Promoting exercise for the Senior Client and the Nurse’s Role

As the populous baby boomers approach senior age status and the nursing shortage continues it becomes critical for the health care worker to understand the importance of promoting a preventive approach to the health-care needs of the older population. Because the nurse is often the one who has the most consistent contact with these clients, he or she plays a vital role in promoting a lifestyle for them that includes an exercise protocol geared to their unique needs. Many of the chronic illnesses that affect this era of life can be prevented or at least improved with an appropriate activity level geared to their needs. Understanding the barriers unique to seniors, the particular activities which are the most beneficial, and giving individualized encouragement with a caring, multidisciplinary approach are strategies that the nurse can implement to promote a more active lifestyle for the aging client.

Research in the field of aging has clearly shown that there are many changes that occur such as cardiovascular changes, slow progressive decline in body mass, and decrease in muscle strength and mass. As we age our physiology changes but many of these changes respond well to a variety of interventions, especially an active lifestyle that includes cardiovascular and muscle strengthening protocols. Hartman (2003) states that even frail older adults can benefit from resistance training but that a proactive, rather than a reactive approach, should be taken for the baby boomers. Even moderate levels of physical activity have been shown to reduce the risk of dying from heart disease (Sabin 2005). Preventive medicine, in this case promotion of an active lifestyle, is clearly beneficial for the aging population and can be part of the nurse’s role in servicing the aging client.

There are barriers unique to the older client and the nurse needs to understand them. Barriers include past experiences with exercise, how the individual feels about her/himself as a worthwhile human being, and physical changes that occur with aging including brain chemistry changes. Though there might be barriers, the nurse can teach the older client that even small changes in lifestyle may result in large changes in health, especially preventive health. Emphasizing the potential benefits for exercise participation, the potential undesirable consequences for nonparticipation and implementing short-term goal-making will help motivate and encourage. Keeping the given information simple and understandable will also help to ensure success. Belza (2004) addresses several factors that help the senior to succeed in an exercise program. The most common motivational factor is social interaction. With this knowledge, nurses can encourage walking which is an activity that can also be shared in a social context with others. The nurse should be aware of local community agencies, senior centers, and family structures to be able to implement a strategy which includes social contact as well as a more active lifestyle for the senior.

Knowing where to refer the clients will help them succeed because of the social aspects to these places. Encouraging the types of activities that will give the most benefit with the least amount of discomfort are also important strategies. Although walking is the preferred activity, there are also other activities which can greatly increase health for the older person. Yoon (2006) points out that although a multi-set training program resulted in greater improvements in some exercises, one study of thirty-two sedentary older men and women revealed that low-volume resistance training produced very significant improvements and was found to be an effective strategy for the mature population. In other words, one set of 10 repetitions of one exercise, such as biceps curls, rather than several sets, can be nearly as effective as several sets. The nurse can refer older clients to programs that incorporate strength-training exercises geared to the aging person that emphasize single-set, simple, and relatively easy exercises that also give good results.

Seniors will benefit from these strategies because of their increased strength and energy level which may also help prevent osteoporosis and falls. Finally, the nurse’s caring, multidisciplinary approach will help the older client to achieve a healthier activity level as well. This type of caring is demonstrated by the Escalante Health Partnership, a community-based, nurse-managed health promotion and wellness center that was initiated in 1991 by representatives from a college of nursing, a local health department, and social service crisis network in Arizona (Nunez 2003). It has resulted in significantly less doctor visits per year in comparison with the others who did not participate in this program. When caring nurses collaborated with other caring individuals and organizations a difference was made to address the health issues of that population. The nurse shows care by being educated in the specifics of the older adult, by encouraging the individual client, and by teaching them the benefits of simple, uncomplicated lifestyle changes. The caring nurse also networks with a multidisciplinary approach that includes other health care workers and organizations.

The registered nurse’s impact on seniors and the coming baby-boomer seniors is significant. Because exercise and a healthy lifestyle are important in health promotion for seniors, one role of the nurse is to promote it to them. Understanding the barriers unique to seniors, encouraging the types of activities that will give the most benefit with the least amount of discomfort or complication, and finally, giving individualized encouragement with a multidisciplinary approach are strategies that have worked towards helping seniors to live healthier, stronger lives.



(Intervention 1) Understanding the barriers unique to seniors

(Disadvantage 1) Discrimination

One of the barriers to understanding the senior and the particular barriers to the implementation of a healthy exercise program for the senior is the practitioner’s own discrimination or prejudice. There are many misconceptions about older adults, such as that most elderly people are sick, that they don't pull their own weight in society, that they are set in their ways (you can't teach an old dog new tricks), aren't mentally or physically sharp and alert, or just are incapable of making lifestyle changes such as smoking cessation for instance. Kelly (2005) states that Nursing older people is often perceived as low status and that a positive reframing of gerontological nursing is needed.

(Disadvantage 2) Lack of relationship with the senior client

Another barrier to understanding the unique barriers to a healthy exercise program for seniors is the lack of relationship with the client. Liking or not liking other participants or staff are both reasons for attending or not attending a health-promoting exercise program. When relationships are negative or undeveloped encouragement cannot be given as appropriately, likes and dislikes will not be known, and various other hindrances will also result. Social contact and personal knowledge of the client is clearly important and needs to be addressed to effectively plan interventions which take into account the particular, unique needs of the senior client. Buijs ( 2008) states that relationship is key and that frequent contact with other participants and staff contributed to social support, which plays an important role in the development and maintenance of active living.

(Intervention 2) Understanding which activities are the most beneficial for the senior client

(Disadvantage 1) Knowledge Deficits

Although the nurse can have a pretty good idea of which activities will be most beneficial for the senior client, an important barrier to implementation for the client is the knowledge deficit of the client. They may not understand how a particular exercise program will benefit them and it can take a while for the benefit to be realized. They may have faulty beliefs about exercise or believe it could even do them harm. Seniors (and older middle-aged clients) have a high need for education in health needs including many areas that interrelate to physical exercise health promotion such as healthy diet, and psychosocial (family communication for instance) and fitness. Su (2007) states that ideally, when planning health-promoting education programs for this age group, course content should be influenced by the knowledge needs of the particular client or group of clients.

(Disadvantage 2) Feeling powerless

The nurse and the client may understand which activities will be beneficial but the client may still have a sense of powerless in his or her ability to act on this knowledge. They may be unwilling or too embarrassed to discuss their particular challenges such as hearing impairment for example. Visual impairment may also be a challenge causing the client to feel powerless. The client may believe that somehow the healthcare provider or team can make them better and not have a sense of personal responsibility for their own health issues. Oliver ( 2005) states that in addition to teaching the client, it is the aim of nursing care to empower older people in their choices and control over their lives.

References
Belza, B. (2004). Older adult perspectives on physical activity and exercise: Voices from multiple cultures [Electronic version]. Preventing Chronic Disease Public Health Research, Practice, and Policy,(4),1-12.

Buijs, R., Ross-Kerr, J., O'Brien Cousins, S., & Wilson, D. (2003, Summer). Promoting Participation: Evaluation of a Health Promotion Program for Low Income Seniors. Journal of Community Health Nursing, 20(2), 93-107. Retrieved April 23, 2008, doi:10.1207/153276503321828022

Hartman-Stein, P., & Potkanowicz, E. (2003). Behavioral determinants of healthy aging: Good news for the baby boomer generation. Online Journal of Issues in Nursing, 8(2), 127-146. Retrieved January 29, 2008, from Academic Search Premier database.

Kelly, T., Tolson, D., Schofield, I., & Booth, J. (2005 2). Describing gerontological nursing: an academic exercise or prerequisite for progress?. Journal of Clinical Nursing, 14(3a), 13-23. Retrieved April 23, 2008, from CINAHL database.

Nuñez, D., Armbruster, C., Phillips, W., & Gale, B. (2003, January). Community-Based Senior Health Promotion Program Using a Collaborative Practice Model: The Escalante Health Partnerships. Public Health Nursing, 20(1), 25-32. Retrieved January 29, 2008, from Academic Search Premier database.

Oliver, S., & Hill, J. (2005, July). Arthritis in the older person: part 2. Nursing Older People, 17(5), 23-5. Retrieved April 24, 2008, from Academic Search Premier database.

Sabin, K.L. (2005). Older adults and motivation for therapy and exercise: Issues, influences, and interventions. Topics in Geriatric Rehabilitation, 21(3).18-19 Retrieved March 16,2007,from Expanded Academic ASAP.

Su, C., Annells, M., & Wood, B. (2007, February). Health-promoting education needs of middle-aged persons in a rural community in Taiwan. International Journal of Nursing Practice, 13(1), 52-60. Retrieved April 24, 2008, doi:10.1111/j.1440-172X.2006.00603.x

Yoon, B. & Kravitz, L. (2006). Single-versus multiset resistance exercise in older adults: comparing the two for muscular-fitness and functional-performance benefits. IDEA Fitness Journal, 3. 18-22. Retrieved March 16,2007, from Expanded Academic ASAP database.