Promoting the mental health of elderly African Americans: a case illustration

Promoting mental health in an illness-oriented health care delivery system is challenging. Health promotion from a holistic perspective requires that mental health be viewed as important as physical health. The mental health needs of the elderly are numerous and often not addressed during routine visits for primary health care. Research consistently reports that elderly African Americans are not equal participants in the formal health care system. Consequently, promoting mental health in the African American elderly is a challenge made even more complicated because of this group's limited access to and use of mental health care services. Promoting the health of African Americans confronts many traditional values and practices of health care institutions and mental health practice. Therefore, health care providers must be innovative and creative to facilitate mental health promotion in this population of clients. The authors suggest that the Revised Health Promotion Model can serve as a framework for guiding the mental health care of elderly African Americans. Aspects of the model are particularly relevant for this population. The case of an elderly Black woman is presented as an illustration of ways in which the model may be applied with many cultural nuances.     

Older women and the meaning of health

Health promotion has become an essential component of comprehensive health care, especially considering the growing female population. Older women, in particular, have demonstrated an increasing need for preventive services or health care maintenance and promotion. These needs consist of services provided by health care professionals that can help women meet their own self-care demands. However, before the health care needs of women can be met, they first must be identified. Using Orem's Self-Care Theory, a three-part qualitative phenomenological study was conducted in an attempt to understand what health actually means to older women and what types of health behaviors they feel are important to maintain or promote health. Three different groups of women age 55 and older with a variety of education, socioeconomic, and racial backgrounds were interviewed. Their responses were analyzed carefully, and each participant was interviewed a second time to validate recurrent themes regarding their statements about health. Results of the interviews with the three different groups of women were surprisingly similar. Although each participant had a unique application of their definition of health, there were five recurrent themes identified by 75% to 80% of the women. The themes were interactions with a being greater than themselves, acceptance of self, humor, flexibility, and being other-centered. Numerous examples supported the five themes. In addition, several "healthy behaviors" also were identified. Based on the findings of this 3-year study, older women seem to have their own perspectives on what health actually means and how they can best monitor or maintain their health. While the list is slightly different than the traditional one prescribed by health care professionals, perhaps it is time to encourage older adults to become more of a partner in their care. These healthy behaviors could be incorporated easily into the treatment and management plans and thereby reflect both parties' definitions of what it means to be healthy. Health care professionals must continue to ask older adults about their view of health and encourage their partnership in health-related issues. All individuals, no matter what age, are being encouraged to assume more responsibility for their own personal health, and by including older adults in the decision-making process, this partnership can be strengthened.     

The Neuman System Model applied to mental health nursing of older adults

As we move into the 21st century, nurses are facing the challenge of contributing to the health care of a society with an increasing proportion of ageing persons. This group of people become more heterogeneous as they age, bringing with them an extended life history of experiences of wellness and illness. They have been faced with numerous stressors and losses and have made successful or unsuccessful adaptation to those life experiences. One of the disconcerting stressors of the elderly is the promotion and maintenance of mental health. In this paper we will examine the application of the Neuman System Model to the mental health nursing of older adults.     

Long-term care: a health promotion challenge

There is a lack of health promotion for the elderly residing in long-term care facilities. It becomes imperative therefore for the nursing profession to readjust its thinking and practice to include health promotion strategies and interventions for institutionalized elderly in the long-term care sector. From using the empowerment theory in the discussion it is clear that nurses can help the elderly receive health promotion strategies and interventions to help the older person make informed choices about their lifestyle, health and treatment. The elderly population continues to grow and more than likely will spend some part of their life in a long-term care setting. Evidence from studies performed by Robertson (1991), Caserta (1995), Phillips (1994) and McBride (2000) suggests that health promotion efforts positively correlate with improved physical and psychological elements of health for the elderly. Nurses largely determine the kind of care that is given and thus can influence the quality of life that elderly client's experience. By advocating for health promotion interventions and strategies for their elderly clients, nurses are demonstrating to the community, their patients, and institution that nurses do have the power to make and influence change for the better. Nurses advocating for health promotion for their elderly patients not only empower choice, but also create an active and involved elderly population. Health promotion exists at all stages of life and does not cease when one is admitted to a long-term care facility (Hutchings, 1999; McBride, 2000).     

Adult learning center: a unique adventure for a school nurse.

The school nurse's role in an Adult Learning Center presents a unique challenge. The learning center serves clients who range in age from infancy to elderly adults. The population includes low-income children in day care to alternative high school or adult education classes. Many participants have no health insurance or source of primary health care. The school nurse provides care to meet individual health needs, needs that may be illness related or involve health promotion or primary prevention. The nurse's involvement includes health assessment and appropriate nursing care. This learning environment, although non-traditional for a school nurse, offers health services to those who are at risk due to lack of health education, poor health habits, or lack of access to health care. The school nurse is an essential bridge to people who need care and who may have no other source of health information or care in the community.     

The Role of Physical Therapists in Living Environment Maintenance of the Home-bound Elderly Disabled

[Purpose] This study explored the roles of physical therapists (PTs) in living environment maintenance, which is essential for living securely and stably at home, and examines how physical therapists can fulfill these roles more efficiently and effectively. [Subjects and Methods] A questionnaire on living environment maintenance was given to PTs working at randomly selected hospitals, health care facilities for the elderly requiring long-term care, home-visit nursing stations, and other such facilities and directly providing physical therapy to the home-bound elderly disabled. The subjects of the study were 77 PTs who returned valid responses. [Results] For awareness of systems for living environment maintenance, PTs were more aware of the system based on the Long-Term Care (LTC) Insurance Act than the system based on the Act on Welfare for the Home-Bound Elderly Disabled. PTs who have worked at two or more types of medical, welfare, and intermediate institutions were more aware of such systems than PTs who have worked at only one type. For PTs handling living environment maintenance for the home-bound elderly disabled, approximately 80% of respondents answered that they have handled some living environment maintenance, and PTs with longer clinical experience have handled more living environment maintenance cases. [Conclusion] The results demonstrated that PTs understand their living environment maintenance work well and handle the work. The results, however, also suggested that educational and operational improvements are urgently required for PTs handling living environment maintenance essential for the lives of the home-bound elderly disabled.Key words: Living environmental maintenance, Physical therapists, Home-bound elderly disabled     

Actual Conditions and Countermeasure of Yun‐bian Old Men's Health

The purpose of this study was to investigate how the aging problem in China was reflected in Yun‐bian, an area where the Korean‐Chinese converge, and to forecast future aging issues. The findings of this study revealed that 60% of the elderly identified themselves as healthy or normal, while 30.8% of them identified themselves as having a disease. Over 80% (80.6%) of the population who had an illness were elderly. The most prevalent diseases were hypertension, angina pectoris, arthritis, cerebral thrombosis, and digestive and respiratory disease. The leading causes of death were cerebrovascular disorders, accidents, malignant tumors, and heart disease. Among the Yun‐bian elderly, 68.8% were found to be cared for by their families, with 30.8% of them living with their offspring. Only 0.45% of the Yun‐bian elderly were found to be living in social welfare centers. The medical treatment services provided were either community‐centered or hospital‐centered. It was concluded that reinforcement for administration and organization of the health‐care services, policy development regarding medical insurance for the aged, professional health‐care provider education for the elderly, and health‐care program development for the elderly are needed.     

Delivery of rehabilitation services to people aging with a disability

The disabled elderly population continues to grow. Systems of care for the disabled elderly are vast, ranging from inpatient facilities to outpatient programs and home programs. Recent advances in technology allow us to reach patients in their homes through telemedicine. Support services within the community are growing, and case managers are becoming more necessary as it becomes more difficult to navigate the health care system. As providers of rehabilitative services, we must help our patients find the most appropriate setting to receive care. As the focus continues to shift from inpatient to outpatient care and to home services, we must approach health care in a dynamic fashion and with flexibility. We must be advocates for our patients and their caretakers. Significant research questions remain, and health care policy requires development. As the population ages and the disabled elderly population become a focus of fiscal experts, we must look to provide the most cost-effective yet functionally productive health care. We may shift from focusing on functional performance in a therapy gym or inpatient rehabilitation unit to functional performance at home. We must focus on IADL and QOL indicators and must strive to find ways to provide efficient, cost-effective care. Medicaid, Medicare, and third-party insurers offer various options.The VHA offers additional benefit to those who are eligible. Advocacy groups such as the American Association of Retired Persons struggle to meet its members' needs and concerns while generating income to provide education and other resources. We must work to promote the strengths of the elderly population by addressing preventive strategies while maintaining functional independence.     

Questions of distributive justice: public health nurses' perceptions of long-term care insurance for elderly Japanese people

This study examines public health nurses' perceptions and concerns about the implications of Japan's new long-term care insurance law concerning care provision for elderly people and their families. Respondents voiced their primary concern about this law as access to services for all elderly people needing care, and defined their major responsibility as strengthening health promotion and illness prevention programmes. Although wanting to expand their roles to meet the health care, social and public policy advocacy needs of elderly persons and their families, respondents also stated their concern for the possible lack of enough resources for this expansion to support family caregivers adequately. They viewed their first function as developing collaborative relationships with local government officials to help to assure sufficient resources to provide the necessary foundation for long-term care programmes to deliver services to all those in need. These concerns fall within the larger ethical issue of distributive justice in a society based on the obligations of the state to citizens and the family to its members, especially elderly relatives, who, according to traditional Japanese values, retain respect.     

Health Maintenance,Health Promotion: Is There a Difference?

Nurses in community settings are seeing more health care consumers who are medically stable and who are asking for assistance in areas such as exercise, stress reduction, nutrition, and illness and accident prevention. These requests can be characterized as concerns of health maintenance or health promotion. Two nursing diagnoses, altered health maintenance and health-seeking behaviors (specify), enable the practitioner to address these concerns in clinically useful ways. Through case studies and comparative tables, the differences between these two diagnoses is clarified to enable nurses to identify, treat, and evaluate efforts made to enhance health-oriented behaviors.     

Determinants of health promotion activities in nursing clinic clients

Nursing clinic clients' health beliefs, values, and demographic characteristics were analyzed for their impact on health promotion activities. A sample of 175 clients was administered measures of health beliefs, health values, and health promotion activities. The type of health care clients had requested at the clinic for the previous 2 years was categorized as health promotion, illness prevention, health maintenance, or health restoration. Findings included: health value was not related to self-reported health promotion activities or to types of clinic visits; a strong belief in chance was negatively associated with engaging in health promotion activities; a strong belief in powerful others was negatively associated with a high percentage of restoration visits. The combination of beliefs, values, and selected demographic factors accounted for 16% of the variance in health promotion activities and 18% of the variance in the type of health care sought.     

Health promotion in specialist and community care: how a broadly applicable health promotion intervention influences patient's sense of coherence

Background

Chronic illness health interventions aim to strengthen individuals' wellness resources, in addition to their ability to handle their condition. This presupposes a partnership between patients and professionals and flexibility in care organization.

Aim

This study aims to investigate possible changes in individuals' sense of coherence while living with long‐term illness as they engage in a broadly applicable health promotion intervention developed in specialist care settings that was later implemented in the community care context.

Method

This study had a pre–postdesign. Sense of coherence was measured using the SOC ‐29 questionnaire at baseline and within 14 days of programme completion. The total baseline sample included 108 Norwegian adults (aged 21–89) with chronic illness. Data were analysed using paired samples t ‐tests.

Results

In both clinical sites, the total sample's mean SOC score changed positively from the baseline to the follow‐up 4 months later. This change was larger for the participants in the community care context. Manageability increased significantly for women. Significant positive changes in SOC score and the manageability dimension were also identified among participants who had children. Similar findings were found for those who were living with a partner, as well as for public transfer payment recipients.

Conclusion

The intervention contributed to a positive change in participants' SOC while living with illness. The findings revealed that the intervention is a flexible health promotion tool across age, diagnostic categories and clinical sites. The community participants' SOC changed the most, which indicates that the intervention is especially relevant in the follow‐up of persons living with long‐term illness within the community. The intervention contributes to a shift of perspectives in health care towards strenght‐based care and health within illness.

     

Elderly Clients'' Perceptions of Public Health Nursing Care

Although the health benefits of illness prevention and health promotion are accepted, little is known about the reasons for which elderly clients attend public health programs or the benefits they perceived from public health nursing care. This study reports the major reasons for which men and women age 60 and over sought care in a public health nursing program and the major benefits they perceived. The sample included 137 new and 360 returning clients. Responses to open-ended questions were content analyzed into categories of like statements, which in turn were placed into overall groups. The results suggest that most clients realized significant benefits from receiving public health care and were able to articulate these benefits. Eliciting client's perceptions can assist public health nurses to implement and market programs in a way that is acceptable and accessible to the recipients.     

Silent no more: elderly women's stories of living with urinary incontinence in long-term care

Urinary incontinence (UI) is a prevalent health issue affecting the quality of life of many elderly women living in long-term care. Minimal consideration has been given to understanding the lived experience from women's perspectives. Using one-to-one interviews, this study explored elderly women's experiences with UI while living in long-term care facilities. Data were analyzed using thematic analysis that revealed three themes related to the meaning of UI to the women, physical implications of UI, and institutional culture of UI in long-term care. Within these three themes, the women expressed common concerns. The results of this study provided information that could influence changes in nursing practice related to individualized UI care, empowering women experiencing UI, and dispelling ageism in long-term care. The study also suggests opportunities for improving health care education related to the quality of life of women who experience UI, and the need to make the experience more visible and openly discussed as a health issue rather than the traditional condition of aging.     

The need for a more holistic health care system

As a result of the evolution of health problems in the United States, the current health care system must change its focus from the traditional biomedical model to a holistic health oriented model. The holistic health oriented system is based on the enhancement and maintenance of health, not on the cure of disease. Given positive research findings concerning the health and cost benefits of worksite health promotion programs, it appears that industry, along with third party payers, nurses, and other health care professionals, could alter the emphasis and direction of health care. The worksite provides an ideal setting for the development of holistic programs. The occupational health nurse, whose role involves health promotion, health protection, environmental screening, and illness intervention, is in the best position to work with management in developing health promotion programs.     

Health maintenance alteration: a nursing diagnosis of the elderly

The continually growing numbers of elderly persons in our society and the corresponding increase in health care needs for those over age 65 are providing significant challenges to the health care delivery system. Diminishing health care resources and a desire to avoid institutionalization of the elderly client are creating nursing roles for helping the elderly maintain healthful living within the community. Accurate assessment provides the nurse with access to client perceptions of health status as well as a picture of the health management practices of the older adult. A nursing diagnosis of health maintenance alteration is the basis for an individualized plan of care of nursing intervention which is directed toward reducing risk factors and assisting the elderly client to achieve optimum levels of function and independence within the limits of defined health maintenance alterations.     

Health beliefs: a cultural division?

Uptake of preventive health programmes seems to be related to people's underlying motivations, attitudes and beliefs about health and illness. Current theories used to account for variance in behaviours by social group (such as the health belief model and locus of control model) explain only some of the variance in these motivations and attitudes, and have not been adequately tested on women from different ethnic minority groups. Health beliefs have important implications for nursing given the role of the nurse in health promotion and patient teaching. This paper identifies and compares the health beliefs of women of Asian origin and white indigenous women living in an inner-London borough, through in-depth semi-structured interviews, and considers the findings in relation to health promotion practices and the role of the nurse. The Asian women rated their health as worse than the white women; this requires further study. Comments and views gathered about the causes of various diseases indicated that it may be unrealistic to fit a person's health beliefs into a distinct model. Beliefs about disease appeared to be culturally sensitive; health education, therefore, must also be culturally sensitive.     

Health promotion in heart failure--a paradigm shift

For people living with heart failure, levels of health exist along a continuum in correlation with the illness experience. A focus on health promotion rather than only disease or symptom management expands opportunities for self-care and presents an emerging paradigm shift in the care of people with heart failure. Results from 2 studies revealed that few health-promoting behaviors were reported by patients with heart failure until a focused intervention that emphasized health promotion as part of self-care was implemented.