Health promotion

Prepared by:
Dr. Soad Hassan
Lecturer of Gerontological
Nursing
 Health promotion of the elderly
Health promotion is the process of
enabling people to increase control
over & improve their health by
developing their resources to maintain
or enhance well being.

Health promoting is an action for

health using knowledge, communication
& understanding
 Objectives of health promotion
 Increase quality and years of
healthy life
 Maintain function
 Eliminate health disparities and
independency
 Improve (enhance) quality of life
 Extend life expectancy → ↓
premature mortality caused by
chronic& acute diseases
 Component of health promotion
1. Exercise
2. Nutrition
3. Rest & sleep
4. Periodic medical check up
5. High risk behavior
6. Spiritual well-being
7. Psychosocial well-being
 1- Exercise

Psychological

Benefits of
exercise

Physical Social
 Physical benefits of exercise
1) Consumption of body fat
2) Improve cardio-vascular capacity( by↑
blood flow----- keep tissue healthy
3) Control hypertension& blood sugar
4) Improve respiratory function
5) Improve joint flexibility
6) Improve pattern of sleep & rest
7) ↑ independency
8) Improve sense of well –being & relaxation
9) Maintain mind’s function
10) Promote sense of normality
11) Peristaltic movement
Psychological benefits of
exercise
1. Improve mood state
2. Improve self-image
3. Reduce stress
4. Enhance sleep
5. Improve depressive state of elderly
 Social benefits of exercise

 Improve social interaction & relation

with other
 Types of
exercise

Isotonic Isometric
 Role of the nurse during
exercise
I- Assessment done at the beginning of
exercise program include:
1. History & physical examination (CVS,
resp, musculoskeletal & neurological
system)
2. Renal & liver function tests
3. ECG,& exercise stress test
4. Assess range of motion & use of
assistive devices.
5. Assess environmental hazards
II-Set a regular time to exercise each day
III- Before starting exercise the nurse should advice the
elderly 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. Enclosed shopping malls are sheltered
places for walking during the extreme
weather or when there are concerns
about neighborhood safety.
2. Exercising with a partner provides
both encouragement to continue
exercising and safety.
3. Nurse should advice the older adults
to stop exercising and seek help if they
experiences chest pain or tightness,
shortness of breath, dizziness, or
palpitation during exercise.
 During exercise
 Monitor heart & resp. rate

 Stop exercise if elderly has fatigue ,

chest pain or ↑heart & resp. rate
After exercise:
 10 minutes cooling up at end of
exercise
 Monitor pulse rate during cooling
for returning to resting ht. rate
 Nutrition- 2
It is neglected especially those
living alone or with low income.
Factors affecting nutritional status:
1) Age related changes

2) Psychosocial factors

3) Economic factors

4) Cultural factors
 Age related changes
 ↓ Taste & smell
 ↓ Visual acuity
 Loss of teeth & poor fitting denture
 ↓ Gastric secretion→ influence in
absorption of B12, folic acid& iron.

Food remain longer time in

stomach + ↓ gastric secretion will
lead to indigestion &feeling of
fullness.
 Psychosocial factors
 Depression is common ( losses, death,
retirement, change of body appearance,
impaired vision &poor physical fitness) this
will lead to lack of interest in eating&
anorexia and ↓ food intake.

 Living alone also will lead to lack of

incentive to cook &eat.
 Economic Factors
 Low income
 Limited access to food and food
choices
 Inadequate facilities to food storage
and preparation
 Cultural factors
 Eating habits may miss certain food group
as vegetarians.
Nutritional requirement of
elderly
1- Calories
 Caloric requirement diminished by
10% in age 51-75 years and by 20-
25% in age more than 75 years.

 N.B: Fat yield 9 cal/gram, CHO and

protein yield 4 cal/gram, mineral
and water yield no calories
 2- Protein requirement
 0.8 g/kg body wt
 A balanced diet of a healthy
elderly should contain 12-14% of
total caloric intake.
 During infection, stress, trauma
protein ↑ to 1.6 or 1.5 g/kg body wt
 Fat requirement-3

 Fat either saturated or

unsaturated
 Total fat intake limited to 30 %
or less of total energy intake
 Saturated fat limited to 10-15%
of total energy intake
 Dietary cholesterol intake
limited to 300mg/ day or less
 Carbohydrates requirement- 4

 CHO is essential for maintaining

normal bl. glucose level & preventing
protein break down.
 50% of total calories---- CHO
 Simple CHO as sugar, honey ( avoided)
 Complex CHO as vegetables, grains,
fruits
 Complex CHO has vit, minerals, fibers
which help in bowel elimination& ↓ bl.
cholesterol level.
 Fluid intake-5
Elderly at high risk for dehydration due to:
1. ↓ Thirst sensation
2. Inadequate fluid intake (2000-3000 cc/day) required
3. Some medications, such as for high blood pressure or
anti-depressants, and diuretic
4. Some medications may cause patients to sweat more
5. Frail seniors have a harder time getting up to get a
drink when they’re thirsty, or they rely on caregivers
who can’t sense that they need fluids
6. As we age our bodies lose kidney function and are less
able to conserve fluid (this is progressive from around
the age of 50, but becomes more acute and noticeable
over the age of 70)
7. Illness, especially one that causes vomiting and/or
diarrhea, also can cause elderly dehydration
 Vitamins & mineral- 6
requirements
 Calcium:---for mineralization of bone
&has a role in blood & cardiac function.
 Daily requirement 1200 mg./day if
there is no contraindications

 Vitamin D :------ needed for calcium

absorption& metabolism.
 Exposure 15 minutes/day to sun is
enough
 Nurse Role
 Assessment involves: nutritional
history, physical examination,
anthropometric measurements,
biochemical evaluation, cognitive &
mood evaluation

 Health history related to nutrition

 Anthropometric measurement
 Client and family education
 Dietary guideline for old
persons
 Eat a variety of food
 Maintain a healthy wt

 Choose a diet low in fat,

saturated & cholesterol

 Choose a diet plenty of

vegetables, fruits &

grain products
 Use sugar & salts in
moderate
 Drink 200-3000cc/daily
 Rest& sleep- 3
 Person spend 1/3 of his life in sleep
 Sleep is time for cell growth& repair
 Elderly need 5-7 hrs at night

Importance of Rest& sleep:

1) Conserve energy

2) Provide organ respite (rest)

3) Restore the mental alertness&

neurological efficiency
4) Relieve tension

5) Emerge feeling of well being

 Factors affecting sleeping
patterns
 Age related changes in sleep
patterns
 Internal factors
 External factors
 Nursing measures adopted to promote
sleep
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 bedtime
6. 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.
 Periodic medical- 4
examination
Importance of Periodic medical
examination:
1. Assess elderly level of well-being
2. Detect early signs of disease
3. Educate client how to promote his
health
4. Reinforce + ve promoting &
protecting behaviors
5. If examination done at home, it
permit evaluation of environment
( hazards care giver…)
 Types of health screening
Health screening Period
Bl. p Each Dr. visit or 3-6
months
Ht & wt Periodically as part of
comprehensive
physical examination

Dental check up Once / year( annually)

Fecal occult blood& (annually)
sigmoidoscopy

Vision including Every 2 years

glaucoma test
Health screening Period

Hearing Evaluate
periodically

Cholesterol level Every 5 years

Cancer screening Annually

Mammography for years 1-2

women under 70 y
Digital rectal Annually
examination
 Immunizations
Vaccination Period
Influenza (over Annually (mid
65y) October to mid
November)
Tetanus & Every 10 years
diphtheria
Pneumococcal Once at age 65y,
vaccination revaccination for
high risk fatal
pneumonia/6 y
 High Risk Behavior- 5
 It is behavior that damage physical
health.

It includes:
 Over the counter medication (multiple
medications )
 Smoking

 Caffeine
 Smoking
 Nicotine & toxic substances in cigarette
has impact on detoxication process in
the body------- cell damage& variety of
diseases as cancer, respiratory, CVD, ↑
risk of osteoporosis

 Cessation of smoking improves cerebral

blood flow& ↑ pulmonary function
 Multiple medication
 Older people consume many
medication--------↑adverse drug
reaction

 The most common over the counter

medication: Analgesics, laxatives&
antacids followed by cough
products, eye wash& vitamins.
 Caffeine
 Found in coffee, tea, soft drinks,
chocolate
 It is mood elevator
 It stimulates sympathetic nervous
system
 ↑motor activity
 ↑ muscle capacity & alertness
 ↑ Rapid pulse
 ↑ calcium excretion
 Spiritual Well- being- 6
 Spiritual well-being is the practice
and philosophy of the integral aspects
of mental, emotional and overall
wellbeing.

 Spiritual well-being is a state in

which the positive aspects of
spirituality are experienced,
incorporated and lived by the individual
and reflected into ones environment.
Signs of spiritual distress:
 Doubt

 Despair

 Guilt

 Boredom

 Expression of anger toward god

 Benefits

 The practice and incorporation of

Spiritual Wellbeing into one’s life
influences and includes benefits for
ones; Emotional Wellbeing,
Physical Wellbeing, and
Mental Wellbeing.
Some of the measurable benefits that people experience
from spiritual wellbeing counseling and groups
include:
 A feeling of being more contented with their life’s
situation
 Greater enjoyment of self time, finding an inner peace
 Greater ability to take control of and resolve their
life’s issues
 A greater sense of satisfaction in their activities and
life situations
 Ability to take a more active part in life rather than
standing still and watching it pass by
 Ability to build more intimate, loving and lasting
relationships
 A greater feeling of purpose and meaning in their life
 Measures to increase Spiritual
well being
 Identify ways that believes give meaning to
life
 Use problem solving to solve any conflict
related to spirituality
 Meeting with religious man at regular
intervals
 Presence of religious literatures in the
immediate environment such as Quran on
beside table
 Reading in religious books & praying
 Discuss role of spirituality in one’s life
 Psychosocial Well-- 7
being
Psychosocial changes may alter an
individual relationship with others.
Physical wellbeing depend on:
 Psychosocial wellbeing

 Social structure

 Personal relationships

In Later years many adjustment are

necessary
 Role of the nurse in health
promotion
 Assessment to his physical health,
Psychosocial Well- being, lifestyle pattern,
hobbies, high risk behaviors, knowledge,
believes& attitudes that affect health &
wellbeing.
 Assess health needs
 Assess social , environmental & cultural
influences on health behaviors
 Lifestyle modifications is a comprehensive
approach for effective change in heath
promotion behaviors
 Nurse role should directed toward helping
elderly to cope with his function level
------delay disabilities & impairments.
 Nurse identify environmental hazards &
make necessary modifications
 Identify social needs & encourage
participation & social support groups.
 Nurse should inform elderly & caregivers
about aging process, common disorders &
disabilities , different services available
 Encourage elderly to take better
care to them, avoid high risk
behaviors,& hazards affecting their
health.
 Regular and continuous evaluation is
important aspect of nurse’s role.