CARE OF THE OLDER ADULT

HEALTH PROMOTION AND

WELLNESS OF THE OLDER PERSON
MODULE 4
ERLINDA M. GUZMAN, RN, MAN
Instructor
 OVERVIEW/INTRODUCTION:
• Aging often requires the need to make significant lifestyle changes,
such as taking new medications, following a different diet or changing
an exercise regimen.

• Older people may also have unique motives for making these lifestyle
changes. For example, they may not wish to be a burden to their
family and this may provide an additional incentive for maintaining
their physical capacity. They may also want to live to see their
grandchildren grow up so that they can influence the next
generation. Unlike younger adults – who may not see the impact of
their negative behaviors until the future – older adults may see
immediate and potentially life-threatening effects.
 OVERVIEW/INTRODUCTION
• This module will focus on the principles and concepts in promotion of
health and wellness in older people.
• It will also emphasize the role and responsibilities of the nurses in the
implementation of the strategies and programs to promote health and
wellness in the older groups. Nursing care plan on health and wellness
promotion to elderly is also stressed in this module.
 LEARNING OUTCOMES:
At the end of the module, students should be able to:
1. Explain the principles of health and wellness promotion in older
people.
2. Describe recommended health-maintenance practices and how
they change with aging.
3. Identify older adults who are most at risk for experiencing health-
maintenance problems.
4. Utilize the nursing process in promoting health and wellness in older
people.
5. Apply nursing interventions that are appropriate for older adults
experiencing alterations in health maintenance in various situations.
PROMOTING
EFFECTIVE
BREATHING
 AGING CHANGES IN THE LUNGS
• The lungs have two main functions. One is to get oxygen from the air into
the body. The other is to remove carbon dioxide from the body. Your
body needs oxygen to work properly. Carbon dioxide is a gas the body
produces when it uses oxygen.
• During breathing, air enters and exits the lungs. When you breathe in
(inhale), air flows through the airways into the lungs. The airways are
made of stretchy tissue. Bands of muscle and other support tissue wrap
around each airway to help keep them open.
• Air keeps flowing into the lungs until it fills tiny air sacs. Blood circulates
around these air sacs through tiny blood vessels. Oxygen crosses into the
bloodstream at the place where the blood vessels and air sacs meet. This
is also where carbon dioxide crosses from the bloodstream into the lungs
to be breathed out (exhaled).
 AGING CHANGES IN YOUR BODY
AND THEIR AFFECTS ON THE LUNGS
Changes to the bones and muscles of the chest and spine:
• Bones become thinner and change shape. This can change the shape
of your ribcage. As a result, your ribcage cannot expand and contract
as well during breathing.
• The muscle that supports your breathing, the diaphragm, becomes
weakened. This weakness may prevent you from breathing enough air in
or out.
• These changes in your bones and muscles may lower the oxygen level in
your body. Also, less carbon dioxide may be removed from your body.
Symptoms such as tiredness and shortness of breath can result.
 AGING CHANGES IN YOUR BODY
AND THEIR AFFECTS ON THE LUNGS
Changes to lung tissue:
• Muscles and other tissues that are near your airways may lose their
ability to keep the airways completely open. This causes the airways
to close easily.
• Aging also causes the air sacs to lose their shape and become baggy.
• These changes in lung tissue can allow air to get trapped in your lungs.
Too little oxygen may enter your blood vessels and less carbon
dioxide may be removed. This makes it hard to breathe.
 AGING CHANGES IN YOUR BODY
AND THEIR AFFECTS ON THE LUNGS
Changes to the nervous system:
• The part of the brain that controls breathing may lose some of its
function. When this happens, your lungs are not able to get enough
oxygen. Not enough carbon dioxide may leave the lungs. Breathing
may get more difficult.
• Nerves in your airways that trigger coughing become less sensitive.
Large amounts of particles like smoke or germs may collect in the
lungs and may be hard to cough up.
 AGING CHANGES IN YOUR BODY
AND THEIR AFFECTS ON THE LUNGS
Changes to the immune system:
• Your immune system can get weaker. This means your body is less
able to fight lung infections and other diseases.
• Your lungs are also less able to recover after exposure to smoke or
other harmful particles.
 COMMON PROBLEMS
As a result of these changes, older people are at increased risk for:
1. Lung infections, such as pneumonia and bronchitis
2. COPD, emphysema, asthma
3. Shortness of breath
4. Low oxygen level
5. Abnormal breathing patterns, resulting in problems such as sleep
apnea (episodes of stopped breathing during sleep)
 PREVENTION

To decrease the effects of aging on the lungs:

1. DO NOT smoke. Smoking harms the lungs and speeds up lung aging.
• Includes, second hand smoking
2. Do physical exercise to improve lung function.
• Aerobics, walking, deep breathing exercises, incentive spirometry
3. Get up and move.
• Lying in bed or sitting for long periods allows mucus to collect in the
lungs. This puts you at risk of lung infections. This is especially true
right after surgery or when you are ill.
COMMON RESPIRATORY
ILLNESSES IN OLDER
ADULTS
 ACUTE RESPIRATORY DISTRESS
SYNDROME (ARDS)
• ARDS is a serious condition that most often occurs when a senior is
already ill or has recently experienced a trauma.
• It is caused by damage to the tiny blood vessels in the lungs, which
causes too much fluid in the air sacs. This can be caused by a number
of different trauma-related factors, including a blood or lung infection,
an injury to the chest or head, or exposure to a toxic substance.
• Whatever the specific cause, ARDS is a medical emergency because
it prevents your organs from getting the oxygen they need. If not
immediately addressed, it can cause organ failure and even death.
 AGING LUNGS
• Unfortunately, all seniors can expect to feel the effects of weaker
lungs as they age.
• Bones change shape and become weaker with age, which causes
the rib cage to contract so that our lungs can no longer expand as
much when we breathe in.
• The muscles in the respiratory system also weaken, which makes it
harder to pull air in and push it out.
• All of these changes can cause seniors to become more easily
winded and make physical activity a little harder. Although if you are
otherwise healthy, the effects of aging lungs should not be too
significant.
 ASTHMA
• Asthma is common in children, but can also cause serious problems
for seniors.
• The main symptoms of asthma in seniors are similar to what they are in
people of any age: difficulty breathing, coughing and a lightness in
the chest. But because of the other effects of aging, when these
symptoms arise in the elderly, they are more severe.
• Asthma is often difficult to diagnose in seniors because the symptoms
look similar to those of chronic obstructive pulmonary disease (COPD).
But proper diagnosis is crucial for a patient to receive treatment to
avoid possible respiratory failure.
 CHRONIC BRONCHITIS
• Chronic bronchitis. It occurs when the bronchial tubes, the airways
that carry oxygen to the lungs, become inflamed. The inflamed tubes
produce a lot of mucus, which leads to symptoms that include
coughing, difficulty breathing, shortness of breath and wheezing.
• While acute bronchitis is common across age groups, as a chronic
condition (meaning it lasts for months, rather than just days or weeks),
seniors are at a higher risk.
• It is most frequently caused by smoking, but can also be the result of
years spent breathing in air pollution, dust or fumes.
 EMPHYSEMA
• Emphysema. It occurs when the inner walls of the air sacs in the lungs
are weakened over time and rupture. Because the air sacs no longer
work properly, when someone exhales, the old air becomes trapped
and leaves no room for fresh air to enter, meaning less oxygen enters
the bloodstream.
• Many people with emphysema also have chronic bronchitis and the
main causes are the same.
• The primary symptom of early emphysema is shortness of breath and it
can lead to heart problems and holes in the lungs.
 IDIOPATHIC PULMONARY
FIBROSIS (IPF)
• IPF is a fairly rare respiratory disease characterized by a scarring and
thickening in the lungs. The condition is most common in seniors and
produces common symptoms that make it difficult to diagnose, such
as coughing and fatigue.
• The cause of the disease is unknown and the prognosis is serious. On
average, only 20-30% of patients survive five years past the initial
diagnosis.
• But there are treatments that can slow the progression of IPF, so
getting an accurate diagnosis as soon as possible is important.
 WHAT SENIORS CAN DO
TO IMPROVE THEIR
RESPIRATORY HEALTH
There are three main steps seniors can take to improve their
respiratory health and reduce the risk of being felled by these illnesses:
 EXERCISE
• Staying physically active will help strengthen the lungs and reduce
the effects of respiratory illnesses. Ask for doctor’s advice about safe
exercises that a senior can do — remember not to overdo it and do
further harm.
• By adding some physical activity into a senior’s daily routine, the
respiratory system can stay healthier longer.
• Aerobics exercises
• Active or Passive Exercises
• Deep breathing/ coughing exercises
• Incentive Spirometry
 GET FREQUENT CHECK-UPS
• For many of these disorders, early diagnosis and treatment can make
a big difference. The most important step a senior can take is to go to
the doctor regularly and talk honestly and openly about how they are
feeling.
• Do not discount any respiratory discomfort as a typical part of aging.
Speak up if there is a problem that should be checked out. Sometimes
mild symptoms can point to serious issues and it is better off being safe
than sorry.
 STOP SMOKING
• If a senior smokes now, make sure they quit. If not, try to avoid
exposure to second-hand smoke.
• Smoking is a factor in many of the respiratory illnesses described
above and cutting exposure to cigarettes and smoke can play a big
role in improving respiratory health.
• Aging brings with it a lot of health issues that we have little control
over, but you always have the power to take steps to stay healthier
and reduce the risk of facing additional illnesses and issues.
 BREATHING EXERCISES TO
INCREASE LUNG CAPACITY
• Lung capacity is the total amount of air that your lungs can hold. Over
time, our lung capacity and lung function typically decrease slowly as
we age after our mid-20s.
• Some conditions like chronic obstructive pulmonary disease (COPD)
can significantly speed up these reductions in lung capacity and
functioning. This leads to difficulty in breathing and shortness of breath.
• Fortunately, there are exercises that can help maintain and increase
lung capacity, making it easier to keep your lungs healthy and get
your body the oxygen it needs.
 DIAPHRAGMATIC BREATHING
• Diaphragmatic breathing, or “belly breathing,” engages the diaphragm, which is
supposed to do most of the heavy lifting when it comes to breathing.
• This technique is particularly helpful in people with COPD, as the diaphragm is not
as effective in these individuals and could be strengthened. The technique best
used when feeling rested.
• You should do the following to practice diaphragmatic breathing:
1. Relax your shoulders and sit back or lie down.
2. Place one hand on your belly and one on your chest.
3. Inhale through your nose for two seconds, feeling the air move into your
abdomen and feeling your stomach move out. Your stomach should move
more than your chest does.
4. Breathe out for two seconds through pursed lips while pressing on your
abdomen.
5. Repeat.
 PURSED-LIPS BREATHING
• Pursed-lips breathing can slow down your breathing, reducing the work of
breathing by keeping your airways open longer. This makes it easier for the
lungs to function and improves the exchange of oxygen and carbon
dioxide.
• This breathing exercise is often easier for beginners than diaphragmatic
breathing, and you can do it at home even if no one has showed you
how. It can be practiced at any time.
• To practice the pursed-lips breathing technique:
1. Inhale slowly through your nostrils.
2. Purse your lips, as if pouting or about to blow on something.
3. Breathe out as slowly as possible through pursed lips. This should take
at least twice as long as it did to breathe in.
4. Repeat.
 TIPS FOR KEEPING YOUR
LUNGS HEALTHY
Prevention is the best medicine, and working to keep your lungs healthy is
much more efficient than trying to repair them after something goes
wrong. To keep your lungs healthy, do the following:
1. Stop smoking, and avoid second-hand smoke or environmental irritants.
2. Eat foods rich in antioxidants.
3. Get vaccinations like the flu vaccine and the pneumonia vaccine. This
can help prevent lung infections and promote lung health.
4. Exercise more frequently, which can help your lungs function properly.
5. Improve indoor air quality. Use tools like indoor air filters and reduce
pollutants like artificial fragrances, mold, and dust.
 PROMOTING
EFFECTIVE
CIRCULATION
 UNDERSTANDING BLOOD
CIRCULATION
• A person’s blood circulation determines whether or not organs and
tissues are adequately supplied with freshly oxygenated blood and
nutrients.
• A tiny blockage or congestion in this perfectly laid-out system of veins
and arteries can compromise your body’s major organs—the heart,
the brain, the lungs—and cause a host of medical conditions in the
process.
• Inadequate or interrupted blood flow also slows down the body’s
healing process against injury or illness, even further complicating such
conditions.
 UNDERSTANDING BLOOD
CIRCULATION
• While circulation problems can happen to anyone, they can also
occur naturally as one ages. Our blood vessels’ baroreceptors, which
are responsible for monitoring and maintaining blood pressure,
become less sensitive with old age which helps explain why a lot of
older people experience dizziness caused by a dip in their blood
pressure as they move from lying down to standing, also referred to as
orthostatic hypotension.
• The aorta itself, the heart’s main artery, becomes thicker and less
flexible with aging, forcing the heart to work harder and increasing
one’s blood pressure as a result.
 POOR BLOOD FLOW AMONG
THE ELDERLY
• While circulation is an involuntary and rather natural process, it can become
problematic as we age, as the body begins to struggle with pumping blood
from the heart throughout the rest of the body.
• Factors that contribute to poor blood circulation among seniors, which
include everything from diabetes, smoking, and a sedentary lifestyle among
others, and this can lead to a whole host of symptoms, such as swollen feet,
cramps, and aching in the extremities.
• Many seniors who experience such symptoms can be suffering from one or
more of three common circulation problems: peripheral artery disease,
varicose veins, and deep vein thrombosis—all of which involve an obstruction
in one’s veins and arteries, leading to inadequate blood flow. Various
measures can be taken to help prevent these circulatory problems or to help
alleviate symptoms of such existing conditions.
 MOVING AROUND
• Moving around can be the simplest yet most effective method to get
your blood to flow normally. There are many activities that seniors can
try such as walking, swimming, yoga, or using exercise equipment for
pedal exercises. Pedal exercisers are particularly useful for the elderly
as they allow them to simply sit on their chair and exercise their legs
and arms.
• Take the elderly to outdoors. Consult their physician first, use a slow to
moderate intensity and, take necessary rest periods from time to time.
 MONITORING BLOOD PRESSURE
• Among the diabetic and obese, medical conditions such as
hypertension or high blood pressure contribute significantly to poor
blood circulation, which is why taking your prescriptions religiously
and continuously monitoring one’s health is a must among older
adults.
• To ensure optimal health, keep track of your blood pressure readings
regularly.
 FOODS FOR PROPER CIRCULATION
• Diet affects our health significantly, so it goes without saying that diet
can affect one’s circulation as well. Since poor circulation can cause
plaque build-up in the arteries because of high cholesterol, diabetes,
and the like, eating healthy foods to prevent such complications is
vital.
• As an example, food rich in omega-3 fats, such as fish and other kinds
of seafood, is known to improve blood flow and prevent heart
disease. Food rich in vitamins B, C, and E also significantly contribute
to improved circulation and blood flow in the body.
NUTRITION AND PHYSICAL
ACTIVITY FOR OLDER
PERSONS
 FACTORS THAT AFFECT
NUTRITION IN OLDER PEOPLE
• When an older person does not get the proper amount of nutrition or
hydration, many times his or her symptoms can be mistaken for a
disease or illness.
• As our bodies age, our approach to cooking, eating, and socializing
over meals can change drastically. Unless we pay special attention to
the shifting needs of our loved ones, we may assume it is “business as
usual” and miss an opportunity to be proactive and supportive.
 CHANGES THAT AFFECT NUTRITION
AND HYDRATION IN OLDER PEOPLE:
• Taste buds decrease as we age, as does our taste for salty and sweet. This
can make food taste bitter or sour.
• The loss of smell makes food less appealing and can lead to poor food
choices.
• Diminished or loss of hearing makes it hard to hold a conversation during a
meal and can limit a person’s enjoyment of an otherwise social experience.
• Dentition, which is the make-up of a set of teeth (how many, their
arrangement, and their condition), and how well dentures fit, can cause
people to avoid crunchy or chewy foods.
• Gastrointestinal changes such as constipation and gas may cause older
people to avoid fruits and vegetables.
 CHANGES THAT AFFECT NUTRITION
AND HYDRATION IN OLDER PEOPLE
• Older people experience an increasing disassociation between how
hydrated their bodies are and how thirsty they feel because of
changes in the hypothalamus portion of their brain. Coupled with
medications or diseases that increase a person’s fluid needs, it is no
wonder that elderly dehydration is one of the ten most frequent
admitting diagnoses for hospitalizations.
• As we age, our bodies lose kidney function and are less able to
conserve fluid—this condition often becomes acute after age 70.
Keeping hydrated helps kidneys work better, cognition remain clearer,
and medications get better absorbed.
 FACTORS THAT AFFECT PHYSICAL
ACTIVITY IN OLDER PEOPLE
Barriers to physical activity participation includes:
• Poor health,
• Lack of professional guidance, and
• Inadequate dissemination of information on available programs.
• Motivation to maintain physical and mental health and access to stimulating and accessible
physical activity programs.
• Three groups of factors affect structured physical activity participation in older adults.
1. Personal (i.e., age, sex, socioeconomic status),
2. Social/cultural (i.e., social support of family and friends, influence of physician),
3. Environmental (i.e., access to physical activity, travel time).
• Health (i.e., pain, disease),
• Knowledge (lack of understanding, awareness),
• Childhood exercise (i.e., physical activity experiences as a child).
 ENCOURAGING EXERCISE
AND PHYSICAL ACTIVITY
• Exercise has proven benefits for older people. It reduces risk of
cardiovascular disease, hypertension, type 2 diabetes, osteoporosis,
obesity, colon cancer, and breast cancer. It also decreases the risk
of falls and fall-related injuries.
• Older people may know that exercise is good for their health, but they
may not have the motivation or encouragement to do it. You can
guide your patients by asking about their daily activities and whether
they engage in any kind of regular exercise or physical activity.
 ENCOURAGING EXERCISE AND
PHYSICAL ACTIVITY
• There are several ways to encourage older patients to exercise:
• Whenever appropriate, let them know that regular physical
activity—including endurance, muscle-strengthening, balance,
and flexibility exercises—is essential for healthy aging.
• Help patients set realistic goals and develop an exercise plan.
• Write an exercise prescription, and make it specific, including type,
frequency, intensity, and time; follow up to check progress and re-
evaluate goals over time.
• Refer patients to community resources, such as mall-walking
groups and senior center fitness classes.
 ENCOURAGING EXERCISE
AND PHYSICAL ACTIVITY
• Recommended levels of physical activity for adults aged 65 and
above
• In adults aged 65 years and above, physical activity includes
leisure time physical activity (for example: walking, dancing,
gardening, hiking, swimming), transportation (e.g. walking or
cycling), occupational (if the individual is still engaged in work),
household chores, play, games, sports or planned exercise, in the
context of daily, family, and community activities.
 ENCOURAGING EXERCISE
AND PHYSICAL ACTIVITY
In order to improve cardiorespiratory and muscular fitness, bone and
functional health, reduce the risk of NCDs, depression and cognitive decline:
• Older adults should do at least 150 minutes of moderate-intensity aerobic
physical activity throughout the week or do at least 75 minutes of vigorous-
intensity aerobic physical activity throughout the week or an equivalent
combination of moderate- and vigorous-intensity activity.
• Aerobic activity should be performed in short period of at least 10 minutes
duration.
• For additional health benefits, older adults should increase their moderate-
intensity aerobic physical activity to 300 minutes per week, or engage in 150
minutes of vigorous-intensity aerobic physical activity per week, or an
equivalent combination of moderate-and vigorous-intensity activity.
 ENCOURAGING EXERCISE
AND PHYSICAL ACTIVITY
In order to improve cardiorespiratory and muscular fitness, bone and
functional health, reduce the risk of NCDs, depression and cognitive
decline:
• Older adults, with poor mobility, should perform physical activity to
enhance balance and prevent falls on 3 or more days per week.
• Muscle-strengthening activities, involving major muscle groups, should
be done on 2 or more days a week.
• When older adults cannot do the recommended amounts of physical
activity due to health conditions, they should be as physically active
as their abilities and conditions allow.
 BENEFITS OF PHYSICAL
ACTIVITY FOR OLDER ADULTS
Overall, strong evidence demonstrates that compared to less active
men and women, older adults who are physically active:
• have lower rates of all-cause mortality, coronary heart disease, high
blood pressure, stroke, type 2 diabetes, colon cancer and breast
cancer, a higher level of cardiorespiratory and muscular fitness,
healthier body mass and composition;
• have a biomarker profile that is more favorable for the prevention of
cardiovascular disease, type 2 diabetes and the enhancement of
bone health; and
• exhibit higher levels of functional health, a lower risk of falling, and
better cognitive function; have reduced risk of moderate and severe
functional limitations and role limitations
 STRATEGIES TO IMPROVE
NUTRITION IN OLDER ADULTS
• Older patients may develop poor eating habits for many reasons. These can range
from a decreased sense of smell and taste to teeth problems or depression. Older
people may also have difficulty getting to a supermarket or standing long enough
to cook a meal. Energy needs may decrease with age, the need for
certain vitamins and minerals, including calcium, vitamin D, and vitamins B6 and
B12, increases after age 50.
Strategies to encourage healthy diets:
• Emphasize that good nutrition can have an impact on well-being and
independence. Involve the elderly with food plan.
• If needed, suggest liquid nutrition supplements, but emphasize the benefits of solid
foods.
• If needed, suggest multivitamins that fulfill 100 percent of the recommended daily
amounts of vitamins and minerals for older people, but not megadoses.
• Offer a referral to a nutrition services program
 MISSING IN THE DIET OF THE
OLDER PEOPLE
• Needs more protein to retain muscles mass, dental health, and a healthy
immune system. Other common nutrient deficiencies in the elderly result
from inadequate intake of vitamin A, B, C, D, E, folic acid and niacin.
• Social and economic factors also affect how a person shops, cooks and
eats.
• Loneliness, especially after the loss of a spouse, causes a person to lose
interest in cooking or learning to cook.
• Fear of falling or hurting one’s self can prevent regular trips to the grocery
store or use of a hot stove or oven.
• Financial concerns, including medical and prescription medication costs,
may cause an older person to skimp on meals.
 WHAT SHOULD OLDER
PEOPLE EAT AND DRINK?
The USDA food patterns suggest that people 50 or older choose healthy foods every day
from the following:
• Fruits — 1-1/2 to 2-1/2 cups
• What is the same as 1/2 cup of cut-up fruit? A 2-inch peach or 1/4 cup of dried fruit
• Vegetables — 2 to 3-1/2 cups
• What is the same as a cup of cut-up vegetables? Two cups of uncooked leafy
vegetable.
• Grains — 5 to 10 ounces
• What is the same as an ounce of grains? A small muffin, a slice of bread, a cup of
flaked, ready-to-eat cereal, or ½ cup of cooked rice or pasta
• Protein foods — 5 to 7 ounces
• What is the same as an ounce of meat, fish, or poultry? One egg, ¼ cup of cooked
beans or tofu, ½ ounce of nuts or seeds, or 1 tablespoon of peanut butter
 WHAT SHOULD OLDER
PEOPLE EAT & DRINK?
• Dairy foods — 3 cups of fat-free or low-fat milk
• What is the same as 1 cup of milk? One cup of yogurt or 1-1/2 to 2
ounces of cheese. One cup of cottage cheese is the same as ½ cup of
milk.
• Oils — 5 to 8 teaspoons
• What is the same as oil added during cooking? Foods like olives, nuts,
and avocado have a lot of oil in them.
• Solid fats and added sugars (SoFAS) — keep the amount of SoFAS small
• If you eat too many foods containing SoFAS, you will not have enough
calories for the nutritious foods you should be eating. Examples are fats
that are solid at room temperature, like butter, shortening, lard, and stick
margarine and added “empty calories” like high fructose corn syrup.
 RESOURCES:
Textbooks:
Kane, Robert L., Resnick, Barbara, Essentials of Clinical Geriatrics 6th Edition (2009),
Mc-Graw-Hill Companies, Inc.
Mauk, Kristen L., Gerontological Nursing: Competencies for Care 2nd edition (2010),
Jones and Barlett Publishers
Natividad, J. N., Kuan, L. G., S. R. Bonito, A. O. Balabagno, et. al., Caring for the
Older Person (2005), University of the Philippines, Office of Academic Support and
Instructional Services
Tabloski, Patricia A., Essentials Of Gerontological Nursing 1st Edition (2006), Pearson
education Inc.
Walker, Lynne, Patterson, Elizabeth, et. al., General PRACTICE Nursing (2010), Mc-
Graw-Hill Companies, Inc.
Internet Sources:
http://www.info@jbpub.com/
http://www.doh.gov.ph/