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Health promotion

Prepared by:
Istianna Nurhidayati
Lecturer of Gerontological
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
 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


Benefits of

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

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
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
2- Nutrition
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
 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
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
 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
5-Fluid intake
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
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

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

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

 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

 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:

1) Conserve energy
2) Provide organ respite (rest)
3) Restore the mental alertness& neurological
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
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
4. Engage in relaxing activities near bedtime.
5. Avoid tobacco at bedtime
6. Avoid drink any caffeinated beverages before mid
7. Limit fluid intake after the dinner hour if nocturia is a
8. Limit daytime naps to 30 minutes or less.
9. Avoid using the bed for watching TV, writing bills,
and reading.
4- Periodic medical 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
5. If examination done at home, it permit
evaluation of environment ( hazards care
Types of health screening
Health screening Period
Bl. p Each Dr. visit or 3-6 months
Ht & wt Periodically as part of
comprehensive physical

Dental check up Once / year( annually)

Fecal occult blood& ( annually)

Vision including glaucoma Every 2 years

Health screening Period

Hearing Evaluate periodically

Cholesterol level Every 5 years

Cancer screening Annually

Mammography for 1-2 years

women under 70 y
Digital rectal Annually
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
5- High Risk Behavior
 It is behavior that damage physical health.

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

 Smoking

 Caffeine
 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&
 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


 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
 A feeling of being more contented with their life’s
 Greater enjoyment of self time, finding an inner
 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
 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 &
 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 &
 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.