13 Chapter 12: Health Promotion and Disease Prevention
Tracy Everitt and Megan Davies
Chapter 12 Learning Objectives
At the conclusion of this chapter, students will be able to:
Learning Objectives
- Understand the goals of disease prevention and how these are carried out.
- Understand the goals of health promotion and how these are carried out.
- Describe the differences between the health promotion and disease prevention approaches.
- Describe ways to prevent injury and falls in older adults.
- Understand how community nutrition services provide important resources for older adults.
- Describe resilience and its role in active and healthy aging.
Introduction
The aging population is triggering dramatic demographic, epidemiological, and anthropological changes, highlighting the importance of active and healthy aging. Active aging is a multidimensional concept affected by several factors, including physical functionality, lifestyle, urban environment, and social inclusion. The WHO defines active aging as “the process of optimizing opportunities for health, participation and security to enhance the quality of life as people age”… the process of developing and maintaining the functional ability that enables well-being in older age” (2020). Ultimately, healthy aging should consider the social dimension and the crucial impacts this has on developing and maintaining health at all ages. Healthy aging should consider several domains, including health status, income security, capability, and environment, also known as the social determinants of health.
The social determinants of health are the non-medical factors influencing health outcomes (WHO, 2020). They are the conditions in which people are born, grow, work, live and age, and the broader set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. Research shows that the social determinants of health can be more important than health care or lifestyle choices in influencing health.
Diet resilience is defined as having or developing adaptive strategies to maintain a nutrient-dense diet sufficient to meet requirements despite challenges. The foundation for diet resilience is the motivation to eat well, fuelled by pleasure and health.
Education programs that focus on tasty, easy-to-prepare food, emphasizing the importance of nutrition for health, helping older adults understand dietary resilience, and identifying community resources to promote food intake are positioned to support healthy aging. Healthcare systems play a key role in integrating nutrition care for older individuals across primary, acute, subacute, chronic care and home settings.
12.1 Fall and Injury Prevention
A simple accident like tripping on a rug or slipping on a wet floor can change your life. If you fall, you could break a bone, which thousands of older adults experience each year. For older people, a broken bone can also start more serious health problems and lead to long-term disability (NIA, n.d.). The risk of falling and fall-related problems rises with age. However, many falls can be prevented.
Figure 12.1.1: What causes falls in older adults?
Source: https://www.nia.nih.gov/health/falls-and-fractures-older-adults-causes-and-prevention
Many things can cause an older adult to be more at risk of falling. One’s eyesight, hearing, and reflexes might not be as sharp as when they were younger. Certain conditions, such as diabetes, heart disease, or problems with the thyroid, nerves, feet, or blood vessels, can affect one’s balance and lead to a fall. Conditions that cause rushed movement to the bathroom, such as incontinence, may increase the chance of falling. Fall risk increases with mild cognitive impairment or certain types of dementia. Age-related loss of muscle mass (sarcopenia), problems with balance and gait, and postural hypotension are all risk factors for falling. Foot problems that cause pain and unsafe footwear, such as backless shoes or high heels, can increase fall risk. Medication side effects such as dizziness or confusion increase the risk of falling; the more medications taken, the higher the risk. In addition, safety hazards in the home or community environment can contribute to falls.
Taking care of overall health supports a lower chance of falling. Fall prevention strategies include staying physically active, balance and strength training exercises, fall-proofing the home, addressing changes in vision and hearing, learning about medication side effects, getting enough sleep, avoiding alcohol, and wearing the proper footwear. Nutritional prevention strategies to lower fall risk include preventing sarcopenia with adequate protein intake, and preventing osteoporosis with adequate vitamin D and calcium intake.
12.2 Disease Prevention
Prevention includes a wide range of interventions aimed at reducing risks to health. There are three types of prevention: primary, secondary and tertiary. Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures or hazards that cause illness or injury, altering unhealthy or unsafe behaviours, and increasing resistance to disease or injury should exposure occur. Secondary prevention aims to reduce the impact of an illness or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often complex health problems and injuries to improve their ability to function to increase the quality of life and life expectancy as much as possible. Health promotion and disease prevention are examples of upstream approaches that can support the process of healthy aging.
Older Adults and STIs
Canadian health data shows that rates of infection of gonorrhea, syphilis, and chlamydia have risen in all age groups, including seniors, from 2010 onwards (Government of Canada, 2024). Several factors may increase STIs in older adults, such as medical interventions including erectile dysfunction drugs and hormone replacement therapy, people living together in assisted living facilities, several decades since their last sexual health education, people dating after losing a spouse, and a lack of screening guidelines for older adults (University Hospitals, 2023). Additional factors such as the prevalence of dating sites as well as no risk of unwanted pregnancy after menopause may be contributing to the issue. In a small study of elderly folk’s knowledge of STIs, participants answered an average of less than 12 out of 27 questions correctly (Smith et. al, 2020). This demonstrates a need for seniors to have access to sexual health education. Seniors may also benefit from screening guidelines being developed.
Prevention of Chronic Disease
Lifestyle choices can contribute to many chronic diseases. By supporting and educating older adults about healthier choices, they can experience a reduced likelihood of getting a chronic disease, leading to improved quality of life. Increasing clinical preventative services is also a strategy for preventing chronic conditions. This includes screening for symptoms, disease immunizations, and counselling about personal health behaviours.
Healthy Eating
Healthy Eating is important in preventing, delaying and managing chronic diseases such as heart disease, type 2 diabetes, and cancer. A balanced, healthy dietary pattern includes a variety of fruits, vegetables, whole grains, lean protein, and low-fat dairy products and limits added sugars, saturated fats, and sodium. Healthy eating can work for everyone‘s tastes, traditions, culture, and budget.
Physical Activity
Regular physical activity can help prevent, delay, or manage chronic diseases. Physical activity is any form of movement that causes a person’s body to burn calories including walking, gardening, cleaning, and many other regular activities. Daily physical activity is important. Low physical fitness is as strong a risk factor for dying as smoking is. Adding more physical activity to one’s day is one of the most important things one can do to help improve and maintain overall health.
Other important behaviours to prevent chronic disease include avoiding smoking and alcohol, and regular screening for chronic conditions.
Source: https://norwegianscitechnews.com/2018/09/does-weather-influence-older-adults-physical-activity/
Health Equity
Not everyone has access to affordable, nutritious food and safe places to be physically active. Environmental and systemic barriers to health exist for many older adults, highlighting a need to address health inequities. Health equity is the state where each person has a fair and just chance to obtain their best health. Addressing health inequities means addressing the disadvantages people may experience so they can reach their full health potential. Factors such as race, culture, gender, sexual orientation, religion, disability, geography or other characteristics can act as barriers to achieving good health. For example, systems of oppression and low socioeconomic status create conditions that make accessing safe and affordable housing, quality education, and quality health care difficult. Health equity objectives include providing economic stability, access to quality education and quality health care, creating neighbourhoods that promote health and safety, and promoting socialy supportive communities. (CDC, 2021).
12.3 Health Promotion
The WHO defines health promotion as “the process of enabling people to increase control over, and to improve their health“ (1998). Health promotion seeks to strengthen individual and community capacity for better health and address the social determinants of health through meaningful participation and intersectoral work for better health equity (PAHO, 2018). Strategies to support health promotion requires social, political strategies to address the social determinants of health, to reduce health inequities and improve health. The key settings for multisectoral collaboration to promote health and improve the quality of life for older adults include housing, workplaces, hospitals and health centers, religious centers, markets, emergency shelters, and urban and rural communities, among others. This approach ensures that no one is left behind. Another strategy is enabling community participation, empowerment, and civil society engagement. The empowerment of communities – their ownership and control of their concerns– requires community access to complete, accurate and appropriate information; learning opportunities for health; and access to sufficient funding to address issues. Strengthening health systems and services is important to support health.
Community Nutrition Services for Older Adults
Communities can support older adults have adequate nutrition through the following initiatives:
- Reduce hunger and food insecurity;
- Ensuring adequate access to acceptable, nutritious foods;
- Promote social support;
- Ensuring access to health-promoting services;
- Promoting physical activity.
Many nutrition programs are funded by federal, provincial and local governments, volunteer organizations or supported through various foundations. Many services prioritize older adults, recognizing they have the greatest social and economic needs.
Activity!
Conduct a web search. What community nutrition services are currently available in your community for older adults? Does this adequately address the needs?
12.4 Resilience
Please read the MacLeod, et al., 2016 article and answer the following questions.
MacLeod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266-272.
Learning Questions from MacLeod, et al., 2016:
- How can the term resilience be defined/described?
- Why is resilience an important concept of healthy and active aging?
- What are the dimensions of resilience?
- Where does resilience come from?
- What are ways to strengthen resilience among older adults?
References
Centers for Disease Control and Prevention (2021). “Health equity.” Retrieved from https://www.cdc.gov/nccdphp/dnpao/health-equity/index.html
Government of Canada. (2024, January 4). Report on sexually transmitted infection surveillance in Canada, 2019. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-sexually-transmitted-infection-surveillance-canada-2019.html
Liotta, G., Canhao, H., Cenko, F., Cutini, R., Vellone, E., Illario, M., … & Marazzi, M. C. (2018). Active ageing in Europe: adding healthy life to years. Frontiers in medicine, 5, 123.
Pan American Health Organization (2020). “Renewing health promotion within the context of sustainable development goals.” Retrieved from https://www3.paho.org/hq/index.php?option=com_content&view=article&id=14889:hp-sdgs-rio&Itemid=0&lang=en#gsc.tab=0
Smith, M.L., Bergeron, C.D., Goltz, H.H., Coffey, T., Boolani, A. (2020, April 3). Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test–Retest Reliability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177870/
University Hospitals. (2023, July 11). Why STIs Are on the Rise in Older Adults. https://www.uhhospitals.org/blog/articles/2023/07/why-stis-are-on-the-rise-in-older-adults
World Health Organization (1998). “Health promotion” Retrieved from https://www.who.int/health-topics/health-promotion
World Health Organization (2020). “Health topics – Social determinants of health.” Retrieved from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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