Primary and secondary prevention strategies in the older adult

Standpoints of Traditional Persian Physicians on Geriatric Nutrition

The present article aimed to compile information on the nutritional management for geriatric people. Popular textbooks of Persian medicine from 10th to 18th century were studied to derive relative viewpoints and considerations. The temperament, which is defined as the combination of 4 main elements (fire, air, water, and soil) and 4 humors made subsequently (black bile, yellow bile, phlegm, and blood), changes during age periods. Imbalance in proportional amounts of humors in elderly should be corrected with food and medicaments having opposite nature to the current condition. Traditional foods included mostly well-cooked soups, pottages, and porridges containing fresh sheep or chicken meat. Mono-ingredient foods were also administered according to their medical properties. Nutritional recommendations were also concerned with geriatrics’ physiological conditions such as constipation, sleep disorders, and memory deficits. Many of traditional geriatric nutritional requirements are relevant in the present day. However, there are still notes that may be beneficial for consideration.

Physical exercise: does it help in relieving pain and increasing mobility among older adults with chronic pain?

AIM

To provide a physical exercise programme for older adults living in nursing homes.

BACKGROUND

Pain is common among older persons and for those already in long-term care and having difficulty in coping with pain will be at risk of further reducing their optimal independent function.

DESIGN

A quasi-experimental single group pretest-posttest design.

METHOD

Older persons from a nursing home were invited to join an eight-week physical exercise programme. Each session lasted an hour and sessions were conducted once a week by physiotherapist and nurses. Physical exercise programme consisted of stretching, strengthening, balancing, towel dancing and self-administered massage to various acupressure points. On completion of each session, older persons were given a pamphlet with pictures to illustrate the exercise of the day and they were encouraged to practise these exercises by themselves. Outcome measures including pain intensity, range of movement, activities of daily living and mobility were collected before and after the physical exercise programme.

RESULTS

There were 75 older adult participants (57 female and 18 male, mean age 85.14 SD 5.30). Seventy-three percent (n = 55) of them had pain in the previous three months and were referred as pain group, while 25% (n = 20) were no pain group. Pain scores of 4.89 (on a 10-point scale) indicated medium pain intensity before the intervention for the pain group; the location of pain was mainly in the knee, back and shoulder. On completion of the physical exercise programme, there was a significant decrease in pain intensity to 2.89 (SD 2.14) (p < 0.01). There was a significant increase in range of movement in the neck, shoulder, back, hip and knee rotation, flex and abduction (p < 0.01). Mobility level was significantly increased post intervention, yet activities of daily living remained unchanged.

CONCLUSIONS

The present study demonstrated the effectiveness of a physical exercise programme in relieving pain and enhancing functional mobility for older persons. Relevance to clinical practice.  It is important to educate older persons, especially those living in nursing homes, on the importance of engaging in regular physical exercise and maintaining mobility.

Therapeutic effects of an indoor gardening programme for older people living in nursing homes

AIMS

To explore the activities of daily living and psychological well-being of older people living in nursing homes and also to examine the effectiveness of a gardening programme in enhancing socilaisation and life satisfaction, reducing loneliness and promoting activities of daily living for older people living in nursing homes.

BACKGROUND

Life in nursing homes can mean very limited physical and social activity, leading to further decline in function for many older people.

DESIGN

This was a quasi-experimental pre and posttest control group design.

METHODS

Older people from nursing homes were invited to join the eight week indoor gardening programme (experimental group), while older people in other nursing homes were treated as the control group; they received regular care without the eight week indoor gardening programme. There were 26 older people (25 female and one male; mean age 85 years) in the experimental group and 27 (20 female and seven male; mean age 82 years) in the control group. Demographic data including age, gender, educational level and financial situation were collected, in addition to information regarding life satisfaction, loneliness, physical activity and social network situation, before and after the eight week indoor gardening programme for both the experimental and control groups. Also, details of experimental group subjects' experience of the indoor gardening programme were elicited using open-ended questions.

RESULTS

There were significant improvements in life satisfaction and social network and a significant decrease in perception of loneliness for older people in the experimental group after the eight week indoor gardening programme, while the activities of daily living were unchanged for both groups after the programme.

RELEVANCE TO CLINICAL PRACTICE

Given the positive effects of gardening activities, it is suggested that they be promoted more widely among nursing home residents.

Reducing my risk of intrusion: an intention of old homebound women who live alone

BACKGROUND

In assessing home safety for older persons, nurses have checked home security or assessed fear of crime but neglected to explore intentions to reduce the risk of intrusion.

OBJECTIVES

To describe the intentions of old homebound women relative to reducing the risk of intrusion.

METHODS

A descriptive phenomenological method was used. The 40 participants (aged 85-98 years, M = 89.6) met criteria for age, living alone, and homebound status. Over 18 months, a series of tape-recorded interviews was completed, focusing on perceptions about changes in feeling safe at home and precautions to prevent the need to reaching help quickly. Data analyzed were drawn from interviews with the 32 women who reported intentions to reduce intrusion risk.

FINDINGS

Feeling safe in-place was contextual to recognizing intrusion risk and intentions to reduce the risk. Most women denied a recent change in feeling safe but reported intentions to reduce intrusion risk. The nine women who reported feeling less safe referred to various personal-social situations as explanatory. The five components of the phenomenon were keeping watch here, keeping out of harm's way here, preventing theft and vandalism here, discouraging people who might want to get in here, and keeping intruders out of here. Each component phenomenon was the umbrella for a variety of specific intentions to reduce intrusion risk.

CONCLUSIONS

Each woman was intending to reduce intrusion risk in unique ways. When conducting home safety assessments, nurses should explore intentions to reduce intrusion risk and use that information as a basis for individualized interventions to promote safety, rather than relying on generic suggestions such as locking the door.

Actions taken by frail older widows to allow home care providers access to their homes

Nurses have been advised to encourage older persons to keep their doors locked, but there is little guidance about how home care providers should best gain access to the homes of clients. During a descriptive phenomenological study of the experience of home care (N = 25), 9 frail older women explained their strategies for allowing providers access to their homes. Women who typically left their doors open for their own reasons were not uncomfortable leaving the door open when a provider was expected. However, women who left the door unlocked at the request of a provider expressed misgivings about doing so. Older women need personalized counseling about ensuring access to care providers while maximizing safety. For practical, ethical, and legal reasons, home care providers who ask older women to leave their doors open should reconsider that strategy.

Oral health promotion programme for older migrant adults

OBJECTIVES

This study evaluated the impact of a community-based oral health promotion programme on the use of oral health services, oral health knowledge, attitudes, and practices of older Greek and Italian adults attending community clubs and living in Melbourne, Australia.

METHODS

The oral health promotion intervention consisted of three components: a series of oral health seminars, held at the clubs in the participants' native languages, the provision of oral health care products, and the production of oral health information sheets. The intervention programme was known as the Oral Health Information Seminars/Sheets (ORHIS). The content of each session was determined following suggestions and findings from the data collected. A pre-test-post-test non-equivalent control group quasi-experimental design was chosen to evaluate the intervention. A total of 520 independent-living older adults, members of Greek or Italian social clubs participated in this evaluation.

RESULTS

Participants who took part in the intervention responded with higher levels of achievement than those in the control groups. After controlling for baseline variables, experimental groups were significantly more likely than the control groups at post-test to have improved oral health attitudes, oral health knowledge, and self-assessed physical health status, as well as, self-reported oral hygiene practices and use of oral health services.

DISCUSSION

The ORHIS approach was successful within the setting of social clubs, and highly acceptable to these communities. As such, it represents a helpful approach for the design of (oral) health interventions in older adults. Further research is required to test the long-tem impact including the economic evaluation of the ORHIS approach.

Nutrition and health promotion in older adults

During recent decades, the concept of health promotion has become a legitimate part of health care because of the aging of the postwar baby boom generation. As this population ages, the potential strain on health care systems will increase because the greatest use of health care services occurs during the last years of life. In older adults there are many correctable health factors that can be assessed through screening protocols. Hypertension, cholesterol, hearing, vision, diabetes, and cancer screening are well integrated into health promotion programs; nutrition promotion programs are not as well integrated. Reluctance to develop health promotion programs for older adults exists because of a perception that they would not follow such plans or change their lifestyles. However, longitudinal studies have shown that health promotion activities extend the number of years of health in older people although the relationship weakens in older age. Changes in diet and exercise patterns are most effective in the prevention of nutrition-related conditions when they are instituted early in life, but positive effects can occur at any age. If nutritional interventions are instituted early, a substantial reduction in health care expenditures may result from a decrease in the incidence or the delayed onset of these conditions. Changes in behaviors (reducing salt and fat intake) were positively associated with a belief that consuming a healthful diet would contribute to better health. The use of a variety of adult education theories and models will enhance behavior changes that lead to more healthful habits and enable a health educator to be successful in effecting change.

A key to successful aging: learning-style patterns of older adults

A sample of 61 volunteer older adults, age 64 to 88, living independently in a suburban, residential senior citizen setting, participated in this dual-pronged investigation. It was the first study of its kind to analyze the current and previous learning styles of a sample of older adults. Current learning-style preferences were assessed through the Productivity Environmental Preference Survey (PEPS) and recalled learning-style preferences identified through the Previous Learning Experiences Questionnaire. Each older adult participant was administered the Short Portable Mental Status Questionnaire to assess their cognitive functioning. Two directional research hypotheses were tested. Single-sample t tests confirmed that these older adults scored significantly different on learning-style elements as measured by the PEPS from the original normed group. Single-sample t tests also revealed that older adult men were significantly different from older adult women on certain learning-style preferences. Research conducted with the Dunn and Dunn Learning-Style Model during the past 30 years has yielded valuable insights into how learning-style preferences evolve over time. This model's research continuum, until recently, extended from early childhood through the midlife years of between 40 and 50. This investigation currently has expanded the learning-style continuum to incorporate octogenarians. The element of perception has provided additional information that is important and useful for educators when preparing instructional sessions that include diverse older adult participants.