Health Problems among the Elderly and Need for Health Promotion

“I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well-being and prevent disease than let disease happen when it is avoidable and then try and cope with it.” – Nola J. Pender, PhD, RN, FAAN (Sitzman & Eichelberger, 2010).

One of the major aspects that influences the length and quality of life of a human being is health. This fundamental aspect controls day-to-day life experience causing one to be fully functional or dependent on other people around. Health has caused many to deflect from their loved jobs and occupations, while it made others change their lifestyles for the remaining days on earth. Hence, it is something that one must be careful about and observe in order to live happily and long enough. However, it is evident that many have failed to observe their own health. As their days come to a halt towards an old age, life becomes unbearable and they end up beeing a burden to those around them and the society.

A closer look at the life of a human being reveals that it is a smooth curve that rises and falls at the end. That is, at a tender age one begins to gain strength and insight, and as people become teenagers, youths, and then aduls, they are energetic and alive. Old age is a phase that changes all factors of life of an individual as one slowly becomes more dependent person rather than independent. At an old age, the immune system becomes weaker and strength decreases. As a result, maintaining health becomes expensive and a major hindrance to enjoying everyday life. Despite natural body patterns that cause significant health changes in a person, various aspects have been introduced, which can effectively change the destiny of an individual in terms of health at old age. The Theory of Pender is one that presents an opportunity to live the best enjoyable life even at old age. It all revolves around healthy living.

It is important to note that healthy living is all about person’s attitude and contribution to making the same. As opposed to the common understanding of health that the focus should be on preventing illnesses and living diseases-free, health is all about behavioral and individual performance aimed to achieve long and high-quality life. This is what the Theory of Pender is all about (Peterson & Bredow, 2009).

What is Pender Theory?

This medical theory focuses on the wholesome living of individuals that enhances their health. It refers to a health promotion model, which perpetuates the idea that healthy living is not merely living without diseases, but is a positive dynamic state, which embraces wellbeing. It embraces other facets of human life, such as interaction with other people and the environment, to achieve health stability. Hence, it refers to a multidimensional approach to health.

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Nola J. Pender, PhD, RN, FAAN, a Professor at University of Michigan first developed his Theory of Pender in the year 1982. The old version embraced two concepts that were too wide to merge: health protection and health promotion. However, integrating the two together added more value as people could live without diseases and also enjoy healthy living. The same was later revised by Nola in 1996 and redesigned to fit contemporary health lifestyles. Consequently, this was a model that encouraged healthy behavior as well as healthy living. A revised version included theoretical perspectives amongst other empirical findings, which played an extensive role in making of a fully functional healthy person. In the book “Nursing Theorists and Their Work, 7ed” Alilgood and Tomey (2010) narrate the story of how Pender was inspired to come up with his theory. It was due to experience she went through with her aunt while she was sick that probed her to find a model that promoted healthy living. Therefore, she came up with a plan of a promotional model that focused its interest on the psychological aspect of how people perceive themselves in terms of lifestyle and behavior, which is composed of scientific behavioral points. It is a middle-range theory that primarily narrows down to day-to-day life practices and experiences.


As noted above, the idea to establish a health model came while Pender was taking care of her ill aunt, The same reason abides to discovery of a health model. Therefore, its core purpose is to develop practical lifestyle that promotes health and develops healthy living in the absence of diseases. The model checks into life practices of an individual in reference to health factors. Thus, it suggests ideas that establish the correct way of living.

The model also embraces the aspect that focuses on health as a critical feature of human survival, but does not mean being disease free only. According to this input, health also involves having the right attitude towards living. As noted in the revised version, the model primarily focuses on the right way of living with a correct attitude. On the other hand, the model was meant to present knowledge and understanding of how to embrace health with motivation for healthy behavior. In addition, it is a significant contribution to nursing practice because it introduces basic knowledge primarily about improving health among patients.


  • The model assumes that patients have a major part to play in the behaviors they involve themselves in every day. This means that every person decides how he or she lives;
  • The model notes that a person gets into contact with the surrounding much often. Hence, this is a factor of choice on how the environment will influence his or her life and vice versa;
  • It is also assumed that behavior change is a factor of self-initiation.

Key Concepts of Theory of Pender

Amongst the key concepts fundamental in the Health Promotional Model are:

  • Personal characteristics and behaviors that contribute to health promotion. These may be the activities and characteristics of an individual that either perpetuate or diminish health. The same is closely associated with the environment, which a person interacts with frequently. Thus, the environment influences individual behavior;
  • From a different angle, Health Promotional Model explains that elimination of diseases in an individual is all about working it out from ones behavior. This includes involvement in practices that discourage illnesses and encourage health. At the same time, the model highlights that detecting and enhancing disease prevention is equally profitable;
  • Self-efficacy is well described as an aspect that has positive effect on health matters. This attitude causes one to push away any likelihood of being vulnerable to disease and maintains positive effect of the same from the inside of a person;
  • Behavioral outcomes are critical in making health choices. According to this health model, the plans that one has made can influence the need to have a healthy lifestyle and thus one can commit to certain practices because of the outcomes.
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Propositions of the Theory

  • The strength of this Health Promotion Model lies in the following strategy that goes hand in hand with person’s lifestyle;
  • Individual characteristics of a person control one’s beliefs about health and contribute extensively to forming healthy or unhealthy behaviors;
  • All behaviors that an individual adopts go in line with the understanding of establishing again through the same;
  • Any issues that can hinder an individual from committing to a healthy lifestyle lead to decreased health and quality of living;
  • Every person with intentions of adhering to healthy living principles of the Health Promotion Model can easily commit due to self-efficacy and high competences ability;
  • High sense of self-efficacy contributes to elimination of specific healthy barriers;
  • Positive input towards a behavior creates more chances to develope a positive impact in the health of a person;
  • Direct relations and connections between a behavior and its positive effect lead to commitment to an action;
  • Commitment to the adoption of certain behaviors comes because of inspiration from role models and other major contributors to the same;
  • Commitment increases due to the influence from close people such as peers, family, and members, who have a direct impact on a person;
  • Health behavior can be improved and established in one’s life through situaltional influences;
  • High commitment to establishing a certain behavior directly guarantees success in that behavior;
  • Barriers stand in the way of success in practicing a health habit despite having committed to a plan to improve the same;
  • Committing to a plan of accomplishing a task or polishing a behavior leads to success in the same over time (Health Promotion Model, 2012).

Congruence with Nursing Discipline

One of the most critical aspects that have made remarkable contribution to the field of nursing is the Health Promotion Model. This is a model, which has effectively promoted medical interventions to bigger heights with a major aim of establishing a healthy society. For instance, it is through this model that modern health is not about disease prevention. This wholesome subject focuses on general well-being even in the absence of a disease. The same message has expanded the field of nursing to strengthening resources, capabilities, and other potentials, which are fundamental in creation of a healthy society.

The Theory of Pender has also been the main avenue through which medical information, knowledge, and understanding have been released to the society. Unlike in the past, health matters were left to medical practitioners as determinants. However, today, nurses can motivate patients and families to ensure they practice healthy behavior as a way of living healthy. Consequently, it has added a lot of value and motivation to the nursing fraternity. Likewise, medical practitioners have an opportunity to work hand-in-hand with their patients.
It is a great advantage to the older population as mentioned in this paper. The Health Promotion Model presents the best opportunity to make up a lifestyle that allows them to live healthy. The consequence of not adhering to Pender Theory is that the elderly people will have to keep struggling with medication. However, it is a theory that has come at a prime time to improve health and lifestyle amongst the older population.

Published Research Studies That Have Used or Tested the Theory in Elderly People

Research on Effect of Caffeinated Drinks on Elderly Patients within the Nursing Facility

One of the leading diseases, which have raised mortality rate amongst elderly people is Urinary Tract Infection. UTIs are diseases that a person can easily contract even without noticing. The worst thought is that it is a disease, which corrodes life gradually from the inside. UTIs have thus been treated but at the same they remain a major challenge, especially in the adult population. It has thus been a major source of concern to establish a serious form of treatment to curb this infection amongst the elderly (Schollum, 2012). The Theory of Pender was thus put to test in this issue to determine the differences in health management amongst this population.

A retrospective study was carried out to determine the effect of Health Promotion Model of Pender on the treatment of UTIs amongst the elderly. The study was carried out amongst patients who took high levels of caffeine, which has a significant dehydration effect (Tomey & Alligood, 2013). Therefore, this study was carried out to determine the effect of drinking caffeinated drinks on the elderly with an intention to promote healthy lifestyles for better health and disease prevention. As noted by Tomey & Alligood (2013), it is better to eliminate the chance of a disease before it strikes, especially amongst the adult community. The study focused on the diagnosis and effects of caffeine consumption among the tested individuals.
A sample for a study included 40 people of above 70 years of age living nearby nursing health facilities. These were 6 males and 34 females. The sample population was consuming caffeinated beverages for at least three months during the study. The results released after 3 months of living under the Health Promotion Model that 30 percent of the population was found to have UTIs while the rest 70 percent did not have any infection. The rate of consumption of caffeinated beverages was at least 1½ cups per day. Despite such positive results, it is evident that other factors contributed more to the reduction of theh likelihood of attaining UTIs within the nursing facility rather than caffeinated drinks.

Heart Related Condition and the Health Promotion Model

This research was carried out majorly to study the effects of having a healthy lifestyle on the contraction of heart-related illness amongst the adults. It can be concluded that elderly people are found to be more at risk of heart-related conditions than any other age group. It is also clear that cardiac patients are often likely to engage in unhealthy eating habits that deteriorate their health. Personal characteristics and behaviors have equally contributed to the development of such ailments.

In a study project carried out by Carambas (1994), it was discovered that there was consistency in health practices carried out by cardiac patients. To understand this concept, the study was carried out among cardiac patients and elderly population who practiced healthy behaviors. The results showed that amongst healthy elderly people, the ones with lower risk of heart illnesses are those with consistent healthy practices. Additionally, there was a pattern of activities, which seemed recurrent amongst all cardiac patients. Other contributing factors and health behaviors included nutrition, exercises, stress management, interpersonal support, and self-actualization. Hence, healthy living equates to healthy behaviors.

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Research on the Effect of the Health Promotion Model on Medication Adherence in Older Patients

Although it may not be the same for every old person, most of the people in this age group are prone to taking medication due to inevitable sicknesses that catch up with them at this time in their lives. Often, such people undergo constant medical checkups with multiples of tabs to improve their health. However, the same people are also prone to forgetting things due to different factors. Therefore, this study was carried out to determine the effect of having healthy behavior by using the Health Promotion Model on this population. Two major functions were observed among old patients: depression and cognitive function. Others included internal support, environment, and self-efficacy (Haus, 2003).
The study established that older people have a major challenge adhering to medication. Often, old people who live with their relatives are likely to depend on them for reminders, while those who live alone utilize different strategies to remember to take their medication at the right time. Hence, there are both structured and unstructured means of medication adherence to drugs amongst old people. Thus, the study established that cognitive remedies and depression may only work for a short time as older people have difficulty engaging with structured instructions. However, other factors, such as self-efficacy and social support, can prove efficient in adapting to medication adherence among older people. In the same capacity, social support and self-efficacy can play a major role in developing healthy behaviors and promote healthy living.

Diabetes Clinical Case and Its Application of the Middle-range Theory

One of the patients I have noticed who attends regular clinics at the main hospital in town is an old man suffering from diabetes. This is a disease known to have a significant effect on old people. Unfortunately, it has extended disheartening impact on old men and women. This disease is ranked amongst top killer diseases worldwide. Hence, people male their best effort to ensure that this menace is curbed in order to live one more day. However, it must be noted that this is a disease that calls for more than regular clinic visits.

As compared to other terminal diseases, the thought of having diabetes has long disturbed Mr. Smith, whom I have noticed while visiting my ailing grandmother at the hospital. He does not get late, but ensures that he follows doctor’s instructions to the letter. Having suffered a mild stroke a couple of months ago, he is ready to do all it takes to maintain a healthy lifestyle. As he tells me his story, I realize this is not only a one time visit, but he is yet to attend many more clinics to maintain his sugar levels for the rest of his life. He also testifies of a consistent family history of diabetes. The old man of 65 years does not look scared but rather looking up to better days ahead despite his terminal condition.

A brief look at this medical picture showed that Mr. Smith is overweight and has high sugar levels of about 300 mg/dL. He was diagnosed with Diabetes Type 1 about 2 years ago after having a mild stroke. He had symptoms such as often feeling hungry, tired, and frequent urination. His blood pressure is alarming at 135/90 mmHg. The old man is a retired teacher and lives in his countryside home. He is a part time farmer on his ranch. Occasionally, he takes a short walk in the garden at the end of the day. He confesses eating heavy meals during the day. He has been advised to watch his weigh as he is obese weighing 220 pounds at 5 feet, 10 inches height.

Although diabetes is a terminal disease, it is a type of condition that can be maintained and one can live a healthy and normal life with it. There are cases of people who have lived with similar conditions much longer by following healthy lifestyles. The important aspect of this issue is to ensure that an individual with a disease understands his or her conditions in detail. In the above case, Mr. Smith could have developed sugar disorder over time without even realizing it. However, the same could have been well managed only if he would have followed healthy lifestyle. It is critical in this case to note that he has a family history of diabetes. Consequently, any symptom of diabetes should have been reported earlier in order to keep all factors on point. Nevertheless, after diagnosing the same, there is still a chance of living healthy and happy.

According to a Health Promotion Model, Mr. Smith is well advised to ensure that he obtains as much information about diabetes as possible. This will incease his understanding of his situation and how he can manage it. The same recommendation also goes to his family members for the sake of offering him immediate support during this difficult time in his life. It is imperative that a medical practitioner attending his clinic guarantees the best advice in reference to the stage at which his condition has reached. Likewise, this explains how much attention he requires.
In order to maintain a high standard of healthy living, it is of immediate concern that Mr. Smith adopts a different healthy lifestyle. As an old man at retirement age, he must not lead sedatory lifestyle. It is advisable that he keeps his body active to maintain high blood circulation and manage his body weight. This way he is able to remain active and enjoy his old age rather than remain relaxed and ill. As noted in the health model, he must come up with healthy behaviors such as taking at least 30 minutes walk, drinking water, and maintaining a proper diet.
Although the condition is alarming, the Health Promotion Model recommends a positive attitude towards living, which improves life. It is worth noting that Mr. Smith must look at the positive side of the situation that he can still improve. Hence, thinking about contributing to the society or participating in some short term activity in managing the farm can be extremely beneficial to his health. It becomes evident that by the end of the day, Mr. Smith will be more active than he was, which contributes in developing a new lifestyle and thus live longer and happier.

Nursing Assessments and Interventions

The above case may present a discouraging state, but it can also be controlled and the patient can live on for many years. In regular nursing practices, medical interventions and assessments, which have played a key role in assisting such people to live long and happy have been suggested. However, it is worth noting that personal contribution of the patient is equally important for his or her survival through this storm.

During the assessment, patients in the category of Mr. Smith can undergo tests once the desease has been suspected early enough. A patient has to undergo medical laboratory examinations.

  • Medical history: explains whether there is a consistency in the family of the same medical condition;
  • Confirmatory laboratory testing: this includes glucose tolerance test, fasting plasma glucose, blood pressure, glycosylated hemoglobin, and body weight;
  • Physical examination: changes in urination patterns, anxiety, fatigue, muscle cramps, decreased muscular strength, circulation, nausea, loss of appetite, pain, or ulcers.

Diabetes intervention methods are:

  • Weight measurements taken daily to ensure maximum control.
  • Maintain constant observation of signs of infections such as fever, open cuts, ulcers, etc. also ensure maximum hygiene and practice aseptic techniques.
  • Maintain high standards of skin and foot care and reduce risk of injuries.
  • Maintain the intake of recommended dietary supplements as prescribed by the nutritionist.
  • Be careful to observe signs of hypoglycemia, hunger, dizziness, etc.
  • In case of dehydration ensure constant water intake.
  • Constant assessment of skin turgor, peripheral pulses, and mucous membranes.
  • Assess breathing patterns and body temperature.
  • Look out for family history and increaseknowledge about the condition.
  • Provide adequate information for the patient and family concerning the condition.

Diagnosis in the case of diabetes mellitus calls for active participation of the patient. Interventions include:

  • Pharmacological treatment is administration of drugs to a person diagnosed with diabetes in accordance with that person’s need and the stage of the disease.

-Glycemic treatment revolves around insulin administration or other insulin combination;
-Blood pressure management is important to eliminate cases of stroke and heart attacks. This implies the use of angiotensin-converting enzymes.

  • Self-management of patients, especially related to embracing healthy habits, can improve health. In this concept, the following are applicable as per physician’s advice
    a. Nutrition therapy;
    b. Physical activity;
    c. Foot care;
    d. Weight control.

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