmental & cultural

influences on health behaviorsinfluences on health behaviors Lifestyle modifications is a comprehensive Lifestyle modifications is a comprehensive

approach for effective change in heath approach for effective change in heath promotion behaviors promotion behaviors

Nurse role should directed toward Nurse role should directed toward helping elderly to cope with his function helping elderly to cope with his function level ------delay disabilities & level ------delay disabilities & impairments.impairments.

Nurse identify environmental hazards & Nurse identify environmental hazards & make necessary modificationsmake necessary modifications

Identify social needs & encourage Identify social needs & encourage participation & social support groups.participation & social support groups.

Nurse should inform elderly & Nurse should inform elderly & caregivers about aging process, common caregivers about aging process, common disorders & disabilities , different disorders & disabilities , different services available services available

Encourage elderly to take better Encourage elderly to take better care to them, avoid high risk care to them, avoid high risk behaviors,& hazards affecting their behaviors,& hazards affecting their health.health.

Regular and continuous evaluation is Regular and continuous evaluation is important aspect of nurse’s role. important aspect of nurse’s role.