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.

1. Health promotion for 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

2. Health promotion for elderly
Health promotion involves making lifestyle and
behavior changes in order to move toward optimal
health. Health promotion efforts include:
• Increasing awareness of health issues
• Promoting healthier behaviors
• Creating supportive environments
• Developing preventive strategies
• Encouraging early detection and treatment

3. Objectives of health promotion
• Increase quality and years of healthy life
• Maintain function
• Eliminate health disparities and promote
independency
• Improve (enhance) quality of life
• Extend life expectancy → ↓ premature
mortality caused by chronic& acute diseases

4. 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
8. Safety measures
9. Stress management

5. 1- Exercise
Physical Social
Psychological
Benefits of
exercise

6. 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

7. Psychological benefits of exercise
1. Improve mood state
2. Improve self-image
3. Reduce stress & anxiety
4. Enhance sleep
5. Improve depressive state of elderly
6. Improves Cognitive Function
7. Helps with memory and concentration
8. Improves mood

8. Social benefits of exercise
• Improve social
interaction &
relation with other
• Improves Social
Function
• Increases
independence
• Increases social
networks and
involvement
• Enables person to
participate in and
enjoy social activities
more

9. Types of
exercise
Isotonic Isometric

10. 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

11. 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.

12. 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.

13. 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

14. 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

15. 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.

16. 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.

17. Economic Factors
• Low income
• Limited access to food and food
choices
• Inadequate facilities to food storage
and preparation

18. Cultural factors
• Eating habits may miss certain food group
as vegetarians.

19. Important of nutrition
• It has been estimated that 10 to 25 percent of elderly
people suffer from poor nutrition
• Poor nutrition can contribute to:
– Heart disease
– Cancer
– Diabetes
– Depression
– Anemia
– Frailty
– Obesity
– Osteoporosis
– Isolation

20. Barriers to Good Nutrition
• Disability
• Changes in appetite
• Nausea
• Medication side effects
• Dental problems
• Difficulty shopping
• Difficulty cooking
• Swallowing problems
• Poor vision
• Financial problems
• Depression or anxiety
• Social isolation
• Transportation
problems
• Other medical
conditions

21. Overcoming Barriers to Good Nutrition
• Chewing problems – juices, canned fruits, creamed
or mashed vegetables, eggs, cooked cereals
• Difficulty shopping – Look into grocery delivery or
shopping services, ask friends, family, church
members for help
• Difficulty cooking – Try microwaveable meals, group
dining programs

22. Overcoming Barriers to Good Nutrition
• Poor appetite – Eat with others, ask doctor if
medicine side effects could be causing problems, try
different spices
• Financial concerns – Use coupons,share with
someone, try low-cost options such as beans, bean
soups, whole grain cereals, look into food bank
programs or other community assistance
• For expert help – Talk to doctor about a referral to a
registered dietician

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.
• N.B: Fat yield 9 cal/gram, CHO and protein
yield 4 cal/gram, mineral and water yield no
calories

24. 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

25. 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

26. 4- Carbohydrates requirement
• CHO is essential for maintaining normal bl.
glucose level.
• 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.

27. 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,
6. As we age 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

28. 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
contraindications
• Vitamin D :------ needed for calcium absorption&
metabolism.
• Exposure 15 minutes/day to sun is enough

29. 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

30. 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 2000-3000cc/daily

31. Quick Tips for Healthier Eating
• Eat more fruits and vegetables
• Eat whole grains, nuts, beans
• Get enough calcium
• Get enough protein from
low fat sources
• Cook with less fat
• Minimize foods high in sugar
• Drink enough water

32. 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
efficiency
4) Relieve tension
5) Emerge feeling of well being

33. • Important Things to Know About Ageing and Sleep
• Older people usually sleep as much each day
as younger adults.
• Older people often take daytime naps as well
as sleeping at night.
• Age increases the risk of some sleep disorders.
• Medical conditions that arise with ageing can
disrupt sleep.
• Sleeping pills are best used only for short
periods of time.
• Try to go to bed and get up at the same time
each day

34. Why is older people's sleep different?
• At night, our body makes a hormone that promotes
sleep, called melatonin.
• Older people make less of it so they find it more
difficult to get off to sleep.
• Other factors may interfere with sleep and cause
wakenings during the night.
• These include hot flushes in postmenopausal women
(see Menopause and Sleep), the need to go to the
toilet during the night and other medical problems
such as arthritis that make it difficult to stay in one
position for the whole night.
• In addition, after retirement many people find it
convenient to take a short nap during the day.

35. • How do older people sleep differently?
• Most people sleep between 7 and 9 hours each day.
• However older people may not have all their sleep at
night, around 4 in 10 older people have at least one nap
every day.
This is usually for at least half an hour.
Most people over the age of 80 nap for more than one
hour each day.
At night, some older people take more than half an hour
to get to sleep.
• This is the case for about 1 in 3 women and 1 in 6 men.
Older people also tend to wake up more at night and
spend less time in deep, refreshing sleep.

36. Factors affecting sleeping patterns
• Age related changes in sleep patterns
• Internal factors
• External factors

37. Internal factor
Many diseases can make it harder to sleep. Some that
are common in older people are arthritis, osteoporosis,
Parkinson’s disease, incontinence, indigestion, heart
disease and lung diseases such as asthma or COPD. The
drugs used to treat these conditions may also interfere
with sleep. Some sleep disorders are more common in
older people, including sleep apnoea and periodic limb
movement disorder.

38. Sleep Disorders and Aging
• The sleep disorders that increase with age are
sleep apnea and periodic limb movements in
sleep (PLMS). Periodic limb movement
disorder is also called nocturnal myoclonus.

39. • Sleep apnea is the interruption of breathing
during sleep.
• It is commonly caused by obstruction
(blockage) of the airway.
• Rarely sleep apnea is caused by a problem in
the nervous system, which controls breathing.
• Sleep apnea is very common among older
overweight people.

40. Self-Care at Home
cont…….
• Maintain a regular wake-up time.
• Maintain a regular time to go to sleep.
• Avoid or decrease daytime naps.
• Exercise daily but not immediately before
bedtime.
• Use the bed only for sleeping or sex.
• Do not read or watch television in bed.
• Do not use bedtime as worry time.
• Avoid heavy meals at bedtime.

41. Self-Care at Home
cont…….
• Avoid or limit alcohol, caffeine, and nicotine before
bedtime.
• Maintain a routine period of preparation for bed, (for
example, washing up and brushing teeth).
• Control the nighttime environment with comfortable
temperature, quietness, and darkness.
• Wear comfortable, loose-fitting clothes to bed.
• If unable to sleep within 30 minutes, get out of bed
and perform a soothing activity, such as listening to
soft music or reading, but avoid exposure to bright
light during these times.
• Get adequate exposure to bright light during the day.

42. 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.

43. 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 behaviors
5. If examination done at home, it permit
evaluation of environment ( hazards care
giver…)

44. 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&
sigmoidoscopy
( annually)
Vision including glaucoma
test
Every 2 years

45. Health screening Period
Hearing Evaluate periodically
Cholesterol level Every 5 years
Cancer screening Annually
Mammography for
women under 70 y
1-2 years
Digital rectal
examination
Annually

46. Immunizations
Vaccination Period
Influenza (over 65y) Annually (mid October to
mid November)
Tetanus & diphtheria Every 10 years
Pneumococcal
vaccination
Once at age 65y,
revaccination for high risk
fatal pneumonia/6 y

47. 5- High Risk Behavior
• It is behavior that damage physical health.
It includes:
• Over the counter medication (multiple medications )
• Smoking
• Caffeine

48. 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

49. 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.

50. 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

51. 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.

52. Signs of spiritual distress:
• Doubt
• Despair
• Guilt
• Boredom
• Expression of anger toward god

53. 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.

54. 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

55. 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
• Reading in religious books & praying
• Discuss role of spirituality in one’s life

56. 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

57. 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

58. • 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

59. • 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.

60. Safety measures
• One of the basic needs of elderly
• The old adult who has a mental, sensory or a physical
loss, like poor balance and weak muscles, is a safety
risk.
• Thease losses and the ageing process make older
adults prone to accidents.
• An old person has poor vision and hearing, is confused
and has poor judgement can; slip, fall, get hit by the
car, drink of chemical, cut their hand by saw, overuse of
medicine.
• Safety is a major concern when working with or
peoviding care to older adults.M

61. • Falls, burn, poisoning, accidents are most
common problem.
• General safety measures both at home, and
away from home, are encouraged and
recommended to elderly patients and their
family members.
• Falls and injuries,confusion, adherence to
medical instructions, and future health and
financial planning are among the concerns
pertinent to elderly care.

62. General Home Safety
• Consider a medical alert.
• Keep a fire extinguisher and smoke detector on every floor.
• Use extreme caution when smoking. Never smoke when alone or in
bed.
• Always get up slowly after sitting or lying down. Take your time, and
make sure you have your balance.
• Wear proper fitting shoes with low heels.
• Use a correctly measured walking aid.
• Remove or tack down all scatter rugs.
• Remove electrical or telephone cords from traffic areas.
• Avoid using slippery wax on floors.
• Wipe up spills promptly.
• Avoid standing on ladders or chairs.

63. Bathroom Safety
• Leave a light on in bathroom at night.
• Use recommended bath aids, securely installed
on the walls of the bath/shower stall and on the
sides of the toilet.
• make sure the bath tub has a non-slip bottom.
• To avoid scalds, turn water heater to 120 degrees
Fahrenheit or below
• Use door locks that can be opened from both
sides.
• If possible, bathe only when help is available.

64. Kitchen Safety
• Keep floors clean.
• Mark "on" and "off" positions on appliances clearly and
with bright colors.
• Store sharp knives in a rack.
• Use a kettle with an automatic shut off.
• Store heavier objects at waist level.
• Store hazardous items separate from food.
• Avoid wearing long, loose clothing when cooking over
the stove.
• Make sure food is rotated regularly. Check expiration
dates.

65. Drug Safety
• Review your medicines frequently with your doctor or
pharmacist and when you take new medication.
• Make sure medicines are clearly labeled.
• Read medicine labels in good light to ensure you have
the right medicine and always take the correct dose
• Dispose of any old or used medicines.
• Never borrow prescription drugs from others.
• Check with your doctor or pharmacist before you mix
alcohol and your drugs.