Health Promotion Paper
Health Promotion Paper
Health Promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotion, social, spiritual and intellectual health. It is more than lifestyle change, it is also about changing environments so they are more supportive of making healthy decisions. Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior, and create environments that support the good health practices.
Prevention of Fall for Elderly
Falls in Elderly
Falls have come to be recognized as a major threat to the safety, health and independence of elderly persons. The elderly are increasing faster than any other age group and are particularly vulnerable to many social and health problems. A serious threat to the older population is loss of mobility.
Falls are the leading cause of accidents in persons 65 years of age or older. Falls are also the main cause of serious injuries and deaths in older people. Falls account for 70 percent of accidental deaths in persons 75 years of age and older. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year (2000). Even older people who appear to be strong and well also can fall. Falling is a threat to your living on your own.
The normal changes of aging can cause fall in elderly such as poor eyesight or poor hearing. Physical conditions and illness can affect strength and balance.
In additional, the side effects of medication can also affect balance and make the elderly fall. Medicines like for depression, sleep problems and high blood pressure often cause falls. And even some medicines for diabetes and heart problems can cause someone unsteady on his feet.
Moreover, falls are due to environmental hazards and disorders of balance or gait. Falls occur wherever individuals spend most of their time, usually in or near the home.
The main objective of this program is to prevent the possibility of fall for the community-dwelling elderly
1. improve balance and mobility
2. Monitor medication use by elderly
3. identify home hazards and stimulate activities
4. minimize fall risks in elderly
This health promotion program is directed and aimed to preventing the possibility of fall for community-dwelling elderly because mostly older people are living independently in the community or residents of nursing homes. Studies show that 90 percent of adults aged 65 years old or more live in the community (2000).
Older people are more likely to suffer from injuries and infections than the other age group. The factors that place elders at higher risks are associated with age physiological decrements and drug side effects.
Prevention of falls in the elderly should be directed at identification and evaluation of hazards that exposes them to risks of falls. Most falls are primarily caused by behavior environment interactions. The home of an elderly person should be equipped with nonskid rugs, night lights, guard rails and bathroom safety equipment. Walkways should be kept clear of toys, cords and clutter.
Individuals who have recurrent falls benefit most from a multidisciplinary evaluation, including medical diagnosis, functional status evaluation and home visits. A treatment plan is then formulated to address intervention strategies to reduce the combined effects of multiple factors. This prevention/treatment plan should emphasize interventions that maintain function.
Health Promotion Program
The causes of falls are the risk factors. The greater the number of risk factor to which an individual is exposed, the greater the possibility of a fall and the more likely the results of the fall will threaten the person's independence.
Most of these risk factors can be prevented. But the lack of knowledge about these risk factors and how to prevent them could contribute to many falls. Some people believe that falls are a normal part of aging, and as such are not to be prevented. Lack of knowledge leads to lack of preventive action, resulting in risks of falls.
To prevent these risks of falls, here are some programs
· Careful assessment and monitoring of medication use by the elderly (particularly drug-alcohol interactions) to help reduce falls.
· Exercise programs to improve gait, balance and muscle mass.
· Public and professional education to identify home hazards and stimulate activities that will elicit appropriate behaviors.
· Environmental modification of the living quarters of elderly persons consistent with universal design philosophy (with attention to floor surfaces, lighting, bathrooms, stairs, traffic patterns, and accessibility) to reduce or eliminate hazards.
Health Promotion Model
Despite an awareness of the link between sound nutrition and good health, numerous noninstitutional studies reveal a significant degree of undernutrition that exists among elderly individuals. [9,10]
Diet recommendations for disease prevention should emphasize adequate nutrition, avoidance of excesses and individualization of specific diet prescriptions. All older individuals should consume adequate fiber, calories and fluid. Four servings of fruits and vegetables per day are recommended. All older individuals should avoid excessive salt, fat, alcohol and caffeine. Some older patients need individualized prescriptions for intake of carbohydrates, vitamins and minerals.
Nutritional screening is inexpensive and easy to perform. Assessment ranges from obtaining a history that includes height, weight, skin tone, dietary habits and living conditions to performing laboratory tests when indicated. A three-day food diary can often be helpful. Malnourished patients can then receive proper referral to a dietitian or nutritionist. The AAFP, in cooperation with the American Dietetic Association and the National Council on Aging, has recently issued guidelines on nutritional screening in the elderly, entitled the Nutrition Screening Initiative. [11-13]
Physical inactivity is associated with many age-related medical conditions, such as hypertension, heart disease, diabetes and osteoporosis. Aerobic exercise can safely be prescribed for older persons, as both a preventive measure and a treatment for many clinical conditions. Evidence is accumulating that the benefits of exercise for the elderly are similar to those demonstrated for younger patients.
BENEFITS OF EXERCISE
Exercise training is known to produce a variety of beneficial physiologic changes and may slow the progressive decline in function that occurs with inactivity and aging.  Numerous studies have demonstrated that exercise training provides such musculoskeletal benefits as increased muscle strength, flexibility, range of motion, balance, endurance and posture, all of which promote self-sufficiency.
Cardiovascular and respiratory benefits include lower pulse and blood pressure, improved maximum aerobic capacity, increased maximum voluntary ventilation, increased stroke volume and lower vascular resistance. In an older individual, training can increase oxygen transport to the levels of a sedentary 25-year-old. 
Other benefits include reduced involutional bone loss, increased bone mineral content, improved glucose tolerance, improved lipid profile, decreased constipation, decreased body fat and psychologic benefits, such as increased self-esteem and enhanced quality of life.  Physically active retirees maintain cognitive status, compared with their sedentary peers, who show cognitive decline over time.  Higher levels of physical fitness have been shown to delay mortality from all causes, primarily due to lower rates of cardiovascular disease and cancer. [18,19]
Because muscle weakness and impairment of gait and balance may be the most significant risk factors for falls in institutionalized and noninstitutionalized elderly persons,  it is possible that exercise may improve functional independence, reduce morbidity and prevent falls, as well as improve strength and conditioning.
The level of fitness necessary to produce health benefits is easily attained in older patients through low-intensity activities, such as walking, stationary cycling or swimming. All patients should be encouraged to perform regular fitness activity for at least 20 minutes three or more times per week. Exercise should be prescribed for all patients, from those who are bed-bound to those who are functionally independent.
In the physically limited, range-ofmotion exercises and bed or wheelchair push-ups  are needed to prevent joint contracture, decubitus ulcers and muscle atrophy. The importance of daily rangeof-motion exercises cannot be overstated. Contractures begin to develop within three to four consecutive days of nonuse of a joint, which further limits mobility. Iostonic exercises, wheelchair sit-ups and swimming are a few of the excellent activities for physically limited patients. Information about exercise programs and referrals for patients with arthritis are available from the Arthritis Foundation. Rehabilitation therapists are also very helpful in individualizing exercise programs for physically limited patients.
An assessment should be performed before an exercise prescription is made. The assessment should focus on the feet and musculoskeletal system and should also identify the risk of falls and cardiovascular risk factors. Recently published exercise screening questionnaires summarize helpful guidelines for exercise intensity, drug-exercise interactions and patient education aids.  Detailed practical guidelines to help clinicians maximize patient compliance with a physical activity program are also available. [23,24] Table 1 outlines some important points about exercise counseling.
Regardless of the level of care and functional status, exercise is worthwhile in the geriatric population; it maintains physiologic and psychologic functional status and improves overall quality of life.
It is commonly believed that most elderly persons handle stress at the same levels as when they were younger. But every day, clinicians see older patients with symptoms that may result from stress, such as back pain, gastrointestinal complaints, eating disorders, sleep disturbances and exacerbation of symptoms of existing illness. Stress in older persons often stems from the losses they experience.
Stress management and relaxation training are targeted at reducing physiologic reactions to stress and improving skills for coping with stressful events. Chronic stress is not healthy. For example, studies have shown that
certain behaviors, especially hostility and cynicism, are predictors of subsequent coronary events in some populations. [25,26]
As with other medical diagnoses, identifying the cause of stress is the first step in finding solutions. Financial, professional, mental, physical or social stress may require different approaches. In some respects, all of medicine is geared toward relieving or treating stress.
Many studies have shown that stress reduction improves health. In one study of middle-aged hypertensive patients,27 use of breathing exercises and relaxation techniques accompanied by galvanic skin resistance biofeedback helped maintain a reduction of blood pressure in the treatment group, while blood pressure increased in the control group. Another study  found that regular practice of stress management techniques--diet and behavioral modification plus a mental stress-reducing technique--resulted in an average 50 percent decrease in both inpatient and outpatient medical care.
In a study of 73 retirement home residents (with a mean age of 81 years),  it was found that residents who practiced a specific mental technique to reduce stress had significantly improved health, cognitive mental function and longevity at the end of three years, compared with two other treatment groups.
Prevention of stress-related behavior and illness in the elderly requires more study. However, clinicians can encourage involvement in social groups, community projects, nursing home visit programs and volunteer organizations. Physical and mental exercises, a balanced diet and reduced intake of alcohol, nicotine, carfeine and nonessential medications that affect the central nervous system can have dramatic benefits. Music, laughter, hobbies and school enrollment or part-time employment are just a few activities that may help many elderly individuals reduce stress by diverting their attention from old problems to new pursuits.
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