Health Promotion, Maintenance And Restoration In Older Adults
Aging has been defined as a universal, internally predictable biologic process following maturity. It is characterized by changes accumulated over time that increase susceptibility to disease and ultimately lead to death. Physiologically, aging in the absence of disease involves a steady decline in the functional reserve of organ systems and homeostatic controls, especially when a person is under stress. In addition to disease, nutritional status and other extrinsic factors (i.e., environment, activity, medication, depression) are superimposed on the basic process of aging and create individual differences in how one experiences aging.
Older adults are more likely to suffer from multiple chronic and disabling illnesses than younger adults. Approximately 80% of elderly people in the United States have one or more chronic diseases. Chronic conditions result in limitations in activities of daily living for 50%, major limitations in activities for 18%, and home confinement for 5%. Heart disease, cancer, and strokes account for 80% of deaths in people older than age 65. Clients with hypertension, arthritis, pulmonary disorders, diabetes, visual and hearing problems, dementia, and depression require ongoing care and rehabilitation.
A traditional definition of health as the absence of disease or disability is clearly not applicable to older people. A more appropriate focus is on health as a state of mind and on the ability to live and function effectively in society. Health encompasses an interaction of physical, functional, and psychosocial factors. Health promotion goals, therefore, must include individual and group efforts related to spiritual, emotional, psychosocial, and physical concerns. Elders can make efforts to control aspects of their health and move toward wellness.
With advanced age, the body does not respond as vigorously to illness or disease because of diminished physiologic reserve. People often attribute discomforts to “old age” and accept the changes as inevitable, thus failing or refusing to seek help for potentially treatable conditions. A frequent complicating factor in identifying and treating disease in older people is the presence of multiple ailments. The number of pathologic conditions that a person has at one time is strongly correlated with age. The presenting picture may be further complicated by atypical or altered presentation of disease (i.e., weakness, weight loss, confusion, or failure to thrive).
Atypical or altered presentation of disease can be displayed in various ways. For example, an older adult with pneumonia may exhibit confusion, have an increased respiratory rate, and generalized weakness instead of the classic symptoms of productive cough, fever, and chest pain. Frequently, manifestations in one organ system may cause abnormality in another system. This results in manifestations unrelated to the actual problem, such as confusion accompanying a urinary tract infection. Chronic conditions can mask the presence of acute illness. This can be seen in new-onset heart failure, when orthopnea might be hidden if a person regularly uses multiple pillows because of gastroesophageal reflux, arthritis, or obesity.
Finally, expected manifestations may not be present at all, as in the case of a myocardial infarction unaccompanied by chest pain. Risk factors for many chronic diseases in old age are manifested in early-to-middle adulthood. Increasing age and chronic disease, functional disabilities, and hospitalization intensify the demand and need for health care services. This has implications in any health care setting which includes a hospice.
Self-Care and Self-Responsibility
As older adults become better informed and increasingly aware of the self-help movement, health care expectations also rise. There is an increasing desire to be in control of one’s body, mind, and spirit and to assume responsibility for one’s own wellness. This does not mean that traditional health care providers are ignored. Instead, strategies are taught that enable people to respond to their body signals and to take action accordingly. Given adequate information, elders can practice effective self-care through a process of examining choices and making informed, meaningful decisions. Most older people want to have as much control as possible over their body, mind, and spirit.
Exercise and activity are essential for health promotion and maintenance and for achieving an optimal level of functioning. Approximately half of the physical deterioration in the elderly population is caused by disuse rather than by the aging process or disease. Positive effects of exercise on health include (1) increased energy, (2) improved eating and sleeping, (3) decreased discomfort and stress, and (4) decreased smoking and alcohol use.
Nutritional status is important to an older person’s ability to remain healthy, to maintain structural integrity, think clearly, and to possess the necessary energy to engage in social and fitness activities.
Socioeconomic factors can contribute to malnutrition. With reduced income, some elders may restrict food intake to near-starvation levels because they may choose to pay rent and buy medicine over spending for food. Diets may be unbalanced because of the expense of fresh fruits, vegetables, and meats. Lack of transportation and the inability to carry heavy quantities of groceries can prohibit some people from obtaining food. Living alone can also be associated with poor nutrition, since many older adults may lose the motivation to prepare a balanced diet for just themselves.
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