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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 • Exercise • Nutrition • Rest & sleep • Periodic medical check up • High risk behavior • Spiritual well-being • Psychosocial well-being
Physical benefits of exercise • Consumption of body fat • Improve cardio-vascular capacity( by↑blood flow----- keep tissue healthy • Control hypertension& blood sugar • Improve respiratory function • Improve joint flexibility • Improve pattern of sleep & rest • ↑ independency • Improve sense of well –being & relaxation • Maintain mind’s function • Promote sense of normality • Peristaltic movement
Psychological benefits of exercise • Improve mood state • Improve self-image • Reduce stress • Enhance sleep • Improve depressive state of elderly
Social benefits of exercise • Improve social interaction & relation with other
Role of the nurse during exercise I- Assessment done at the beginning of exercise program include: • History & physical examination (CVS, resp, musculoskeletal & neurological system) • Renal & liver function tests • ECG,& exercise stress test • Assess range of motion & use of assistive devices. • Assess environmental hazards II-Set a regular time to exercise each day
III- Before starting exercise the nurse should advice the elderly about: • Document baseline resting function status (ht &resp rate, bl.sugar) • 10 minutes warms up stretching exercise • Drink water before and after exercise is important as water will be lost during exercise • Clothes worn during exercise should allow for easy movement and perspiration. • Athletic shoes provide both support and protection • Outdoor exercise should be avoided in extremely hot or cold weather.
Enclosed shopping malls are sheltered places for walking during the extreme weather or when there are concerns about neighborhood safety. • Exercising with a partner provides both encouragement to continue exercising and safety. • 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
2- Nutrition It is neglected especially those living alone or with low income. Factors affecting nutritional status: • Age related changes • Psychosocial factors • Economic factors • 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
3-Fat requirement • 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
4- Carbohydrates requirement • 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.
5-Fluid intake Elderly at high risk for dehydration due to: • ↓ Thirst sensation • Inadequate fluid intake (2000-3000 cc/day) required • Some medications, such as for high blood pressure or anti-depressants, and diuretic • Some medications may cause patients to sweat more • 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 • 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) • Illness, especially one that causes vomiting and/or diarrhea, also can cause elderly dehydration
6- Vitamins & mineral 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
3- Rest& sleep • 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: • Conserve energy • Provide organ respite (rest) • Restore the mental alertness& neurological efficiency • Relieve tension • 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 • Engage in exercise program • Avoid exercise within 3-4 hr. of bedtime. • Spend time out door in the sunlight each day but avoid period between 12 Md to 3 PM sunshine exposure. • Engage in relaxing activities near bedtime. • Avoid tobacco at bedtime • Avoid drink any caffeinated beverages before mid afternoon. • Limit fluid intake after the dinner hour if nocturia is a problem. • Limit daytime naps to 30 minutes or less. • Avoid using the bed for watching TV, writing bills, and reading.
4- Periodic medical examination Importance of Periodic medical examination: • Assess elderly level of well-being • Detect early signs of disease • Educate client how to promote his health • Reinforce + ve promoting & protecting behaviors • If examination done at home, it permit evaluation of environment ( hazards care giver…)
5- High Risk Behavior • 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
6- Spiritual Well- being • 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
7- Psychosocial Well- 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.