Health Promotion For Older Adults Research Articles

Population Aging: Implications for Nurse Practitioners

Population aging has occurred as a result of increased longevity throughout the lifespan coupled with declining birth rates. In the practice arena this demographic shift will increase the need for health services focused on chronic disease, comorbid status, and the unique health promotion for older adults. Nurse practitioner programs and continuing education providers must strengthen content on geriatrics and chronic disease management. Research on health care needs and care outcomes of older adults must increase. Nurse practitioners can best position themselves for this demographic shift by increasing their knowledge about health care needs of older adults.

Oral health‐related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City, India

To assess whether oral health-related quality of life (OHRQoL) is associated with nutritional status in the institutionalised elderly population of Mysore. Malnutrition in the elderly has an evident impact on their general health and quality of life. Analysis of data of the Geriatric Oral Health Assessment Index (GOHAI) and their association with the Mini Nutritional Assessment (MNA) results improves our understanding of the complex relationship between oral health and malnutrition. The study was conducted among the institutionalised elderly population in Mysore city, Karnataka. Data on socio-demographic, oral health status were gathered. OHRQoL was evaluated using GOHAI, and malnutrition risk using MNA. Out of 141 elderly, 41.1% were men and 58.9% were women with mean age of 72.2 ±7.5 years. Mean GOHAI score was 47.03 ± 9.2, with 69.5% had low perception of oral health. Mean MNA score was 9.91 ± 2.4, 15.6% were malnourished, 52.5% were at risk of malnutrition and 31.9% were adequately nourished. A strong association was found between the mean GOHAI and MNA scores. Oral health-related quality of life was associated with nutritional deficit, and it requires a greater integration between dentistry and nutrition in the health promotion of older adults.

Preparing the Dental Workforce for Oral Disease Prevention in an Aging Population

The growing proportion of older adults in the U.S. population, as well as escalating dental expenditures, is leading to major changes in the demands on oral health care delivery. Researchers over the years have clearly demonstrated the shortcomings of traditional restorative treatment and the cycle of repeat interventional care. Oral health care professionals are constantly seeking advances in technology, protocols, methodologies, and materials to meet the needs of the growing, diverse older population. Early stages of oral diseases such as caries and periodontal disease are vigorous, preventable, and reversible. Assessment of social, systemic, and oral risk factors that emphasize patient counseling to facilitate risk reduction, along with individualized evidence-based disease prevention planning, is more cost-effective than traditional restorative treatment and will improve overall outcome. The purposes of this article are to briefly describe current issues and challenges related to oral health promotion for older adults and to examine strategies for disease prevention and health promotion in health and dental care settings.

Sexual Behaviors, Condom Use, and Sexual Health of Americans Over 50: Implications for Sexual Health Promotion for Older Adults

In the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives. This study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50. Information regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined. Sexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience. Although sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participant's evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to men's evaluation of the experience. Relationship status was the most consistent predictor of women's evaluation of the experience. Condom use rates remained low for participants across age groups. Many older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.

Ageing, the urban-rural gap and disability trends: 19 years of experience in China - 1987 to 2006.

BackgroundAs the age of a population increases, so too does the rate of disability. In addition, disability is likely to be more common in rural compared with urban areas. The present study aimed to examine the influence of rapid population changes in terms of age and rural/urban residence on the prevalence of disability.MethodsData from the 1987 and 2006 China Sampling Surveys on Disability were used to estimate the impacts of rapid ageing and the widening urban-rural gap on the prevalence of disability. Stratum specific rates of disability were estimated by 5-year age-group and type of residence. The decomposition of rates method was used to calculate the rate difference for each stratum between the two surveys.ResultsThe crude disability rate increased from 4.89% in 1987 to 6.39% in 2006, a 1.5% increase over the 19 year period. However, after the compositional effects from the overall rates of changing age-structure in 1987 and 2006 were eliminated by standardization, the disability rate in 1987 was 6.13%, which is higher than that in 2006 (5.91%). While in 1987 the excess due to rural residence compared with urban was <1.0%, this difference increased to >1.5% by 2006, suggesting a widening disparity by type of residence. When rates were decomposed, the bulk of the disability could be attributed to ageing, and very little to rural residence. However, a wider gap in prevalence between rural and urban areas could be observed in some age groups by 2006.ConclusionThe increasing number of elderly disabled persons in China and the widening discrepancy of disability prevalence between urban and rural areas may indicate that the most important priorities for disability prevention in China are to reinforce health promotion in older adults and improve health services in rural communities.

Health outcomes of Experience Corps ® : A high-commitment volunteer program

Experience Corps (EC) is a high-commitment US volunteer program that brings older adults into public elementary schools to improve academic achievement of students. It is viewed as a health promotion program for the older volunteers. We evaluated the effects of the EC program on older adults' health, using a quasi-experimental design. We included volunteers from 17 EC sites across the US. They were pre-tested before beginning their volunteer work and post-tested after two years of service. We compared changes over time between the EC participants (n = 167) and a matched comparison group of people from the US Health and Retirement Study (2004, 2006). We developed the comparison group by using the nearest available Mahalanobis metric matching within calipers combined with the boosted propensity scores of those participating in the EC. We corrected for clustering effects via survey regression analyses with robust standard errors and calculated adjusted post-test means of health outcomes, controlling for all covariates and the boosted propensity score of EC participants. We found that compared to the comparison group, the EC group reported fewer depressive symptoms and functional limitations after two years of participation in the program, and there was a statistical trend toward the EC group reporting less decline in self-rated health. Results of this study add to the evidence supporting high-intensity volunteering as a social model of health promotion for older adults.

Potential for Intensive Volunteering to Promote the Health of Older Adults in Fair Health

Volunteer service opportunities for older adults may soon be expanded. Although volunteering is thought to provide health benefits for healthier older adults, it is not known whether older adults in less than very good health are suitable candidates for high-intensity volunteering and can derive health benefits. This manuscript presents a prospective analysis of 174 older adult volunteers serving in Experience Corps Baltimore, a high-intensity senior volunteer program in Baltimore, Maryland. Volunteers served > or =15 h per week, for a full school year, in elementary schools helping children with reading and other skills between 1999 and 2002. Volunteers were assessed with standardized questionnaires and performance-based testing including grip strength, walking speed, chair stand speed, and stair-climbing speed prior to school volunteering and at the end of the school year. Results were stratified by health status. Among 174 volunteers, 55% initially reported "good" and 12% "fair" or "poor" health status. At baseline, those in fair health reported higher frequencies of disease and disability than volunteers in excellent or very good health. After volunteering, a majority of volunteers in every baseline health status category described increased strength and energy. Those in fair health were significantly more likely to display improved stair-climbing speed than those in good or excellent/very good health (100.0% vs. 53.4% vs. 37.5%, p = 0.05), and many showed clinically significant increases in walking speed of >0.5 m/s. Satisfaction and retention rates were high for all health status groups. Clinicians should consider whether their patients in fair or good health, as well as those in better health, might benefit from high-intensity volunteer programs. Productive activity such as volunteering may be an effective community-based approach to health promotion for older adults.

Integrating the ecological approach in health promotion for older adults: a survey of programs aimed at elder abuse prevention, falls prevention, and appropriate medication use

This study assesses the extent of integration of the ecological approach in disease prevention and health promotion (DPHP) programs for older adults in a sample of organisations offering such programming in Québec, Canada. Following from our previous work, the study used a model identifying intervention settings, targets, and strategies as independent dimensions of ecological programming. As a first step, public health units, local community health centres and seniors' day centres were surveyed to identify DPHP programs for older adults. In a second phase, detailed data were obtained about programs in the theme areas of elder abuse prevention, falls prevention, and appropriate medication use. Overall, 132 programs were investigated including 17 public health unit programs, 72 local community health centre programs, and 43 day centre programs. All data were obtained through telephone interviews. The DPHP programs for these organisations tended to be situated in organisational (especially health organisation) and community settings, with individual clients and organisations as main intervention targets. Assessment of the level of integration of the ecological approach showed it to be relatively low, especially in the local community health centres and seniors' day centres.

Deferred Empathy: A Construct with Implications for the Mental Health of Older Adults

Deferred empathy occurs when an experience provokes a memory that after reflection allows people to say, “Now I understand.” Heretofore, the concept was explored only in quantitative research; therefore, the purpose of this phenomenological study was to elicit a more detailed description of the construct of deferred empathy. For most of the participants (n = 20) triggering events involved personal challenges such as loss, loss of control, or interpersonal conflict that reminded them of, and changed, their perception of earlier relationships. Development of empathy involved reflection on past and present events, making choices, changing expectations, and learning acceptance. The process resulted in appreciative understanding of others as well as personal benefits. Findings have implications for mental health promotion in older adults in which life review promotes gerotranscendence.

Understanding the Multidimensional Nature of Health Promotion for Older Adults Through the Application of a Conceptual Framework

ABSTRACT Over the next three decades, the proportion of Americans over age 65 will grow to exceed 25 percent of the population. Although research has shown that health promotion and disease prevention interventions for older adults can lead to positive health outcomes, our understanding of the effects of health promotion on the health and well-being of older people could be improved through the development and use of a conceptual framework. This article presents a conceptual model for understanding the determinants and consequences of engaging in health promotion activities for older adults, describes how to use the model to estimate the impact of health promotion programs on a variety of individual- and community-level outcomes, and then applies the model to two different health promotion programs for older persons: REACH II and the Senior Wellness Program.

Responses to Walking-Speed Instructions: Implications for Health Promotion for Older Adults

This study examined the effect of age on descriptive walking-speed instructions commonly used in health promotion. Participants were 9 young (20-23 years) and 9 older (75-83 years) women. Oxygen uptake and walking speed were measured in response to descriptive walking instructions ("slow," "comfortable," "brisk," and "fast"). Although the older women walked approximately 20% slower in response to all walking instructions and with significantly lower oxygen costs for brisk and fast, the intensity of the exercise represented a much greater percentage of VO2max and showed greater interindividual variation. When asked to walk at a brisk pace, the older women averaged 67% VO2max (SD 20.6), whereas the young women averaged only 45% VO2max (SD 4.5). With older people, brisk might elicit an exercise intensity unnecessarily high for physiological benefit and that might compromise safety and adherence, which emphasizes the need for validation of carefully worded exercise and training guidance for older adults.

A vision for older adults and health promotion.

Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.

Nutritional health promotion for older adults, where is the content?

To describe nurse practitioners' (NPs') educational experiences related to older adult nutrition and eating abilities. Descriptive research with written survey data collected from 80 gerontological NPs recruited from a national nursing conference. Older adults' nutritional health has been related to acute illness, pressure sore development, prolonged hospital stays, and other health problems. Current literature suggests that although nutrition screening and intervention promote older adults' health, practitioners may not consistently receive education on this content. Participants indicated that gerontological-nutrition content was important, that it was missing from their educational programs, and that it needed to be a part of the NP curriculum. Specific nutrition content concerns were organized by the categories (a) disease and functional issues, (b) psychosocial support and environmental impact, and (c) health care team and system considerations. NP programs need to self-evaluate for adequate and appropriate nutrition screening and intervention content. Frameworks such as those developed by the Nutrition Screening Initiative and others provide beginning guidance for further content development.

Disease prevention and health promotion in the aging with a traditional system of natural medicine: Maharishi Vedic Medicine.

This review focuses on a comprehensive, sophisticated system of natural medicine that appears to hold promise for prevention of chronic diseases and disabilities, loss of independence, suffering, and health care costs often associated with "usual" aging. The authors discuss the negative impact of usual aging on our society, with its rapidly growing percentage of elderly, and the challenge of promoting "successful aging." Emphasis is given to research literature suggesting that Maharishi Vedic Medicine (MVM) is particularly effective in retarding usual aging. Proposed mechanisms for the antiaging effects of MVM include reductions in physiological and psychological stress and enhancement of homeostatic and self-repair processes. The authors conclude that this set of innovative strategies may help society achieve recommended health objectives for disease prevention and health promotion in older adults and that widespread implementation of this self-empowering, prevention-oriented approach in the elderly is feasible, cost effective, and timely.

Nutrition and Health Promotion in Older Adults

During recent decades, the concept of health promotion has become a legitimate part of health care because of the aging of the postwar baby boom generation. As this population ages, the potential strain on health care systems will increase because the greatest use of health care services occurs during the last years of life. In older adults there are many correctable health factors that can be assessed through screening protocols. Hypertension, cholesterol, hearing, vision, diabetes, and cancer screening are well integrated into health promotion programs; nutrition promotion programs are not as well integrated. Reluctance to develop health promotion programs for older adults exists because of a perception that they would not follow such plans or change their lifestyles. However, longitudinal studies have shown that health promotion activities extend the number of years of health in older people although the relationship weakens in older age. Changes in diet and exercise patterns are most effective in the prevention of nutrition-related conditions when they are instituted early in life, but positive effects can occur at any age. If nutritional interventions are instituted early, a substantial reduction in health care expenditures may result from a decrease in the incidence or the delayed onset of these conditions. Changes in behaviors (reducing salt and fat intake) were positively associated with a belief that consuming a healthful diet would contribute to better health. The use of a variety of adult education theories and models will enhance behavior changes that lead to more healthful habits and enable a health educator to be successful in effecting change.

Health promotion for older Americans in the 21st century.

To provide a broad overview of the role of the individual, the physical environment, and the social environment on health and functioning in older adults (65 and older), and to highlight interventions and recommendations for action on each of these levels. Published studies and government reports on health and functioning in older Americans and on the individual, social, and physical environmental contributors to health were identified through journal and government documents review and computer library searches of medical and social science data bases for 1980-1999. Preference was given to published studies and government reports that focused specifically on behavioral and environmental contributors and barriers to health promotion in Americans 65 and older and/or that highlighted creative interventions with relevance to this population. Both review articles and presentations of original research were included, with the latter selected based on soundness of design and execution and/or creativity of intervention described. Studies were examined and their findings organized under three major headings: (1) behavioral risk factors and risk reduction, including current government standards for prevention and screening; (2) the role of the physical environment; and (3) the role of the social environment in relation to health promotion of older adults. Although most attention has been paid to the role of behavioral factors in health promotion for older adults, a substantial body of evidence suggests that physical and social environmental factors also play a key role. Similarly, interventions that promote individual behavioral risk reduction and interventions targeting the broader social or physical environment all may contribute to health in the later years. With the rapid aging of America's population, increased attention must be focused on health promotion for those who are or will soon be older adults. Promising intervention strategies addressing the individual, the physical environment, and the social environment should be identified and tested, and their potential for replication explored, as we work toward a more comprehensive approach to improving the health of older Americans in the 21st century.

Eleventh Annual Herbert Lourie Memorial Lecture on Health Policy - Health Promotion for Older Adults: What is the Potential?

As a greater number of people reach old age, medicine is challenged to develop new approaches to this population. Health promotion, not just treatment of disease but improving the quality of life for older persons, must play a role. What happens to individuals in terms of health status as they get older, and what are the implications for health care needs? Where should we focus to get the biggest benefits in terms of health promotion? Overall, we have learned a tremendous amount over the last 25 years about the components of health as people get older, and what modifies their health. We know, for example, that the health status of older adults is a composite of the chronic diseases that they may have, of how many chronic diseases are present, and of underlying physiological changes of aging, such as a decline in muscle strength, that appear to be an intrinsic part of the aging process. Disability can result from chronic disease. In addition, people are more susceptible to acute illnesses and injuries as they get older.

Physical Activity and Health Promotion for Older Adults in Public Housing

Designing health promotion and disease prevention (HPDP) programs for older residents of public housing is hampered by a lack of information about residents' needs and interests. This study addressed whether residents have greater needs for lifestyle modification or for preventive care and assessed interest in programs emphasizing physical activity. Older residents (n = 199) of public housing facilities in Seattle were surveyed to assess HPDP needs. A comparison of residents with older HMO enrollees (n = 2,289) identified which needs were relatively greater in residents of public housing. Residents' interest in physical activity programs was assessed by interviewing residents and by observing their interest in an exercise class. The majority of residents could benefit from physical activity programs (75% of residents reported less than 60 minutes per week of exercise); fewer residents could benefit from smoking cessation programs (21%) and alcohol counseling (4%). The largest difference between residents and HMO enrollees was the greater need of residents for physical activity promotion. Residents and HMO enrollees reported similar use of preventive care services. Though residents seldom identified physical inactivity as a major concern, residents demonstrated interest in physical activity programs. Eighteen (41%) of 44 residents participated regularly or irregularly in an exercise class offered at their facility. When the class was scheduled to be discontinued, residents successfully lobbied city government to sustain the class. The results suggest promoting physical activity should be a major goal of HPDP programs for older residents of public housing.

Selection bias and nonresponse to health promotion in older adults.

Some epidemiologic studies have compared the characteristics of individuals who participate, refuse, and are unreachable in population studies, but results have been inconsistent. The Rural Health Promotion Project attempted to recruit all Medicare Part B noninstitutionalized individuals age 65-79 years in a rural community for a trial of preventive health services. Of 962 potential subjects, 360 (37.4%) participated, 253 (26.3%) refused, 176 (18.3%) were ineligible, and 152 (15.8%) were never reached by phone or mail. Approximately 3 years later, we reinterviewed the participants, refusals, and as many of the unreachables as possible. The 3-year mortality was similar for both refusals and participants (approximately 9%) but was much higher for ineligibles (29.0%) and unreachables (23.7%). Participants were more likely to have disease history, to have behavioral risk factors for disease, and to use health screening services. Refusals were the healthiest and possibly chose not to participate because they did not have risk factors targeted by the program. The unreachables had the highest prevalence of disability and health care inpatient reimbursement and may have been ineligible for the demonstration had they volunteered. We conclude that failure to reach potential participants for health promotion services may be a warning of "high risk."

Research directions in oral health promotion for older adults

Health education and health promotion facilitate voluntary adoption of behaviors and provide educational, organizational, economic, and environmental supports for behaviors conductive to health. Health education and health promotion are complementary and any effort to eliminate oral disease requires both activities. Federal research initiatives in oral health promotion have encouraged more biomedical and behavioral research on oral health and aging through the establishment of research centers. Other initiatives have been established to speed the generation of basic and clinical research. Recent initiatives encourage research on aging and provide opportunities for oral health promotion during the coming decade. These include Healthy People 2000, the nation's health objectives for the decade; the NIH framework for the development of a strategic plan, and the NIDR Long-Range Research Plan, Broadening the Scope.