3.7 Health Promotion 3.7 Identify health promotion programs and strategies to maintain optimum well-being in older
adulthood
Health promotion is defined as health education and environmental changes to enhance an individual’s
ability to improve their well-being, not just manage their diseases. The “health enhancement” or
“wellness” aspects of health promotion make it more than simply the prevention of chronic diseases and
disability.
In contrast to a biomedical model, where the physician is responsible to treat disease, health promotion
emphasizes altering one’s lifestyle practices such as diet and exercise, creating healthier environments,
and changing cultural attitudes and expectations about health. This is because nearly 80 percent of
chronic illnesses may be related to social, environmental, and behavioral factors, particularly poor
exercise and nutrition.
The good news is that health promotion activities decrease the risk of high blood pressure, heart attacks,
strokes, diabetes, and certain cancers and lower rates of hospitalizations, physician visits, and
medications (Healthy People 2020, 2010; Peterson et al., 2009).
Healthy People 2020 provides 10-year national objectives for improving the health of all Americans. For
three decades, it has established benchmarks and monitored progress to see the impact of prevention
initiatives. These objectives are built on a growing scientific evidence of how specific health-promoting
behaviors increase chances of living longer by as much as 10 years. Listen to the story about Arthur to learn to learn more about the link between healthy lifestyles and
longevity. 3.7.1 Exercise as Central to Health Promotion
Regular moderate exercise may be the most effective health habit. But this is often an area where we
have difficulty changing our behaviors. Up to 50 percent of physical changes in older people that are
mistakenly attributed to aging may be due to being physically unfit. Physically inactive people age faster
and look older than physically fit persons of the same age; this is due in part to hypokinesia, which is a
disease of “disuse,” or degeneration and functional loss of muscle and bone tissue.
The benefits of regular aerobic weight-bearing exercise such as brisk walking and strength training, even
at moderate levels, are numerous, even for people with chronic illnesses. There are gains in healthy bones, muscles, and joints;
lean muscle mass and strength;
joint mobility, flexibility, and range of motion;
HDL (good) cholesterol;
metabolic rate; and
balance. And there are reductions in weight and body fat;
arthritis and lower back pain;
blood pressure;
osteoporosis; and
symptoms of anxiety and depression.
Benefits are greatest if people begin exercising in young or middle adulthood. Nevertheless, initiating
regular exercise at any age, even after age 80, has benefits. Aerobic exercise needs to occur regularly,
ideally at least 30 minutes daily. But even moderate walking can reduce the risk of heart disease or
prevent hip fractures (CDC, 2013; Chipperfield, 2008; Healthy People 2020, 2010; NCOA, 2011; Peterson
et al., 2009).
Strength training is successful even with 90-year-olds and even with residents in skilled nursing facilities.
It improves muscle strength, walking speed, and stair-climbing ability. Some adults choose Tai Chi, yoga,
or Pilates as a gentler form of exercise that strengthens muscles without injuring joints, reduces chronic
pain, and improves flexibility, balance, and stability (CDC, 2013; NIH, 2011).
With benefits like these, how can anyone not exercise? Unfortunately, the majority of older adults do
not. Only 25–35 percent of older people participate in regular physical activity (30 minutes or more at
least five times per week), and only about 12 percent in strength training. Men are the most likely to
exercise, whereas the oldest-old, women, Latinos, and African Americans are the least likely. Older
adults’ activity levels are so low that meeting the Healthy People 2020 objectives will require significant
behavioral changes among at least 60 percent of elders (CDC, 2013; Healthy People 2020, 2010; NCOA,
2011). Points to Ponder
Identify healthy and unhealthy behaviors in your lifestyle. Have you ever tried to modify these? If so,
what techniques worked for you? What were some of the obstacles? To what extent do you think that
lifestyle changes when we are old can overcome the effects of poor health habits acquired earlier in life?
Some elders may be motivated to exercise but cannot afford to do so or face obstacles in their
environments. They may live in communities that lack safe and affordable fitness opportunities (e.g.,
walking trails, low-cost gyms), lack support from friends and family to exercise, or feel embarrassed
around younger people working out. Additionally, they may not have time because of caregiving or
employment demands.
A number of strategies work to motivate physical activity. Perhaps you have used some of them in your
own lives or can add to this list. Start slowly.
Choose activities that make your heart beat faster.
Set goals, including developing informal exercise contracts with others.
Monitor yourself.
Develop group or peer support (a walking group).
Turn to peer telephone counseling for support (Healthy People 2020, 2010). 3.7.2 Nutrition
A healthy diet—no matter what our age—and even if we only make modest change—has multiple
benefits. For instance, a moderate reduction in saturated and trans fats can reduce cholesterol levels and
the risk of heart disease. And most of us know how important vegetables and fruits are. U.S. Dietary
Guidelines recommend about 2 cups of fruit and 2.5 cups of vegetables each day. In fact, Healthy People
2020 recommends even higher intake—seven to nine servings per day—for older adults. As one
newspaper article touted, imagine a drug that could whittle your waistline, control blood pressure,
protect your heart, strengthen your bones, cut the risk of stroke, and possibly help you sidestep cancer.
And what if this drug was also easy to obtain, relatively inexpensive, and even tasted good? There’s no
pill with those benefits, but it is fruit and vegetables. Yet the number of elders eating healthy diets is far
below the target of 50 percent set forth in Healthy People 2020. A primary barrier is the cost of fresh
produce. Others are living alone or coping with other health issues, which detract from preparing
healthy meals (Healthy People 2020, 2010; Squires, 2008). Reflection Break
Reflect on your own eating habits on an average day. What kinds of fruits and vegetables are you eating?
Are you eating two cups of fruit and two-and-a-half cups of vegetables a day, as recommended by U.S.
Dietary Guidelines? If so, how are you doing that? If not, how can you increase your consumption of
fruits and vegetables? 3.7.3 Programs That Work
The Administration on Aging funds evidence-based health promotion initiatives that have delayed the
onset of diseases, reduced disability and health care costs, and extended life expectancy. Researchers
have found these programs effectively empower older adults to take control of their health through
increased self-efficacy and self-management. Here are a few examples: Physical activity—Enhance Fitness and Healthy Moves offer low-impact aerobic exercise, strength
training, and stretching.
Falls management—Matter of Balance addresses fear of falling, and Stepping On and Tai Chi build muscle
strength and improve balance.
Nutrition—Healthy Eating teaches the value of eating healthy foods.
Stanford University Chronic Disease Self-Management helps people with chronic conditions change
behaviors, improve health status, and reduce use of hospital services.
You can learn more about these and other effective programs from theAdministration on Aging.
Some wellness programs, which emphasize the whole person, use the arts to engage older adults in
healthy behaviors. One of these is Ruth’s Tablein San Francisco’s low-income Mission District. It
illustrates the benefits of the arts on physical and mental well-being and a way to build community. Ruth’s Table: Wellness and the Arts
A director of community programs for a low-income housing complex held focus groups with older
adults to decide what to do with empty spaces on its first floor. Since the neighborhood was attracting
“artsy” seniors, a decision was made to transform the space into an art-focused cultural center where
older adults could learn through peer-led classes and share artistic talents. The kitchen became an exhibit space to host an artist-in-residence program. The dining hall was
transformed into an art gallery hosting openings where local artists answer questions from community
members. The arts center reached out to the larger community through Facebook and its Web site.
Physical activities were also part of the offerings but combined with forming relationships. In a Tai Chi
class, participants practice together, but then discuss issues and form new friendships after each class.
An intergenerational modern dance program—Dance Generator—involves students from the University
of San Francisco. Creating and sustaining community partnerships were a priority. Space was shared with
the community music center, giving it a place to practice and older adults free music for listening and
dancing (Gable, 2011). 3.7.4 Improving the Impact of Health Promotion Programs
Finding the right exercise for an older adult’s ability level can help motivate them.
Health promotion, particularly increased physical activity, can save individuals and society significant
dollars otherwise used to treat disease. Yet only a small percentage of national health care funding is
currently spent on prevention and wellness services. Fortunately, prevention is a cornerstone of the 2010
health care reform. Another encouraging sign is the increasing number of hospitals, health care clinics,
universities, local governments, and corporations that sponsor health promotion programs. For example,
some county governments offer insurance incentives for people who engage in healthy behaviors. And
health promotion activities have been carried into senior centers, adult day health care, and assisted
living, retirement, and skilled nursing facilities.
But we all know that we do not always act on information that would improve our health. The gap
between health knowledge and health practices can be very wide. Think about the number of people
who continue to smoke despite the empirical evidence linking smoking to lung cancer. In general,
organized health promotion programs have difficulty recruiting more than 50 percent of the target
population, even when focused on people with potentially deadly conditions, such as heart disease.
Attrition ranges from 30 to 60 percent. In sum, sustaining health practices over time is difficult in the face
of years of habit (Christ & Diwan, 2008; Federal Interagency Forum, 2012). Sustaining the Motivation to Change Health Behaviors
You have learned that motivating people to make and sustain changes in their health behaviors is a
challenge. Allowing elders to set their own goals and providing peer support are often keys to success.
One program,Enhance Wellness, focuses on motivation before teaching about healthy behaviors. A team
of a nurse and social worker assesses an individual’s strengths and risks, and develops a plan in which
the participant, not the professional, chooses the behaviors they want to work on. As participants try out
their individualized plan, a volunteer health mentor offers ongoing encouragement, feedback, and
monitoring. Outcomes are reduced length of hospital stays, lowered medication use, diminished
symptoms of mood disorders, and enhanced self-efficacy. The closely related Enhanced Fitness
programs, offered in more than 200 sites nationwide, provide low-cost, evidence-based exercise
programs of stretching, flexibility, balance, low-impact aerobics, and strength training that do not require expensive equipment or large space. Parks and Recreation department programs, such as walking
groups, also offer accessible and low-cost exercise that build on peer support (Enhance Fitness, 2009).
Older people who are likely to participate in health promotion programs are those already oriented to
prevention (i.e., regular users of physicians and dentists for checkups, nonsmokers) and those engaged in
community activities generally. But what can be done to reach those who face barriers to participation?
For example, is it realistic to expect a low-income grandmother caring for three grandchildren to have
time or resources to join an exercise class? What might make her participation feasible? Here is a list of
some strategies found to reduce barriers: Take account of income, living arrangements, social supports, language and cultural values (e.g., offer
free transportation, respite for caregivers, exercises and nutritional programs that fit with the elders’
culture).
Provide social support—exercise buddies and neighborhood walking.
Sponsor intergenerational activities (e.g., healthy eating programs for grandparents and grandchildren).
Design accessible community resources of outdoor paths or malls for walking.
Offer written and oral materials in elders’ native language.
Expand outreach through senior centers, religious institutions, and doctor’s offices.
Increase the availability and affordability of fresh produce in local groceries (Stepnick & Whitelaw,
2006).
Health promotion programs are sometimes criticized for their emphasis on individual responsibility for
change. Encouraging older adults to exercise may be counterproductive if they live in cities with high
levels of pollution or near industrial sites contaminated by toxic waste. Community- and organizationallevel changes are essential that consider the roles of corporations, policy-makers, food manufacturers,
and the mass media in creating unhealthy environments.
It is unclear if baby boomers will be healthier in old age. This cohort includes more informed, healthconscious consumers who will make more demands on the health care system. A significant proportion
will continue their fitness activities. However, some baby boomers, particularly smokers and those who
are obese, are likely to face multiple chronic diseases even as their life expectancy increases.
Additionally, low-income boomer—and those who were moderate income but saw their resources
diminished by the recession—may not have access to preventive services nor have the resources to
adopt a healthy lifestyle, which will negatively affect their well-being.

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