Running head: HEALTH PROMOTION IN OLDER ADULTS 1

Health Promotion in Older Adults

Ellen Sowder

Bon Secours Memorial College of Nursing

Tamera Krukiel, RN, MSN, ANP-BC, PMHNP-BC

NUR 4113

November 8, 2017

I pledge.
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Health Promotion in Older Adults

For this project, I wanted to provide education of health promotion related to falls

to my grandfather. My grandmother passed away in 2010, and my grandfather remarried

shortly after. A coping mechanism that I see in many of my family members on that side,

including myself, is keeping busy. My grandfather is a busy man and even in his

retirement he works part time as a Wild Horse Tour Guide in the Outer Banks. It is

amazing that he is in such good health as an 80 year old and only takes a daily vitamin

aside from intermittent ibuprofen for joint pain. His wife is almost two decades younger

than him, which makes him feel younger than he is. Although he has been in wonderful

health to the present, he participates in behavior that is too risky for someone his age. He

still does a lot of his own home improvements tasks that require physical strength and

dexterity. About a year ago, he was cleaning the gutters on his house when he slipped off

a ladder as he was coming down. Fortunately, he only sprained an ankle, but for someone

his age, it could have been seriously if not fatal. He also imbibes in alcoholic beverages

most every night, which is fine to a point. According to a comparison study of preventing

falls in older adults, modification of the elder’s environmental factors reduced the risk of

falls (Tricco et al. 2017). My health promotion education is aimed at limiting his alcohol

intake and reducing the risk of falls by delegating home tasks to others.

Nursing Diagnosis
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My nursing diagnosis for this patient is as follows: Risk for falls related to alcohol

intake and activity that is inappropriate for his age. This pertains to Healthy People 2020

by addressing the goal to improve the quality of life of older adults. Even though limiting

his riskier activities might seem like its reducing his function, it is actually preventing the

loss of function secondary to a fall that is likely if he continues things like cleaning

gutters/using ladders. Having his limit his alcohol intake as well as limit or stop

physically risky activities would achieve the Healthy People 2020 objective of reducing

the rate of Emergency Department visits due to falls in the elderly.

According to the National Institute of Health, older adults have an increased

sensitivity to alcohol, which puts them at higher risk for falls and other unintentional

injuries (Older Adults, 2008). They recommend that older adults drink no more than three

alcoholic beverages in a day. At this time, my grandfather is not on any medication on the

BEERS criteria list, which would further increase his risk of drinking. According to the

Short Michigan Alcoholism Screening Test, his results are indicative of an alcohol

problem. As a retired man who lives at the beach I understand that drinking alcohol is not

something that should be stopped completely, but with the physical activities he often

does in a day alcohol should be limited and the activities should be limited to those that

do not increase his risk of falls. The Center for Disease Control has extensive information

about the consequences of falls. Some of the outstanding facts include: “One out of five

falls cause a serious injury, each year 2.8 million older people are treated in the

Emergency Department for fall injuries and the injuries caused by falls include broken

bones, head injuries and a fear of falling which leads to an increased chance of future

falls” (Important Facts, 2017). Even one serious fall could start the deterioration of my
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grandfather’s health, which is why this teaching plan is so important for him. Lowering

risk factors for falls will help prevent falls. That is why my short-term goal for him is to

limit his alcohol intake to a maximum of three drinks per day immediately as well as

limiting physical activity to before partaking in alcohol. My long-term goal is that by the

Spring time when he will need heavy chores and work on his house to be done, that he

delegates that task to someone who is younger and better equipped to handle those tasks.

Intervention

As I mentioned before, my grandfather is a smart, independent older man that has

many resources. I wanted to approach the teaching plan in a way that would open his

eyes to the situation, but not belittle him. I spoke to his wife and son about the best way

to approach this, and we agreed to start with some facts and figures, to appeal to his

frugal nature and finally make it fun. His wife agreed to participate in my plan to limit

alcohol, so that they could to it together. First, the teaching consisted of the facts and

figured already addressed in the paper—information about the incidence of falls, the

effects of alcohol on older adults, as well as some monetary figures of the costs of falls.

According to the Center for Disease control the average hospital cost for a fall injury is

over $30,000 with that figure going up with age (Important Facts, 2017). A common

consequence of falls is a hip fracture, and many people who break a hip from falling are

unable to live on their own after (Hip Fractures, 2016). Since my grandfather is so

independent, we discussed that losing the independence of doing intense house and yard

work would increase the chances of him staying independent in the other aspects of his

life by preventing falls. Together we looked into some local landscaping companies that

could take over these tasks and concluded that even the most expensive ones would cost
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less than the consequences of a fall. Next, we discussed that the National Institute of

Health recommends no more than three drinks per day in older adults. Once he realized

his wife was willing to agree to this plan with him he was ready to give it a try. Since on

the Survey of Preferred Learning test it revealed he was primarily a kinesthetic learner, I

came up with a tool that he would be able to be hands-on with. I created a weekly chart

titled, “Limiting Alcohol because We Love Life” with the days of the week across the

top. Under each day there was a column with my grandfather’s and his wife’s initials.

There were three spots for each person under each day. The chart is reusable each week

and it posted on their fridge, so before they take out an alcoholic beverage they put a

mark on which drink of the day it is. The first two spots are ready for a mark each day,

but the third is in red signifying this is the last one! There is a reminder underneath to

take days off completely and that two drinks daily is better than three. This way it is a fun

activity for them to do together with a sweet reminder that it is there because they are

loved and I wanted my grandfather to stay as healthy and independent as he is now. My

grandfather and his wife use the chart daily when they drink alcohol, which meets the

short-term goal of limiting his alcohol intake. As for the long-term goal, we worked

together to pick three landscaping companies to take over the heavy housework he

normally does. In the spring, when it is time for these tasks I will check back to make

sure that he chose one and is sticking to his word about choosing tasks more appropriate

for his age and leaving the ladder climbing to younger people.

Evaluation

My nursing outcome was aimed at preventing falls, which is the secondary level

of prevention. I used screening tools to identify his risk factors for falls as well as
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incorporating my previously known information. We had learned throughout school

about falls in the elderly, so I know he was at risk, but using a screening tool I realized

how much alcohol and his daily activities increased his risk. My grandfather probably

does not have a drinking problem, but alcohol is a slippery slope. With his advanced age,

anything that reduces his ability to think clearly and react quickly increases his risk of

harm. The effectiveness of my teaching was primarily thanks to his pride in my role in

nursing school. He is excited I want to be a nurse and is willing to make lifestyle changes

because I think they are important. He has always encouraged my studies and joked that

this project was, “good practice for when you are a Nurse Practitioner someday”. I think

the teaching was effective, and since it was for my family member he knew it was

coming from love and was not defensive or dismissive of my teaching. I think this

projects directions limited the possible teaching topics to something identifiable by

screening tools I am not overly familiar with and that I could have revised the strategies

to focus on whatever is the biggest issues versus something that is screened for. I enjoyed

the role of a nurse-teacher. When I was younger, I wanted to be a teacher and spent two

years in a student teaching program, so this is an aspect of nursing I enjoy and believe I

do well.
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References

Hip fractures among older adults. (2016, Spetember 20). Retrieved November 8, 2017,

from www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx

Important facts about falls. (2017, February 10). Retrieved November 10, 2017, from

www.cdc.gov/homeandrecreationalsafety/falls/adultsfalls

Older adults. (n.d.). Retrieved November 8, 2017, from www.niaaa.nia.gov/alcohol-

health/special-populations-co-occuring-disorders/older-adults

Tricco, A., Thomas, S., Veroniki, A., Hamid, J., Cogo, E., Strifler, L., Khan, P., Robson,

R., Sibley, K., MacDonald, H., Rive, J., Thavorn, K., Wilson, C., Holroyd-Leduc,

J., Kerr, G., Feldman, F., Majumdar, S., Jaglai, S., Hui, W. & Straus, S. (2017,

November 7). Comparisons of interventions for preventing falls in older adults: A

systematic review and meta-analysis. Retrieved from

www.ncbi.nlm.nih.gov/pubmed/29114830