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Health promotion for the elderly: gerontogeriatric nursing commitment

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 Revision Article

Health promotion for the elderly: gerontogeriatric nursing

commitment

Promoção da saúde da pessoa idosa: compromisso da enfermagem gerontogeriátrica

Promoción de la salud de la persona de la tercera edad: compromiso de la enfermería

gerontogeriátrica

Silvana Sidney Costa Santos1, Edison Luiz Devos Barlem2, Bárbara Tarouco da
Silva2, Maria Elisabeth Cestari1, Valéria Lerch Lunardi1

ABSTRACT
This article had the purpose of reviewing the history of health policies for the elderly, initially using international health conferences, and
then national policies, correlating them with the loss of power usually attributed to the elderly population. Nola Pender’s health promotion
model was used to interconnect the themes, resulting in empowerment as a health promotion strategy for the elderly. Bibliographic material
was used as data source in order to achieve the proposed objective, such as Health Promotion Letters, Gerontology and Nursing themes. The
need for nurses to remain alert for issues of health promotion / education and public policies focused on the elderly is emphasized.
Keywords: Health promotion; Health of the elderly; Geriatric nursing; Health policy; Health education

RESUMO
Este artigo teve como objetivo realizar uma revisão da história das políticas de saúde voltadas às pessoas idosas, inicialmente utilizando as
conferências internacionais de saúde, depois as políticas nacionais, correlacionando com a perda de poder usualmente atribuída ao ser idoso.
Utilizou-se o modelo de promoção da saúde de Nola Pender para interligar os temas, resultando no ganho de poder como estratégia de
promoção da saúde da pessoa idosa. Para atingir o objetivo proposto, foram utilizados como fonte de dados material bibliográfico como as
Cartas de Promoção da Saúde, temas da Gerontologia e da Enfermagem. Enfatiza-se a necessidade do enfermeiro ficar atento às questões de
promoção/educação para saúde e às políticas públicas voltadas às pessoas idosas.
Descritores: Promoção da saúde; Saúde do idoso, Enfermagem geriátrica; Política de saúde; Educação em saúde

RESUMEN
Este artículo tuvo como objetivo realizar una revisión de la historia de las políticas de salud orientadas a las personas de la tercera edad,
inicialmente utilizando las conferencias internacionales de salud, después las políticas nacionales, correlacionando con la pérdida de poder
usualmente atribuida a ser de la tercera edad. Se utilizó el modelo de promoción de la salud de Nola Pender para interligar los temas,
resultando en la ganancia de poder como estrategia de promoción de la salud de la persona de la tercera edad. Para alcanzar el objetivo
propuesto, como fuente de datos fue utilizado el material bibliográfico constituido por las Cartas de Promoción de la Salud, temas de
Gerontología y Enfermería. Se enfatiza en la necesidad de que el enfermero esté atento a las cuestiones de promoción/educación para la salud
y a las políticas públicas volcadas a las personas de la tercera edad.
Descriptores: Promoción de la salud; Salud del anciano; Enfermería geriátrica; Política de salud; Educación en salud

1
Ph.D., Professor of the Nursing Department at Universidade Federal do Rio Grande – FURG- Rio Grande (RS), Brazil.
2
Post-Graduate at Universidade Federal do Rio Grande – FURG- Rio Grande (RS), Brazil, Holder of a CAPES fellowship.

Corresponding Author: Silvana Sidney Costa Santos Received article 10/04/2008 and accepted 16/06/2008
R. Duque de Caxias, 197/503 - Centro - Rio Grande - RS
CEP. 96200-020 E-mail: [email protected]
Acta Paul Enferm 2008;21(4):649-53.
650 Santos SSC, Barlem ELD, Silva BT, Cestari ME, Lunardi VL.

INTRODUCTION related to policies for the elderly, among them: documents

from international health conferences; National Policy for
The elderly population is seen differently in developing the Elderly; Estatuto do Idoso; Pacto em Defesa do Sistema
and developed countries. In the former, the age limit for Nacional de Saúde (SUS), Pacto pela Vida e Pacto de Gestão;
a person to be considered old is 60 years; in the latter, Política Nacional de Saúde da Terceira Idade, among others,
this age limit is 65 years. This differentiation emerged considering that healthcare workers need to become
during the First United Nations World Summit on familiar with these documents, so that they can preserve
Population Aging, through Resolution number 39/125(1). the rights of the elderly population.
The need to establish chronological parameters for old
age becomes more relevant as social and health actions HEALTH PROMOTION FOR THE
are scheduled. ELDERLY: BRIEF CONTEXTUALIZATION
When it comes to elderly healthcare, its main purpose
is to achieve the maintenance of good health conditions, To better understand the international perspective of
so that these individuals can maximize their active life, in public policies for the elderly, in line with the parameters
the environment they are inserted in, along with their that serve as tendencies for national policies, one must
families, with physical, mental and social autonomy and contextualize international health conferences that had
independence(2). Therefore, participating actively in a health promotion as their central topic. Since the
context, preferably family-oriented, and maintaining their Declaration of Alma-Ata, in 1978(5), it has been noted
autonomy is essential for the elderly, and also contributes that measures and characteristics of health promotion
to their health and well-being. imply a search for healthier life styles and active aging.
Issues related with powerlessness are usually present Health promotion is seen as a process of community
in their everyday life, especially as of the moment when qualification, aiming to improve life and health conditions.
people escape from patterns considered acceptable by The promotion actions result from the combination of
society, being marginalized and deprived of possibilities. state actions in the respective public health policies;
This fact occurs, for instance, with the elderly population, community actions, the actions of the individuals
which is sometimes acknowledged as incapable of making themselves, to develop their own capabilities, and also
its own decisions or even assuming its role within society. interventions for joint actions by different sectors.
The health of the individuals and its alleged promotion Among the elements of the conferences that have to
seem to be closely related with power, which implies do with the elderly, the following are noted: education
freedom of choice about several issues. Many of these about the main health problems and the methods to
issues are loaded with ethical dilemmas. During the aging prevent them; promotion of food supplies and adequate
process, a number of losses are perceived, as a natural nutrition; supply of appropriate drinking water and basic
result of the lifecycle, which culminates in old age and in sanitation; immunization against major infectious diseases;
the senior’s higher levels of frailty, making healthcare prevention and control of endemic diseases; appropriate
actions predicted by public policies more difficult. The treatment of common diseases and accident
real needs and difficulties of this share of the population, consequences and availability of essential medication, in
with such specific characteristics, are not taken into account. addition to social resources, such as social groups,
Gerontogeriatric nursing groups knowledge and universities open to the seniors and awareness about the
nursing practices derived from General Nursing, physical capabilities of both healthy and fragile elders.
Geriatrics and Gerontology(3). Gerontogeriatric nursing As of the Jakarta Conference in 1997(5), the elderly
is, in addition, a specific branch of nursing that delivers started to be part of the priority investment groups in
care to the elderly at all levels of prevention, i.e., from health development. In Brazil, this phase can be related
health promotion to rehabilitation. This nomenclature was with the emergence and regulation of the National Policy
selected because it is understood as being more for the Elderly - Política Nacional do Idoso, which was started
comprehensive and adequate(4). by the actions established in Law #8.842/94 and Decree
The purpose of this article was to review the history #1.948/96, whose purpose was to assure the social rights
of health policies focused on the elderly, initially by using of the elderly, creating conditions to promote their
international health conferences, and then going through autonomy, integration and effective participation in
national policies, correlating them with the loss of power society, reaffirming their right to health at the several levels
usually attributed to the elderly. Nola Pender’s health of healthcare.
promotion model was used to interconnect the themes, In 2003, the Statute of the Elderly - Estatuto do Idoso
resulting in empowerment as a health promotion strategy. was established by Law #10.741, which establishes the
In order to meet the proposed objective, a brief review duty of the State in protecting the senior’s life and health
was made by means of documents directly or indirectly through public social policies that allow for healthy aging,

Acta Paul Enferm 2008;21(4):649-53.

Health promotion for the elderly: gerontogeriatric nursing commitment 651

with dignity. and independence than by the presence or absence of

In 2006, federal, state and municipal managers disease.
understood the need to set goals, and also to contribute
to the involvement of society in the defense of the Single EMPOWERMENT AS STRATEGY FOR
Health System (SUS). This pledging process, named Pact HEALTH PROMOTION
for Health - Pacto pela Saúde, is presented in three
dimensions: Pact for defense of the SUS – Pacto em defesa Empowerment is the increase of individual and
do SUS, Pact for Life – Pacto pela Vida and Management collective power of people and social groups in
Pact – Pacto de Gestão, whose purpose was the qualification interpersonal relations and institutions, especially those
of SUS public management, seeking greater effectiveness, submitted to relations of oppression and social
efficiency, and response quality(6). domination (8). As such, empowerment will have the
Pacto pela Vida defined six priorities, the first of which primary purpose of helping people and communities to
was the health of the elderly population, with the following become more independent, generating self-confidence and
guidelines: promotion of active and healthy aging; sense of governance.
comprehensive and integrated elderly health care; One can associate empowerment to health gains, as
encouraging intersectorial actions; implementation of one recognizes that its absence is a risk factor for falling
homecare services; preferential care at health facilities, ill(9). Therefore, so-called health promotion goes beyond
observing risk criteria; strengthening social participation; the small context of health organizations and migrates
permanent development and education of SUS healthcare toward communities, schools and multiple environments,
workers in elderly care; disclosure and information about with the development of personal skills as a way of
the National Health Policy for the elderly to healthcare reinforcing communities.
workers, managers and users of the SUS; promotion of In line with this conception, health promotion has an
national and international cooperation in elderly healthcare interface with health education aiming to improve self-
experiences, and support for the development of studies esteem by reducing estrangement and increasing
and research. knowledge, expanding the field of possibilities and choices
Strategic actions aiming at elderly health are: of individuals, setting them free to choose their own
implementing the Caderneta de Saúde for the elderly, with behaviors(9).
relevant information about their health, permitting better
follow-ups by healthcare workers; Family Health Strategy; PROPOSED ACTIONS FOR HEALTH
stimulating the Permanent Distance Education Program, PROMOTION IN GERONTOGERIATRIC
implementing permanent education activities in the field NURSING
of aging and elderly health, focused on workers in the
basic healthcare network; establishing the Welcoming, by To represent the specific behaviors of this reflection,
reorganizing the process of welcoming elderly patients in a schematic model was sought that simultaneously covered
healthcare units; establishing Pharmaceutical Care, health promotion and the Health Policy for the Elderly,
developing actions that aim at qualifying care delivery and with a view to adopting actions for greater awareness,
access of the elderly population; guaranteeing resulting in attitudes of empowerment and suggestions
Differentiated Care upon Admission, establishing global for gerontogeriatric nursing actions. Nola Pender’s Health
gerontological evaluation, performed by a Promotion Model (10) was used. Through a chart, it
multidisciplinary team, to all seniors admitted in a hospital, manages to represent the behaviors that can lead to health
seen in an out-patient clinic, either institutionalized or promotion.
attended by a Homecare Program; encouraging Homecare, Nola Pender’s Model was developed in the United
valuing the positive effect of the family environment in States in the 1980s, but was little explored in Brazil. It
the recovery process of elderly people, as well as the emerges as a proposal to integrate behavioral sciences with
additional benefits for the citizens and the healthcare nursing theories, seeking to identify factors that influence
system. health behaviors in a biopsychosocial context. It seeks to
The National Health Policy of the elderly, established support its health promotion conception on “activities
by Regulation #2.528/06(7), emerged in response to Pacto focused on the development of resources that keep or
pela Saúde, to restructure Regulation #1.395/99. Its enhance the person’s well-being”(10).
purpose is to recover, maintain and promote the The model is based on three main points: personal
autonomy and independence of the elderly, by means of characteristics / experience of the individual / group;
individual and collective healthcare measures, in harmony knowledge and feelings about the behavior one wishes to
with the principles of the SUS. The concept of elderly reach; the desirable behavior of health promotion. The
health is conveyed more by a condition of autonomy chart is presented as variables, with behaviors and attitudes

Acta Paul Enferm 2008;21(4):649-53.

652 Santos SSC, Barlem ELD, Silva BT, Cestari ME, Lunardi VL.

one wishes to reach at its core(10). In order to achieve health promotion for the elderly,
The original model was adapted for seniors, aiming some of the gerotogeriatric nursing actions for the elderly
at actions under the responsibility of gerontogeriatric are: acquiring specific knowledge of Gerontology,
nursing and strategies of empowerment, highlighting its prioritizing demographic and epidemiological issues;
premises, while proposed reflections/activities/ differentiating physiologic and pathological alterations in
commitments in gerontogeriatric nursing are represented the aging process; knowing the national legislation and
in regular letters (Figure 1). the public policies focused on the elderly population,
In health promotion, empowerment is a process in seeking to disseminate them among the seniors
which people receive support to be able to control factors themselves, their families and the community; developing
that might affect their health. actions that consider the limitations and presence of Non-
It is fundamental that policies related to the social Transmissible Chronic Diseases (NTCD) in seniors in
reintegration of the elderly are effectively complied with. different contexts (home, long-stay institutions, hospitals),
Therefore, it important that the elderly know their rights enabling the maintenance of their autonomy and
and enforce them, using the Estatuto do Idoso so as to independence; qualifying the senior citizens, families,
ascertain their citizenship and political power. It is necessary community, students, teachers and workers about the
to stimulate activities that permit the elders take part in aging process, care for the elderly population and issues
the decision-making processes related to their own lives. related to old age; contributing to changes in individual,

1. Characteristics 2. Specific Behavior 3. Result of Individual

Behavior and Experience
Perceives benefits of the
action – the senior does not
wish to be dependent .
Immediate Requirements
(imposing forces). having to
Perceives barriers to action– CHANGE .
age-related limitations , NTCD, Pr eferences (enhancing
Personal Behavior loss of autonomy and forces): wanting to CHANGE .
Per ception of the senior as a independence .
dependent , fragile being , without
autonomy . Perceives self-effectiveness :
the seniors perceive themselves
as capable . Health promotion behavior:
SEARCHING FOR
EMPOWERMENT.
Feelings about behavior:
positive reinforcement reached
by improvement of self -esteem :
participation in groups , in
UNATI.

Interpersonal Influences Commitment with an action

(family , spouse, standards, plan: Proposed gerontogeriatric
Personal Factors: Biological pr oviders, models , media , nursing actions .
(age); Psychological (low self - church, prejudices , myths): the
esteem and self - motivation ); senior as a USEFUL human
Social -cultur al (limited educational being .
level ).
Situations that influence
(opinions , demands , aesthetics ,
access to health ser vices or lack
thereof , food, home, quality of
life , public policies ): the old
person wants to be a useful ,
impor tant , human being , one
who consumes , participates ,
integrates.

Transcribed and adapted from: Victor JF, Lopes MVO, Ximenes LB. Analysis of the health promotion chart of Nola J. Pender. Acta
Paul Enferm. 2005; 18(3): 235-40.
Figure 1 – Chart of the Health Promotion Model of the Elderly

Acta Paul Enferm 2008;21(4):649-53.

Health promotion for the elderly: gerontogeriatric nursing commitment 653

collective and organizational behaviors regarding the health physiological process of the human being; if elderly health
of the seniors, through health education and health promotion is incorporated by enforcing what is alleged
promotion actions focused on elderly healthcare in the official documents issued from the National Policy
organizations. of the Elderly and focused on actions of the SUS; and if
empowerment of the elderly is considered an essential
FINAL CONSIDERATIONS category in Gerontogeriatric Nursing care.
The questions around aging are quite recent in the
The objective of this concept was to suggest actions Brazilian research scenario. Further research is needed on
that can be developed by Gerontogeriatric Nursing this theme, correlated with professional practice and with
workers, using Nola Pender’s Health Promotion Model, the daily life of these individuals who, despite specific
emphasizing empowerment as a health promotion strategy policies, may ignore their contents, contributing to non-
for the elderly. The model contributed to reflections about enforcement in practice.
Gerontogeriatric Nursing actions and made nurses think Nursing, as a course oriented toward human care and
about the need to act with a view to empowering the self-care teaching, needs to provide improvements in
elderly during care in this specialty. quality of life, through strategies that aim to maintain
This suggestion can be put in practice, provided that autonomy and independence. Toward this goal, using a
health promotion is a priority for the elderly population, health promotion model is a way of translating reality
which will only be possible if one admits that aging is a and showing feasible alternatives of empowerment.

REFERENCES
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Acta Paul Enferm 2008;21(4):649-53.

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