Health Promotion in Later Life - Essay Example

Introduction The elderly, together with women, children and persons with disabilities, are generally regarded as disadvantaged groups of the population, because each of them have particular health needs that are different from the other sub-groups. Health promotion is one of the ways by which these needs are addressed. It is defined as the method of enabling people to hold control over and improve health through education. Promotion of well-being includes health protection, prevention and education, and these three become increasingly important in developing countries where making the most out of available resources is necessary to fit the scarce supplies to the needs of the population. Despite knowing how to prevent diseases and promote well-being, the difficulty of health promotion really lies on transferring it in a manner that can be readily used by its target population (World Health Organization, 1986). After identifying the physical, psychological, financial and social changes associated with aging, this study focuses on discussing health promotion’s importance, methods and issues, in terms of it being directed to the elderly population. Geriatric Population Age-related physical changes It should be noted that with the advancements in medicine, life expectancy has been continuously increasing dramatically (Schoeni, Freedman and Wallace, 2005). Statistics show that certain diseases, such as cancer and heart diseases, are more prevalent among the elderly. Physiologic aging causes changes in taste sensation, bone and muscular weakness, resulting in a loss of appetite, poor nutrition and decrease in mobility (Saxon, Etten and Perkins, 2009). In fact, muscle strength decreases by 15% per decade for those older than 50 and by 30% for those aged 70 and above, primarily due to sarcopenia, or loss of muscle mass, which is common among women than men (Nied and Franklin, 2002). Limitations in activities of daily living had been found to decrease life expectancy by almost three years (Lubitz, et al., 2003). Malnutrition contributes to weaker immune system, making them more at risk of acquiring infections such as high-risk community acquired pneumonia (Saxon, Etten and Perkins, 2009). Social and environmental changes Financial status is also an issue for the elderly, because they are usually retired or unemployed, limiting their resources (Naduva, 2007). In addition, those with difficulties in activities of daily living have an expected cumulative expenditure greater by almost $10, 000 than those without functional disability. Those who were admitted in institutions also spend considerably greater than those not institutionalized (Lubitz, et al., 2005). Additional responsibilities such as child-rearing task for their adult children may also cause undue strain during their elderly years (Naduva, 2007). Epidemiology It is estimated that in two decades, almost a quarter of the U. S. population, or 70 million people, will be older than 65 years. Three-fourths of the geriatric population has sedentary lifestyle (Laurie, 2000). Methods of Health Promotion The effects of such physiologic changes are, however, modifiable through lifestyle choices. Many studies agree that health promotion provides various benefits to the geriatric population. In fact, it is implicated with increasing independence and healthy lifespan among the elderly, as well as decreasing their burden of illness and functional decline (Rana, et al., 2009). The study of Lubitz, et al. (2003) had also verified that better health of an elderly person resulted in longer life expectancy, as compared than those in poorer health condition. Geriatric Assessment This multidimensional process evaluates an elderly person’s functional ability, physical health, cognitive and mental health, as well as socio-environmental history. Usually, it is included in preventive home visits conducted by primary care practitioners. It provides primary prevention by the assessment of general well-being and identification of risk factors, secondary prevention through determination of preclinical disease states and tertiary prevention by evaluating need for rehabilitation (Byles, 2000). Health education One of the primary goals of health promotion is to encourage a healthy lifestyle, particularly physical activity, dietary habits and personal grooming. The information given is hoped to empower individuals in controlling their health, subsequently leading to their improved health status. An active lifestyle and good dietary habits are associated with prolonging good health and preserving the quality of life in late adulthood (Kaplan, et al., 2001). Indeed, the so-called lifestyle diseases, such as diabetes (Khardori, 2012), hypertension (Riaz, et al., 2012) and coronary artery diseases (Bhoudi and Ahsan, 2012), are common among individuals having sedentary lifestyle and excess weight, with age increasing the risk considerably. On the other hand, regular exercise resulted in improvements in blood pressure, blood sugar levels, lipid profile, osteoarthritis, osteoporosis and neurocognitive function, subsequently decreasing mortality and age-related morbidity among geriatric individuals (Nied and Franklin, 2002). Rana, et al. (2009) determined whether a 15-month weekly community-based health education in rural Bangladesh improved the health-related quality of life (HRQoL) of the community’s elderly. This is based on evidence that supporting environments are also important to enforce lifestyle changes significant to improve health. Social support becomes more vital for those who rely on family, friends or community for activities of daily living and companionship. In this case, education focused on health care management (of bone- and joint-related illnesses, diabetes and hypertension), health and social awareness in relation to geriatric health and healthcare. The participants were taught of home-based physical activities, harmful food items, such as excess salt, sugar and fatty food and the benefits of eating fruits, vegetables and fat-free food items. Social awareness was addressed by recreational activities such as watching theater and videos, as well as conducting workshops and small group meetings. Among eight communities studied, half were randomly assigned to receive education and the other half served as control. Those who received the intervention were further classified into compliant and non-compliant individuals, based on response rates. Baseline and 3-month post-intervention HRQoL was assessed using a 24-item multi-dimensional generic survey particular for elderly persons. Multivariate data analyses showed that compliant group had better physical, social, spiritual, environment and overall HRQoL compared to control and non-compliant groups. Exercise programs Recommended exercise regimen is composed of aerobic exercise, strength training, balance and flexibility. Patient motivation starts with setting individual patient goals, addressing concerns and barriers to exercise, encouraging family support and providing positive reinforcement. Since half of the elderly population considers musculoskeletal discomfort or disability as a primary reason for not exercising, decreased exercise intensity and a more varied range of exercise using cross-training can be suggested to lessen discomfort. Aquatic exercises considerably reduce weight-bearing load and provides cutaneous assistance to proprioception. Exercises, such as doing the treadmill, can also be incorporated to prior routine, such as watching television (Nied and Franklin, 2002). Before strength training can be conducted, pre-participation screening should be done to determine the presence of contraindications to aerobic exercise and strength training. Absolute contraindications are recent ECG change, myocardial infarction, unstable angina, third-degree hear block, acute congestive heart failure, uncontrolled hypertension and uncontrolled metabolic disease, while relative contraindications are cardiomyopathy, valvular heart disease and complex ventricular ectopy. It should be noted that exercise programs should start slowly and gradually. Characteristics of physical activities with long-term compliance are straightforward, enjoyable and individualized (Nied and Franklin, 2002). 1. Aerobic activity Nied and Franklin (2002) recommend moderate aerobic activity at least three times for ten minutes each and for at least 4 days a week. Walking briskly for 3 to 4 mph, cycling leisurely for ≤ 10 mph, swimming with moderate effort, double tennis, golf, fishing, canoeing leisurely for 2 to 4 mph, mowing lawn and home painting are just some of the activities geriatric individuals can choose from. 2. Strength training Strength training results in muscle hypertrophy, as well as increased motor unit and recruitment. In effect, it improves walking endurance, prevents muscle wasting and decreases cardiac load. It is recommended that a single set of 10 to 15 repetitions of 8 to 10 different resistance training exercises, targeting all major muscle groups, for 2 to 3 times a week. In the start of the program, resistive bands or tubing, 2 lb hand weights or repeatedly stand-up exercises can be done. It must be noted that each repetition be performed slowly through the full range of motion, while avoiding holding one’s breath (Nied and Franklin, 2002). 3. Balance and flexibility Compared to that of other exercise types, the benefits of balance and flexibility training are yet to be proven. Stretching of compliant major muscle groups once per day before and after exercise should be conducted, especially for deconditioned and sedentary geriatric individuals (Nied and Franklin, 2002). Targeting social isolation and loneliness According to Kupyer and Bengtson’s social breakdown and competence model, the elderly are susceptible to isolation and loneliness, because they are regarded by society as socially incompetent, leading to learned helplessness and dependence. By preventing isolation and loneliness, the elderly also become confident and participative. In the systematic review of Cattan, et al. (2005) of health promotion interventions directed at preventing social isolation and loneliness, nine of the ten effective strategies were noted to be group activities with an educational or support input, such as structured skills courses and exercise. Also seen to be effective was letting the elderly take in charge of the activities conducted by the group. In contrast, 75% of ineffective interventions were based on providing one-to-one social support, giving advice and information, or conducting health-needs assessment. Although these findings could have been significant in standardizing the care for geriatric individuals, transferability of the results may not be valid because some used samples that were not considered representative of the target population. Current Issues on Health Promotion Despite the benefits noted above, there have been disagreements as to the effectiveness of geriatric assessments. A systematic review in 2000 found that health promotional home visits have not been found to significantly improve measurements of physical or psychological function, falls, hospital admission, or mortality. In contrast, studies such as that of Stuck, et al. (2002) have noted that health promotion programs and preventive care are associated with decreased mortality and long-term intuitional care. However, it must be noted that the issue of long-term effects has also been raised in various studies. For example, one study reported a reversal of benefits a year after the intervention (McAuley, et al., 2000). What may cause the ineffectiveness of geriatric assessment may be the poor geriatric assessment practice (GAP) of healthcare practitioners. In the study of Naduya (2007), it was found that Fiji nurses lack of information, training and standard specialized procedures for the elderly, contributing to poor GAP. In fact, in the survey among 23 active nurses in Suva, Fiji, more than 20% did not regard Geriatric Assessment as elderly care and only 17% had any training in Geriatric care. Even then, such training happened more than two years since the conduct of the study. Another factor that may result in poor GAP scores is focus of assessment to health dimensional issues. Nurses were found to note health concerns twice to three times more likely than financial, functional ability, environmental risk, social and carer dimensions. Emphasis on essential daily living such as feeding and self-grooming are only focused upon if they cause disease to the elderly. Even then, despite being more particular on health issues, mental and cognitive functions, as well as bowel habits, urinary problems and trauma, were not extensively discussed during the assessment, reflecting the lack of awareness of health problems particular among the geriatric population (Naduva, 2007). Another problem currently facing the healthcare program for the elderly is the lack of training institutions with any geriatric curriculum and subsequent paucity of geriatric professionals and lack of knowledge regarding geriatric care (Kovner, Mezey and Harrington, 2002). Conclusion Based on the special needs of the elderly, the findings of this report suggest that an interplay of strategies be conducted in the effective delivery of health promotion to the geriatric population, such that aside from geriatric assessment, a group-based health education and exercise program can be conducted not only to address physical health concerns but also their psychological and social being. Summary This study has looked into the various health promotion strategies aiming to improve the well-being of the geriatric population, especially since they suffer from age-related limitations in physical and cognitive processes, as well as susceptibility to diseases. 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