Prepared by:

Dr. MOHSEN

SALMANNEZHAD

Gerontology student (PHD)

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

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

1. Exercise 2. Nutrition3. Rest & sleep 4. Periodic medical check up5. High risk behavior6. Spiritual well-being 7. Psychosocial well-being

Physical Social

Psychological

Benefits ofBenefits of exerciseexercise

PHYSICAL BENEFITS OF EXERCISE

1) Consumption of body fat2) Improve cardio-vascular capacity( by↑

blood flow----- keep tissue healthy3) Control hypertension& blood sugar4) Improve respiratory function 5) Improve joint flexibility6) Improve pattern of sleep & rest7) ↑ independency 8) Improve sense of well –being & relaxation9) Maintain mind’s function 10) Promote sense of normality11) Peristaltic movement

PSYCHOLOGICAL BENEFITS OF EXERCISE

1. Improve mood state2. Improve self-image3. Reduce stress4. Enhance sleep5. Improve depressive state of elderly

SOCIAL BENEFITS OF EXERCISE

Improve social interaction & relation with other

Types of

exercise

Isotonic Isometric

I- Assessment done at the beginning of exercise program include:

1. History & physical examination (CVS, resp, musculoskeletal & neurological system)

2. Renal & liver function tests3. ECG,& exercise stress test4. Assess range of motion & use of

assistive devices.5. Assess environmental hazardsII-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.

Monitor heart & resp. rate Stop exercise if elderly has fatigue ,

chest pain or ↑heart & resp. rateAfter exercise:

10 minutes cooling up at end of exercise

Monitor pulse rate during cooling for returning to resting ht. rate

It is neglected especially those living alone or with low income.

Factors affecting nutritional status:1) Age related changes2) Psychosocial factors3) Economic factors4) Cultural factors

↓ 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.

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.

Low income Limited access to food and food

choices Inadequate facilities to food storage

and preparation

Eating habits may miss certain food group as vegetarians.

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

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 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

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.

Elderly at high risk for dehydration due to:1. ↓ Thirst sensation2. Inadequate fluid intake (2000-3000 cc/day) required3. Some medications, such as for high blood pressure or

anti-depressants, and diuretic4. Some medications may cause patients to sweat more5. 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

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

Assessment involves: nutritional history, physical examination, anthropometric measurements, biochemical evaluation, cognitive & mood evaluation

Health history related to nutrition Anthropometric measurement Client and family education

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

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 energy2) Provide organ respite (rest)3) Restore the mental alertness&

neurological efficiency 4) Relieve tension5) Emerge feeling of well being

Age related changes in sleep patterns

Internal factors External factors

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 bedtime6. 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.

Importance of Periodic medical examination:

1. Assess elderly level of well-being2. Detect early signs of disease3. Educate client how to promote his

health4. Reinforce + ve promoting &

protecting behaviors5. If examination done at home, it

permit evaluation of environment ( hazards care giver…)

Health screeningHealth screeningPeriodPeriod

Bl. pBl. pEach Dr. visit or 3-6 Each Dr. visit or 3-6 monthsmonths

Ht & wtHt & wtPeriodically as part of Periodically as part of comprehensive comprehensive

physical examinationphysical examination

Dental check upDental check upOnce / year( annually)Once / year( annually)

Fecal occult blood& Fecal occult blood& sigmoidoscopysigmoidoscopy

( (annuallyannually))

Vision including Vision including glaucoma testglaucoma test

Every 2 yearsEvery 2 years

Health screeningHealth screeningPeriodPeriod

HearingHearingEvaluate Evaluate periodicallyperiodically

Cholesterol levelCholesterol level Every 5 yearsEvery 5 years

Cancer screeningCancer screeningAnnuallyAnnually

Mammography for Mammography for women under 70 ywomen under 70 y

1-21-2 yearsyears

Digital rectal Digital rectal examinationexamination

AnnuallyAnnually

VaccinationVaccinationPeriodPeriod

Influenza (over Influenza (over 65y)65y)

Annually (mid Annually (mid October to mid October to mid

November)November)

Tetanus & Tetanus & diphtheriadiphtheria

Every 10 yearsEvery 10 years

Pneumococcal Pneumococcal vaccinationvaccination

Once at age 65y, Once at age 65y, revaccination for revaccination for

high risk fatal high risk fatal pneumonia/6 ypneumonia/6 y

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 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 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

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 changes may alter an individual relationship with others.

Physical wellbeing depend on: Psychosocial wellbeing Social structure Personal relationshipsIn Later years many adjustment are

necessary

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.

Take care