Health promotion ,Risk reduction.pptxsct

Health promotion for elderly

1. Health Promotion, risk reduction and disease prevention for the elderly Presented to Prof Dr /Naglaa Gheida Dr /Fatma Elsewerky

2. 0utline Introduction Definition of Health , wellness, and health promotion Principles of health promotion Objectives of health promotion Components of Health Promotion Levels of prevention Approaches of Health Promotion Challenges of health promotion Health Promotion modles Role of the nurse in health promotion

3. Introduction Health promotion can be defined as activities and preventive measures that contribute to an individual’s state of optimal health. Such activities and preventive measure include immunizations, fitness/exercise programs, breast self-examination, appropriate nutrition, relaxation, stress management, social support, prayer, meditation, cultural practices, and promoting environmental health and safety

4. Definition of Health Is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Is a holistic state of wellbeing, which includes soundness of mind, body, and spirit.

5. Definition of Wellness: A balance of the physical, emotional, psychological, social and spiritual aspects of a person's life. This is a dynamic state. Wellness behaviors are those that promote healthy functioning and help prevent illness. These include stress management, nutritional awareness, and physical fitness .

6. Definition of Health behavior Health behavior , is motivated by stimuli in an individual‘s environment. The response to such stimuli may or may not be directly related to health

7. Definition of health promotion Is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions .

8. Principles of health promotion World Health Organization Principles of Health Promotion 1-Empowerment Health promotion initiatives should enable individuals and communities to assume more power over the personal, socio-economic and environmental factors that affect their health. 2-Participative Health promotion initiatives should involve those concerned in all stages of planning , implementation and evaluation.

9. 3-Holistic Health promotion initiatives should foster physical, mental, social and spiritual health. 4-Inter-sectoral Health promotion initiatives should involve the collaboration of agencies from relevant sectors. 5-Equitable Health promotion initiatives should be guided by a concern for equity and social justice or satisfaction

10. 6-Sustainable Health promotion initiatives should bring about changes that individuals and communities scan maintain once initial funding has ended. 7-Multi-strategy Health promotion initiatives should use a variety of approaches in combination with one another, including policy development, organizational change, community development, legislation, advocacy, education and communication.

11. 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

12. Components of Health Promotion Health protection . Health education . Disease prevention

13. Health P rotection : Health protection includes public policies that address fair access to housing, employment, education, and health care. Promotes healthy policies in all sectors (e.g. healthy workplaces, schools, homes, buildings and communities). Health Policies should also emphasize the promotion and prevention.

14. Health education Is defined by the (WHO Centre for Health Development, 2014), as any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes. Steps of health education: To know (knowledge) To feel importance to health (attitude) To change (practice)

15. 3.Disease Prevention Actions aimed at eradicating, eliminating or minimizing the impact of feasible, delaying the progress of disease and disability.

16. Subjects of health promotion Exercise Nutrition Rest & sleep Spiritual well-being Psychosocial well-being 

17. Exercise 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

18. 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

19. Nurse role:- I- Assessment done at the beginning of exercise program include: History & physical examination ( 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. Outdoor exercise should be avoided in extremely hot or cold weather.

20. 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

21. 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

22. 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.  

23. 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. 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

24. 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 Complex CHO has vit , minerals, fibers which help in bowel elimination& ↓ bl. cholesterol level

25. -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

26. - 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

27. 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

28. 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

29. Factors affecting sleeping patterns Age related changes in sleep patterns Internal factors :Body aches or other pains: Certain pains like muscle or joint pain Anxiety or stress : Our bodies are built in such a manner that they respond to stressful or dangerous situations by remaining awake. Same happens in during stress, depression or anxiety External factors : such as what we eat and drink, the medications we take, and the environment in which we sleep can also greatly affect the quantity and quality of our sleep

30. Nurse Role :- 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

31. Spiritual Well- being Spiritual well-being is the practice and philosophy of the integral aspects of mental, emotional and overall wellbeing. Signs of spiritual distress: Doubt Despair Guilt Boredom Expression of anger toward god

32. 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

33. Ability to build more intimate, loving and lasting relationships Measures to increase Spiritual well being 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

34. 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

35. Levels of prevention 1- primordial level prevention of the development of risk factors in the first place with lifestyle only and avoiding the use of medications to treat risk factors Government policy : Increasing taxes on cigarettes; Decreasing advertisement of tobacco Built Environment : Access to safe walking paths; access to stores with healthy food options

36. (2) Primary Prevention Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury. . It includes : A. Health promotion Through education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)

37. B. specific protection 1-legislations and enforcement to ban or control the use of hazardous products or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) 2-immunization against infectious diseases

38. 3) Secondary prevention Stop or slow the progression of disease and to prevent limit permanent damage which targeted at sick individuals. It includes : A. Early detection B. Proper / prompt treatment

39. 4-Tertiary prevention Helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy Targeted at people with chronic diseases and disabilities that can't be cured. It includes:  prevent or limit disability  Rehabilitation

40. 5.Quaternary Prevention " 'an action taken to protect individuals (persons/patients) from medical interventions that are likely to cause more harm than good."

41. Approaches of Health Promotion Medical. Empowerment. Behavior change. Educational approach. Social change

42. 1. Medical or preventive approach Aim: reduce morbidity and premature mortality- To ensure freedom from disease and disability. Methods: uses medical intervention to prevent ill-health or premature death. Example: immunization, screening

43. 2-Empowerment Approach : Identify individual or community health needs and gain the knowledge, skills and attitudes to act upon them through a program of action Two types of empowerment : Self-empowerment : based on counseling and aimed at increasing people‘s control over their own health. Community empowerment : related to community development to create active , participating communities

44. Methods: Counseling, problem solving, community development, advocacy, public participation. Evaluation: Difficult because empowerment is long term , and results are hard to specify and quantify.

45. 3.Behavior Change : Aim: Encourage individuals to adopt “healthy” behaviors, Views health as the responsibility of individuals. Methods: Communication Education Persuasion, motivation

46. 4-Educational Approach To provide knowledge and information. To develop the necessary skills for informed choice. The outcome is client's voluntary choice. Methods: - Information ‐ giving through small groups or mass ‐ media, group discussions role ‐ plays -Group discussion for sharing and exploring health attitudes. 18 -Role play for decision- making and negotiating. Evaluation: knowledge, attitude and practice.

47. .5- Social Change to bring about changes in physical, social and economic environment, which enables people to enjoy better health. To make the healthy choice the easier choice. The focus is on changing society, not on changing the behavior of individuals. Methods: advocacy, policies, fiscal/ financial measures, creating supportive social and physical environmen

48. Challenges of health promotion 1-Poverty: Results in poor living conditions (poor nutrition, poor housing, environmental degradation) that are major obstacle for improving health of people. 2-Education: Low levels of literacy especially health literacy can be an obvious problem when trying to promote better health behavior among people.

49. 3-Economic priorities : Most developing countries have limited resources and many competing demands for these resources. They are seeking to achieve rapid economic gains and development by industrialization and food production that gives priority to foreign markets for earning foreign exchange 4-Political stability: Where there is political instability (internal conflict and war), it is extremely difficult to develop health-promoting environments. Challenges of health promotion

50. 5-Inter-sectoral co-operation : Decision- makers in all sectors (even in areas that are indirectly related to health as agriculture, commerce, education, industry etc.) must focus on the health implications of their policies. 6-Commercial interests: Marketing does not necessarily consider health of citizens of developing countries upper most in their priorities. This often results in poor health outcomes. Challenges of health promotion

51. 7-The double burden of disease: One of the particular challenges that face developing countries is that the epidemic of non-communicable diseases is developing before the burden of communicable (infectious disease) has been dealt with. 8-The speed of change: Populations in the developing world are increasing at a much faster rate than countries in the developed world.

52. Health Promotion modles 1- Health belief model 2- Socio ecological Model 3- Trans theoretical model 4-Pender model of health promotion 5-Tannahill model

53. Health Belief Model The model is used to explain and predict individual changes in health behaviors. It is one of the most widely used models for understanding health behaviors. Key elements of the model focus on individual beliefs about health conditions, which predict individual health-related behaviors.

54. Health Belief Model

55. Constructs of (HBM): (1) Perceived susceptibility (a person’s subjective assessment of their risk of getting the condition, as contrasted with the statistical risk). (2) Perceived severity (the seriousness of the condition and its consequences). (3) Perceived benefits Individual’s belief that behavior change will have a positive impact on health outcomes (potential positive benefits of actions). (4) Perceived barriers (both those that interfere with and facilitate adoption of a behavior such as side effects, time, and inconvenience)

56. (5)Cues to action : (events that spur individuals toward action), Internal Cues ( appearance of symptoms)or External Cues (mass media) (6 )Self-efficacy : (an individual’s confidence that he or she can successfully carry out the indicated actions).

57. 2- Socio ecological Model The model recognize multiple level of influence on health behaviors, including:

58. Intrapersonal / individual factors: ( influence behavior) as Knowledge, attitudes, beliefs, personality . Interpersonal factors As interaction with people (provide social support or create barriers to interpersonal growth that promotes healthy behavior Institutional and organizational factors (rules, regulations, policies) constrain or promote healthy behaviors

59. Community factors: as formal or informal social norms that exist among individuals, groups or organizations can limit or enhance healthy behaviors. Public policies factors: (local, state, and federal policies and laws ) regulate or support healthy actions for disease prevention (detection, control, management).

60. 3- Trans theoretical model

61. This model explains an individual’s readiness to change their behavior. It describes the process of behavior change as occurring in stages 3- Trans theoretical model

62. 1. Pre-contemplation : there is no intention of taking action. 2. Contemplation : there are intentions to take action and a plan to do so in the near future. 3. Preparation : there is intention to take action and some steps have been taken . 4. Action : Behavior has been changed for a short period of time 5. Maintenance : Behavior has been changed and continues to be maintained for the long term 6. Termination : There is no desire to return to prior negative behaviors 3- Trans theoretical model

63. Pender Model Health promotion model that attempts to account for those behaviors that improve well-being Health promotion behaviors are determined by : 1.Individual characteristics and experiences: Prior related behavior : frequency of the same or similar health behavior in the past. Personal Factors : Personal biological factors:  Include variables such as age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, or balance.

64. Pender Model 2.Behavior-specific cognitions and affect Perceived Benefits of Action Anticipated positive outcomes that will occur from health behavior. Perceived Barriers to Action Anticipated, imagined, and personal costs of understanding a given behavior.

65. Pender Model Perceived Self-Efficacy The judgment of personal capability to organize and execute a health-promoting behavior. Activity-Related Affect Subjective positive or negative feeling occurs before, during, and following behavior based on the stimulus properties of the behavior itself.

66. Pender Model Interpersonal Influences Primary sources of interpersonal influences are families, peers, and healthcare providers. Situational Influences Personal perceptions and cognitions of any given situation or context can facilitate or impede behavior.

67. Pender Model 3.Behavioral outcomes Perceived benefits of action Immediate competing demands such as family or work commitments. Commitment to a plan of action

68. 5- Tannahill’s Model

69. 5- Tannahill’s Model created a model that presented health promotion as three overlapping spheres of activity: Health education Health prevention Health protection

70. 5- Tannahill’s Model

71. Role of the nurse in health promotion Assessment to his physical health, Psychosocial Well- being, lifestyle pattern Assess health needs Assess social , environmental & cultural influences on health 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

72. References World Health Organization (2019). Phase V (2009–2013) of the WHO European Healthy Cities Network: goals and requirements. Europe: World Health Organization. http://www.euro.who.int/__data/assets/pdf_file/0009/100989/E92260.pdf Centers for Disease Control (CDC). (2010). Deaths and mortality. Retrieved from www.cdc.gov/nchs/fastats/deaths.htm Centers for Disease Control (CDC). (2013). A framework for prevention. Retrieved from www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html Worldviews Evid Based Nurse. 2016 The Jakarta Declaration on Leading Health Promotion into the 21st Century. HPR/HEP/4ICHP/BR/97.4