Geriatric Health Promotion

Barbara Resnick, PhD, CRNP, FAAN, FAANP

Topics in Advanced Practice Nursing eJournal. 2001;1(1)

Abstract and Introduction

The purpose of health promotion and disease prevention is to reduce the years of life lost to premature mortality and ensure better quality of remaining life. As Americans live longer, it is suggested that health promotion activities are all the more important because these individuals will have more years to benefit from preventive services. Those in the oldest age group (age 90 years and older) are generally less likely to monitor their cholesterol intake, exercise, have their stools checked for occult blood, or have a mammogram or Pap test as recommended. The most common reasons given for not engaging in these activities are advanced age, not being told to by their primary healthcare provider, and having no interest in pursuing abnormal findings. Healthcare providers should consider an individualized approach to health promotion and disease prevention and help older adults make their own decisions about participation in these activities.

Introduction

In developed countries, the average life expectancy is approximately 80 years,^[1,2] and the most rapidly growing segment of the population is the group of people 90 years of age or older.^[3] Current US government figures estimate that the group of individuals 90 years of age and older (the "old-old") will increase from the current level of 1.2 million to 9.6 million by the year 2050. Moreover, US men who are now 90 years of age are expected to live for another 3.85 years, and 90-year-old US women are expected to live for another 4.67 years.^[4] Increased age, unfortunately, correlates with increased risks of cancer,^[5] heart disease,^[1] and functional impairment.^[6]

Health promotion and disease prevention aim to reduce premature mortality and ensure better quality of remaining life. Because people in the United States live longer than people in other parts of the world, it is suggested that health promotion activities are all the more important because these individuals will have more years to benefit from preventive services.

Health promotion and disease prevention activities include primary prevention -- the prevention of disease before it occurs -- and secondary prevention -- the detection of disease at an early stage. Medicare coverage for secondary prevention supports using these services ( Table 1 ).

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Abstract and Introduction
Appropriate Health Promotion Practices for the Old-Old Adult
Exercise Benefits and Recommendations
References

Table 1.
Screening Procedure	Medicare Guidelines for Reimbursement
Mammogram	Women older than 40 years of age are covered for 1 screening every 12 months. The usual Part B deductible is waived for these tests. Coverage includes the radiologic procedure and physician's interpretation.
Pap smears and pelvic exams	Pap smears and screening pelvic exams (also included care clinical breast exams) are covered at 3-year intervals. Annual examinations are covered for women identified as at high risk. The usual Part B deductible is waived for these tests.
Colorectal	Annual fecal occult blood test for those older than 50 years of age.
	Flexible sigmoidoscopy every 4 years for those older than 50 years of age. Colonoscopy for those at high risk every 2 years.
	Screening barium enemas every 4 years for those older than 50 years of age (not at high risk) and every 2 years for those who are at high risk.

Activity	Pros	Cons
Immunizations Pneumonia Flu Tetanus	Disease prevention, particularly to prevent an epidemic	Side effects such as local irritation or flu-like symptoms
Immunizations Pneumonia Flu Tetanus	Decreased morbidity and mortality associated with pneumonia or flu	Side effects such as local irritation or flu-like symptoms
Pap test	Increased risk for cervical cancer occurs with age and can result in unpleasant symptoms if untreated (foul-smelling discharge)	Cervical cancer develops slowly and is unlikely to be the cause of death in those 90 years of age or older
	Older women may not have had the opportunity to have regular Pap tests done, and may want this early screening	There is less risk if the patient is not sexually active, which is not unusual in older women
	Only pursue if the woman is willing to undergo treatment if disease is identified	Difficulty and discomfort of testing in an older woman, particularly one who is no longer (or never was) sexually active
Mammogram	Increased risk for breast cancer with age	New onset breast cancer is not likely to be the cause of death in those 90 years of age and older
	If detected, these tumors are generally estrogen-receptor positive and treatable	Tumors in older women tend to be slow growing
	Only pursue if the woman is willing to undergo treatment if disease is identified	Discomfort associated with mammogram
Prostate	Increased risk for prostate cancer with age	Controversy persists with regard to the effectiveness of treatment options, and the utility of treatment
Prostate	Only pursue if the man is willing to undergo treatment if disease is identified
Fecal occult blood testing (FOBT)	Early detection of a growth that could cause the older adult discomfort and impact quality of life if left untreated	False positives, which can result in additional testing and anxiety for the patient
	Easily performed with no discomfort to patient
	FOBT has better predictive value in older adults than in the young adult population
Diet monitoring	Although not tested in those age 90 years and above, decreasing cholesterol with dieting reduces mortality	Restriction in diet may affect quality of life
		For those 90 years of age and older, there may be no long-term advantage to restricting dietary fat
		The focus on diet should be to eat a healthy diet low in fat and high in fruits, vegetables, and grains
Reducing nicotine	Smoking is associated with increased risk of sudden cardiac death and myocardial infarction	None
	Financial incentive
	May decrease peripheral vascular problems, decrease chronic obstructive pulmonary disease, and prevent further lung disease
Alcohol	Cardiovascular benefits	Drug-drug interactions
	Social interaction	Increased risk of injury/accident
		Peptic ulcer disease
		Nutritional problems
		Exacerbation of cognitive impairments
Exercise	Positive physical health benefits	None
	Positive mental health benefits
	Decreased fatigue
	Decreased pain
	Maintain weight
	Maintain physical function

Type of Activity	Low-Risk Healthy Individual	High-Risk No Symptoms	High-Risk Symptoms	Chronic Disease
Low intensity < 60% MHR	No	No	No	No
Moderate intensity < 60% to 80% MHR	No	No	Yes	Yes
Vigorous activity > 80% MHR	Yes	Yes	Yes	Yes

MHR, maximum heart rate.

Table 4. Table 4. The WALC Intervention
W	Walk 3 times per week for at least 20 minutes each time. Give patient clear guidelines in terms of how much exercise they should do.
A	Address pain, fear, and fatigue during exercise using a variety of techniques (pain medication, heat, ice, visualization); identify goals and provide positive reinforcement/rewards for goal attainment.
L	Learn about exercise; teach patient particularly about the benefits of exercise and ways to overcome the known barriers (time, a place to exercise, fear of getting hurt) to exercise.
C	Cue by visual aids, specifically a large, easily visualized calendar to remind the participant when to walk, and for how long to walk.

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