Health Promotion Plan: Older People

Caspersen .et .al (1985) defined physical activity as any bodily movement produced by skeletal muscles that result in energy expenditure.

The aim of this essay is to plan a health promotion based on older people. Inactivity can lead to health problems, such as obesity, coronary heart disease, stroke, cardiovascular disease and also accident prevention. This assignment will present a series of evidence based on the intervention and will use current theories and models of health that can help prevent, increase and maintain the uptake of physical activity among older adult. These will be formulated through the integration of published scientific literatures. This approach will involve identifying and producing findings which will include the characteristics of determinant of health and health inequality, such as age, belief, class, environment psychosocial whilst applying the Beattie health promotion model in conjunction of specialism and awareness of ethical implication when taking part in health planning.

The rationale of choosing this group is because, due to their age they have reduce physical activity. The proportions of older people in the population are increasing quickly and older people are less active. According to Health Education Authority (HEA 1995b) three out of ten men (33%) and four out of ten women (38%) aged between 55 and 74 years are sedentary (i.e. participate in less than half an hour of moderate intensity physical activity a week). It is known that health-related problems increase with both age and inactivity (Mathers et.al 1999, WHO 1996). Hoffman et.al (1996), Rice et.al (1996) pointed out that 85% of individual aged 65-100 years have at least one chronic condition (cardiovascular disease, CHD, stroke, obesity, diabetes, etc) and the numbers continue to grow with advancing in age. However, evidence showing the rate of progression and severity of many diseases in older people can be prevented, minimized or delayed with the provision of effective health promotion programmes, therapeutic exercise or physical activities (Harvey 1991, Nutbeam et.al 1993). However, older adults are more likely to pull out of exercise programs than younger ones. Paterson (1982), Acheson (1998), Naidoo & Wills (2005) argue that elderly people, for example, may have different health expectations from those who are young, as may those who live in poverty compared with those who live more affluently.

Health Promotion represents a comprehensive social and political process, not only embracing actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental, and economic conditions so as to improve their impact on public and individual health (WHO 1998b) but also defined as the process of enabling people to increase control over, and to improve their health (Ewles & Simnett, 1996). The World Health Organisation (WHO, 1946) defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition is suitable for all groups who need to change to a developmental process Therefore this is evidence that people’s health will be determined by the factor surrounding them such as their beliefs, age, environment etc. Health promotion must be seen in preventing ill health and enhancing positive health. It must also try to develop positive health with an eye for prevention: for example, encouragement to physical exercise, through cycling, running and walking. Blaxter . However, Williams (1983) studied the health beliefs of elderly people living in Aberdeen, found that people could consider themselves, or others, healthy even though they may be badly diseased.

The health of an individuals and populations can be affected positively and negatively by a range of interrelated factors influencing the determinant health (Keleher et.al (2002), Townsend et.al (1988), Acheson (1998). as a concept and set of practical strategies which remains as an essential guide in addressing the major health challenges faced by developing and developed nations, including communicable and non-communicable diseases and issues related to human development and health. Dahlgren and Whitehead (1991), Acheson (1998) see determinants of health as individual influenced by intrapersonal ( such as age, personal confidence, education, social class, and behavioural attributes and skills), socio-cultural, ( these include social support from peers, social support from one’s spouse or family, and influence of a general practitioner), policy and physical-environmental, ( these include climate and seasonal factors, access to physical programmes and facilities), factors such as living and working conditions, and community characteristics which are important to the changing and understanding adult health behaviours. Acheson report (1998), Naidoo and Wills (2005) and WHO (2003) for example, all pointed out that social environmental determinants are highly associated with health. The Office of National Statistics (2007a), Wilkinson (1986) also reported that major causes of sickness and death are circulatory diseases for example, coronary heart disease (CHD), stroke, cancers and respiratory disease, while Stansfield & Marmot (2001) suggested that there may be other links between CHD and psychosocial factors, such as stress and lack of social support, depression and anger. Britton & Macpherson (2000) also contributed that physical inactivity, smoking and raised blood cholesterol are major risk factors for CHD. Fennel et.al (1988) pointed out that growing old is far from necessarily accompanied by becoming sick. Again, in the late 1980s, this was considerably higher among those in higher social classes and the differences increased over the period from the late 1970s to the late 1980s, particularly for women. However, the social rise in classes according to the Office for National Statistics (2008), Townsend et al (1982); Acheson (1998) and Vent and Wise (1991, 1989) suggests that people in the lower social classes working in unhealthy conditions are more likely to experience poor health, life expectancy, longstanding illness and premature deaths than those in social classes I and II.

Caplan (1964) argues that the prevention of disease takes places at different levels. The level of intervention is set out in three main approaches for health promotion action: the downstream primary care approach, the midstream lifestyles/behaviourist approach and the upstream socioecological approach (Murphy & Keleher, 2003). Prevention is the notion of reducing the risk of occurrence of a disease process, illness, injury, disability, handicap or some other unwanted phenomenon or state (Tannahill et.al 1996). According to Naidoo and Wills (2000) tertiary prevention is reducing further disability and suffering in those already ill, preventing recurrence of an illness; e.g. rehabilitation, patient education and palliative care.

It will address a normative need of the elderly. According to Ewles & Simnett (1996) normative need is a need defined by an expert or professional according to her own standards, if it falls short of the standards there is no need. Normative need is based on the value judgements of professional experts, which may lead to two problems. Expert opinion varies over what the suitable standard and the other values and standards of the experts may differ from those of their clients (Ewles & Simnett, 1996).

According to Ewles & Simnett (1996) all planning should have aims and objectives.

The aim of the initiative is to raise awareness of the connection between inadequate exercise and coronary heart disease and how the elderly can partake in reducing their vulnerability to the disease.

Cognitive Objective is making sure the client understands any given information and the development of intellectual skills (Bloom, 1956).

Affective objective is the manner of ways client emotions are dealt with such as feelings, values, appreciation, enthusiasms, motivations and attitudes (Krathwohl et.al., 1973) .

Psychomotor objective is concerned about client physical movement, coordination, and use of the motor-skill areas (Simpson, 1972).

Planning helps elderly people to increase control over their own health, which is the aim of health promotion. Older people who attend the primary care setting have 10 minutes walk, which they find beyond their functional ability. In such a case it is appropriate to support specific activities to help improve mobility and muscular strength and it might require a specialist instruction and supervision from a trained practioner (Ewles & Simnett, 1996).

According to Beattie (1991) he suggested that there are four paradigms for health promotion. They are produced from the aspect of mode of intervention, which ranges from authoritative to negotiated and they lay as

Health Persuasion: This intervention is directed at individual and led by professionals.

Personal Counselling: This intervention is based on client led and focus on personal development that is the health promoter acts as a facilitator rather than an expert.

Community Counselling: This intervention is a similar way to personal counselling that is seeking to enhance the skills of a group or local community.

The chosen mode of intervention which will be used is the personal counselling for health because it brings together individual factors explaining physical activity that is attitudes, beliefs, and values; psychological characteristics such as enjoyment, motivation, perceived health and fitness, barriers, and physical activity self-efficacy (Sallis and Owen, 1999).

Strengths are according to NICE (2006);

Referral to well-trained staff who can draw on a range of experience and training including behavioural change theory that is physical activity expertise and experience in working with people with specific conditions.

Programmes should offer a range of choice of activity and or a choice of venue.

Programmes offering ongoing support in the community ideally linked to a support environment for physical activity.

Programmes run in conjunction with partners – often from the local authority or voluntary sector.

Weaknesses are according to NICE (2006):

Role or capabilities of individual health professionals.

Lack of necessary systems in place within primary care, which limits the ongoing and systematic promotion of physical activity.

Lack of a prevention culture within primary care.

Lack of clarity and consistency on what constitutes an exercise specialist.

Few incentives to promote physical activity within primary care systems.

A pressure to demonstrate cost effectiveness

Autonomy refers to a person’s capacity to choose freely for themselves, the ability to make rational choices and the ability to act on one’s environment. Ewles & Simnett (1996) suggested that there are different ways in helping a client to take control over their health; encouraging people to make their own decisions and resist the advice to take over the decision-making. It is also used to support people to think for themselves, even if this takes much longer than simply telling them.

Autonomy can be obstructed:

If you impose your own solution on your clients’ problems;

Telling them that their ideas are no good and will not work, without giving an adequate explanation or opportunity to try them out

Telling them what to do because they are taking too long to think it out for themselves

Tannahill et.al (1996) defined evaluation as the comparison of an object of interest against a standard of acceptability. The reasons to evaluate are to:

To measure the extent to which projects are achieving their main objectives.

To update the development of materials and methods. Evaluation helps to compare different looms or consider new refinement in methodology

To guarantee ethical practice, that is health promotion activities planning to influence people’s lives in health-enhancing manner.

According to Tannahill et.al (1996) evaluation can be classified according to the exact aspect of the programme, which is to be evaluated that is, the process and product or outcome. Long-term health promotion programmes will have objectives about changes in health status and evaluated in terms of outcome. Process evaluation allows analysis of the factor aspect of a project, that is yielding detailed information of direct importance to the development of materials and methods, the understanding of the relevant and reproduction of approach to other settings. Naidoo & Wills (2000) also stated that process evaluation employed a wide range of qualitative or soft methods. For example, such methods are interviews, diaries, observation and content analysis of documents. The product or outcome evaluation deals with these questions. It is essential to differentiate between the ultimate outcome, (such as health status) and other outcomes, (such as cognitive or behavioural outcomes), that are directly related to the programme objectives. According to Naidoo & Wills (2000) outcome evaluation is often the preferred evaluation method because it measures sustained changes that had stood the test of time. Health promotion needs to been seen as contributing to the ultimate outcome but measures with more direct alliance to health promotion projects in measuring the suitable effects of an intervention.

In conclusion the essay has shown older people inactivity can lead to health problems, such as obesity, coronary heart disease, stroke, cardiovascular disease, and how health is defined according to the group involves different determinants of health affecting older people. It also shows measuring health is not a simple task and lack of agreement about which are the best ways to measure health exits. Finally, the use of different kinds of criteria is explored.