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Older People - Health Promotion and Public Health

Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Top Contributors - Bhanu Ramaswamy, Admin, Lucinda hampton, Kim Jackson, Shahd Mohammed Abdelhafeez Hamed, Vidya Acharya, Tolulope Adeniji, Evan Thomas and Lauren Lopez  

Introduction

Over the past decades, life expectancy has increased globally due to improved living conditions and advances in medicine and technology, and forecasts show that the older population continues to grow. By 2030, around 1 in 6 people worldwide will be aged 60 years or over, and the global population of people aged 60+ is projected to reach about 2.1 billion by 2050.[1] Quality of life (QOL) refers to the general well‑being of individuals and societies. It outlines negative and positive features of life.[2]

The quality of life of older people and health are among the important issues in healthcare services. Despite increased life expectancy, aging is associated with more illnesses and dependency. In addition to biological changes, aging causes changes in the social roles of the elderly, which are associated with retirement and more health problems.[3]The World Health Organization describes healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age, which is strongly influenced by the environments in which people live and age.[4]

Health Promotion and Public Health

Health is determined by behaviours in many ways. Health related behaviors include smoking, alcohol consumption and exercise habits. This health behaviour can be promoted in different ways such as health education and incentives to induce healthy behaviour.

The elderly have long been neglected as the addressee of health promotion activities. The need to promote health among older people was first highlighted in the 1990s. Health promotion targeted to older people differs significantly from that addressing younger generations. Differences include:

Health promotion programs for the elderly have to account for these limitations in health and daily activities and require more involvement of professional health promoters and more individualized approaches.[5]

The core of health promotion for older adults are to increase or maintain functional capacity, maintaining or improving self-care, and stimulating one’s social network.

The goal of this health promotion is to improve and maintain a longer, independent and self-sufficient quality of life.[5]

The Decade of Healthy Ageing (2021–2030)

The Decade of Healthy Ageing (2021–2030) seeks to reduce health inequities and improve the lives of older people, their families and communities through collective action in four areas: changing how we think, feel and act towards age and ageism; developing communities in ways that foster the abilities of older people; delivering person-centred integrated care and primary health services responsive to older people; and providing older people who need it with access to quality long-term care[6].

The Decade aligns with the Sustainable Development Goals and emphasises creating age-friendly environments, tackling ageism and strengthening long-term care, with older people meaningfully involved in planning and implementation.[7]

Physiotherapy

Health promotion strategies for the elderly generally have three basic aims: maintaining and increasing functional capacity, maintaining or improving self-care, and stimulating one’s social network

  • As physiotherapists, we can help older people with the first aim i.e. maintain/increase their functional capacity. With our knowledge we are well equipped to do this via e.g. strength, coordination, CV fitness training, home exercise plans, hydrotherapy, yoga.
  • The Chartered Society of Physiotherapy defines physiotherapy as a healthcare profession concerned with human function and movement, maximizing a person’s potential.[8]
  • We also have a role to play in educating older people to improve their general state of health and well-being.

Take a look at this light heart video on activities and the elderly

[9]

By identifying factors that affect movement, physiotherapists can manage/improve a condition through approaches including health promotion, preventative advice, treatment, and rehabilitation. 

(WHO) definitions on health:

  • Health as defined in the WHO: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities.
  • Health Promotion: The process of enabling people to increase control over, and to improve their health. Health promotion is the practical applicability of health, expressed as a resource to permit people to lead an individually, socially and economically productive life. One of the reasons to single out health promotion and public health for a specific group of population could be epidemiological reasons such as measures targeting vulnerable or disadvantaged groups[5]. This explains why this paper focus on health promotion and public health for aged. Interventions for health promotion includes small projects to large national programs. Funding for these activities usually comes from donations from individuals or NGOs, or through taxation by national governments.
  • Public Health: The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society. To ensure health and health equity a country requires an empowered public sector must utilize principles of justice, participation, and collaboration. Actions include policy coherence across government; strengthening action for equity and finance; and measurement, evaluation, and training  

Between 2005 and 2008, a Commission on Social Determinants of Health was established to collate and publish a report in response to increasing concern about persisting and widening inequalities in social determinants of health globally.[10]

Health Promotion and Public Health for Older adults

Health promotion programs for the older adults differs from that of the younger generation and one reason for this is that it is general belief that the health of older people is generally less than perfect[5]. Also, it is believed that older adults suffer from chronic conditions and multi-morbidities, limiting their functional ability.

It is necessary to pay attention to all social, physical, and psychological variables affecting the elderly’s QOL in community planning for health promotion of elderly. In addition to the elderly’s chronic diseases, other health issues such as oral and dental problems or poor nutrition should also be considered. Planning for the elderly’s social health and participation in society should be also taken into account. In addition, planning for the elderly should be based on age groups and gender differences. Participation in cultural, religious, and sports rituals with peers can help reduce depression among the elderly. Moreover, financial and nonfinancial supports as well as creating job opportunities for the elderly can improve their QOL.[2]

Health promotion programs for the older adults needs to incorporate these challenges of limitation in their health and daily activities.

  1. This health promotion and public health design thus requires specialize knowledge of healthcare practitioner in geriatric practice and education.
  2. Another factors to consider in designing health promotion and public health for older adults is the issue of life span, therefore, immediate results-oriented health promotion program is needed for this cadre of population[5].
  3. In order to maintain quality life in this population, social participation and integration should be taken into consideration when designing health promotion for this population e.g. continuing professional work into later life, learning activities later on, participation in cultural events, volunteer work, maintaining a social network[5].

E-health interventions and physical activity in older people.

Earlier studies showed that the common reasons for older people to avoid performing physical activities are inconvenience and a lack of access to physical activity programs[11], Lack of social support and fear of falling were also identified in the literature as common barriers to the participation of physical activity by older people[12]

E-health refers to health services that are delivered or enhanced through electronic devices, the internet, and related digital technology[13]

E-health interventions are effective at increasing the amount of time spent on physical activity, the energy expended in physical activity, and the number of walking steps. It is recommended that e-health interventions be included in guidelines to enhance physical activity in older people. Walking is the most common form of targeted physical activity promoted in e-health interventions. It is recommended that online social support and automatic tracking (e.g., fall detection and physical activity monitoring) be included in future e-health interventions in order to enhance the effect of those interventions. Further studies should be conducted to examine which e-health strategies are more effective.[14]

Summary

A healthy lifestyle can be promoted by various means, ranging from educational and counseling programs to financial incentives for a healthy lifestyle. These interventions are further offered in various ways, exercising, quitting smoking and limiting alcohol consumption, participating in learning activities and integrating in the community can help to inhibit the development of many diseases and prevent the loss of functional capacity, thus improving quality of life and lengthening life expectancy. [15]

See also Consent and Confidentiality

References

  1. ↑ World Health Organization. World report on ageing and health. World Health Organization; 2015 Oct 22.
  2. ↑ 2.0 2.1 Poursadeqiyan M, Arefi MF, Pouya AB, Jafari M. Quality of life in health Iranian elderly population approach in health promotion: A systematic review. J Edu Health Promot 2021;10:449
  3. ↑ Kinsella KG, Phillips DR. Global Aging: The Challenge of Success; Papulation Bulletin. 2005.60 (1).85‑99.
  4. ↑ https://www.who.int/news-room/questions-and-answers/item/healthy-ageing-and-functional-ability
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Golinowska S, Groot W, Baji P, Pavlova M. Health promotion targeting older people. BMC Health Serv Res. 2016 Sep 5;16 Suppl 5(Suppl 5):345. doi: 10.1186/s12913-016-1514-3. PMID: 27608680; PMCID: PMC5016724.
  6. ↑ WHO Ageing and health Available: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health(accessed 3.11.2021)
  7. ↑ WHO UN Decade of Healthy Ageing (2021-2030)https://www.who.int/initiatives/decade-of-healthy-ageing?
  8. ↑ Chartered Society of Physiotherapy
  9. ↑ Break the stereotypes Break the Stereotype- Elderly Physical Health Promotion. Available from: https://www.youtube.com/watch?v=AdH8TKA0Pu0 (last accessed 20.5.2019)
  10. ↑ http://www.who.int/social_determinants/en/
  11. ↑ Nahm E-S, Resnick B, Brown C, Zhu S, Magaziner J, Bellantoni M, et al. The effects of an online theory-based bone health program for older adults. J Appl Gerontol. 2017;36(9):1117–44.
  12. ↑ Mathews AE, Laditka SB, Laditka JN, Wilcox S, Corwin SJ, Liu R, et al. Older adults’ perceived physical activity enablers and barriers: a multicultural perspective. J Aging Phys Act. 2010;18(2):119–40.
  13. ↑ Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):e20.
  14. ↑ Kwan, R.Y.C., Salihu, D., Lee, P.H. et al. The effect of e-health interventions promoting physical activity in older people: a systematic review and meta-analysis. Eur Rev Aging Phys Act 17, 7 (2020).
  15. ↑ Golinowska, S., Groot, W., Baji, P. et al. Health promotion targeting older people. BMC Health Serv Res 16 (Suppl 5), 345 (2016).


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