Health Promotion
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 Falls in Elderly
“Stay on Your Feet” is a community-based health promotion program that aimed to increase awareness of risks factors that causes falls in elderly, injuries and even death and then reducing incidence of falls and injuries among older people dwelling in communities aged 65 years and above.
Section 1
Falls in Elderly
Falls have come to be recognized as a major threat to the safety, health and independence of elderly persons. Awareness of various factors associated with falls in elderly persons and an understanding of some of the methods of preventing falls can help safety professionals in making appropriate decisions about necessary interventions.
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.
For many reasons, older people are more likely to suffer from injuries and infections than other age group because of age-associated physiological decrements and drug side effects.
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 causes of fall are known as risk factors. The greater the number of risk factors to which an elderly individual is exposed the greater the probability of a fall and the more likely the results of the fall will threaten the person’s independence.
But these risk factors can be prevented. A lack of knowledge about risk factors and how to prevent them contributes 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 and would result to falls.
Prevention of falls in the elderly should be directed at identification and evaluation of hazards that predispose them to 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.
General Objective
The main objective of this program is to increase community knowledge of risks factors that may cause falls in community-dwelling elderly people and at the same time reduce the incidence of falls.
Specific Objectives
1. Promote and strengthen community action
2. Promote positive aging
3. Establish and enhance physical activity programs
The target of the fall-related program of elderly are community-dwelling elderly people because studies shows that approximately 90 percent of the older people aged 65 and above live independently in the community or residents of nursing homes ( 2000).
Section 2
Health Promotion Model and Approaches
The aging population will be living one third of their lives after retirement. It is important that effective health promotion should be developed for this last one third of their lives so that those living longer are healthy. Physical and social activities are independently and diversely associated with mortality and morbidity (1998). What the older people do affects health outcomes.
Numerous programs have been developed to enhance older people behavior. Urban settings are positioned to lead the way in creating community-based programs through which critical mass of older adults, from diverse background could help solve unmeet social needs of the elderly. There are organizations that could effectively harness older adults’ time, and skills and at the same time increase activity levels and provide broad-based health promoting and generative opportunities for aging society.
A social approach to health promotion is designed for elder people, the “Stand on your Feet”. This program is designed to increase elderly people physical, social and cognitive activity that improvement would have health benefits.
Section 3
Ethical Issues
As the number of people 65 years and older increases, so does the number of people who fall. Those who fall suffer moderate to severe injuries such as hip fractures or head traumas that reduce mobility and independence, and increase the risk of premature death. Hip fractures cause the greatest number of deaths and lead to the most severe health problems and reduced quality of life (1997, 2000). Most patients with hip fractures are hospitalized for about one week ( 2001). Up to 25% of community-dwelling older adults who sustain hip fractures remain institutionalized for at least a year ( 2000).
The causes of the fall as the researchers have identified are lower body weaknesses ( 1996), Problems with walking and balance (1996; 2001) Taking four or more medications or any psychoactive medications ( 1989; 1990; 1993; 1998).
Physical incapability could lead to person to immobile and more dependence to others. With this program, this enhances physical activity to elder people to make them move freely and be independent. The sense of control and freedom an individual has is critical to both physical and psychological health. Perceived locus of control and competence are two important aspects of a sense of independence. If one can freely move, he can exercise his independence.
To be able to exercise control over one’s life has often been described as the pillar of human functioning. To be able to exercise control over one’s life has often been described as the pillar of human functioning and living. “At the core of one’s psychological functioning is the belief that he/she is able to undertake various tasks and activities and is capable of performing them successfully” (1984). It follows that a sense of control and freedom becomes critical to both psychological and physical health (1985).
This was demonstrated in now-classic experiments by (1976), (1977), (1976), (1978). Nursing home patients’ psychological and physical health were significantly improved by enhanced perceived control and freedom. Most dramatically, the mortality rate was reduced by the experimental manipulation that stressed enhancement of a sense of personal control and freedom. These experiments and their findings demonstrated that a sense of control is fundamental to human life, even to the very end of it. When people give up personal control, they become helpless and lose the sense of purpose in life as well as the will to live ( 1975).
This importance of personal control and freedom suggests that people want to be able to live their lives independently. It is not surprising that a greater sense of control over life correlates positively with lower rates of illness and better health ( 1993;, 1987).
The biggest constraint to independent living and psychological well-being is the belief that one is not able to undertake tasks and activities and complete them successfully. In other words, a sense of lack of personal control and competence critically undermines one’s desire to live independently.
If independent living is psychologically the essence of human functioning, because it promotes physical and psychological health, it then becomes important for society to create the environment and programs that are likely to enhance a sense of control and competence in its citizens, especially among those whose sense of independent living has eroded due to various factors and circumstances.
Erosion of a sense of personal control and competence is acute among the elderly ( 1990). Physical ailments alone can lead to such undermining effects. This program would enhance older’s physical health and one’s sense of self control and independence as well as social well being.
Section 4
Outline of the Health Promotion Program
Health Promotion Program : Stand On your Feet
Methods
A volunteer sample composed of 80 subjects of 65 years and older people from Winnipeg, Manitoba derived from a pool of participants who are willing to participate in the research.
Then they are called by telephone if they are willing to undergo the research. The subjects are told if they would participate they would undergo a program in 12 weeks. If the subject agreed to participate in the program they would fill out an informed consent form.
Then, subjects that agreed to participate are then randomly group into either an experimental or control group. The final sample was consisted of 30 subjects, with 15 control and 15 in the experimental group.Both groups were pre-tested and post-tested on a number of dependent variables.
Section 5
Evaluation
The intervention for this study was a modified version of the Community Reintegration Program (CRP) (1991). This intervention was originally developed as a transitional therapeutic recreation program for persons who have recently moved from a rehabilitation program back into their home community. (1991) reported that participants involved in the CRP program successfully re-engaged in activities participated in before their accident, and/or initiated new, alternative activities. The program was modified to ensure that all of the activities, discussions and exercises were appropriate for an older adult population. The original CRP program did, however, have some subjects who were older adults.
The CRP is described by (1991) as being conceptually framed in the principle of normalization and social role valorization ( 1972, 1985). (1991) indicate that, “… social role valorization theory identifies the individual’s right and responsibility to assume a valued role in society and society’s obligation to allow the individual to pursue that role without constraint.”
The intervention was also based on social learning theory and social exchange theory. With regards to social learning theory, postulated a theory of self-efficacy which suggested that a primary motivator for an individual is the perception of competence or personal mastery. But (1992, p. 305) suggests that “self-determination refers to the attitudes and abilities required to act as the primary causal agent in one’s life and to make choices regarding one’s actions free from undue external influence or interference.”
Concepts of social role valorization, self-determination, and interdependence helped to drive the leisure education process within the present study. In addition, the dependent variables were closely tied to both the conceptual framework and the intervention. The interdependent nature of the intervention was designed to foster a greater sense of control in each subject. This was facilitated by the self-study nature of the intervention, and tire fact that the Therapeutic Recreation Specialist was trained to foster a reciprocal relationship between herself and each subject. In addition, the process of identifying barriers and ways in which to overcome barriers, and the development of a personal action plan were also designed to foster control in the subjects.
The intervention was also designed to facilitate greater feelings of competence and enhanced participation. The CRP model allowed subjects to take a realistic look at their present repertoire of leisure activities and assess the extent to which they are still meeting their leisure needs. This process is very important for older adults who may have declining health or who may in fact be in the process of disablement. Since most of the subjects in the study had significantly more dexterity problems and more illness symptoms than the rest of the original needs assessment sample, this was particularly important. The present intervention helped subjects to determine what was the most realistic, yet desirable leisure plan for their present abilities. As such, it was individualized to address the unique challenges facing each experimental group subject and designed to ensure that these subjects perceived themselves as competent to achieve their leisure plan, thereby increasing the probability of enhanced participation.
The intervention consisted of a minimum of 12 units conducted by a Therapeutic Recreation Specialist (TRS). Each of the units consisted of a variety of activities such as: discussion exercises, paper and pencil exercises, role playing, and recreation activity participation (See Figure 1). Though each unit had a specific objective and activities to be initiated with all subjects, the leisure education process was individualized to meet the needs of each subject. In some cases the TRS was able to complete more than one unit during an intervention session, while other subjects required more than one session to complete a given unit. The speed at which subjects proceeded through the process depended upon the personal issues that they and the TRS felt were important to address in relation to each unit. For example, some subjects had a substantial number of real and perceived barriers to leisure participation, while others did not. Those who had a significant number of barriers spent a longer amount of time in Unit 6, Barriers.
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