Health promotion

Presented by
Dr. Eman Shokry Ab-dallah
Professor and Head of
Gerontological Nursing Department
 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
 An isotonic exercise is an exercise that forces the
muscles to contract and expand throughout a full
range of motion, while working against some form of
resistance.

 Examples of Isotonic Exercises:

• Resistance training exercises (i.e. curls, bench
presses, deadlifts, squats, pull-ups)
• Aerobic exercises (i.e. running, swimming, cycling)
• Even everyday tasks like cleaning or mowing the
lawn can be considered forms of isotonic exercise.
 Isometric exercises are exercises that involve the
contraction of muscles without any movement in the
surrounding joints.

 Isometric exercises are designed to hold your body

in a position for a set period of time, which can help
build muscular strength and endurance.

 They’re ideal as low-impact exercise, need limited

space, and may help recovery from certain injuries.
 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 requirements -6
 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 examination -4
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 glaucoma Every 2 years

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 65y) Annually (mid October to

mid November)
Tetanus & diphtheria Every 10 years

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- being -7
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.