Prevention of Chronic Disease in the 21st Century, Capstone Project Example

Introduction

Cultural diversity within the community setting requires an astute level of knowledge and available resources to ensure that its population is protected from unnecessary health risks or harm. This reflects the importance of developing a dynamic that will positively impact outcomes and support all health statuses, regardless of age or ethnicity, using expert knowledge to achieve the intended outcomes. The emergence of chronic disease states over the past decade at alarming levels requires an examination of the nature and causes of these conditions, such as poor dietary habits and limited physical activity. Therefore, it is necessary to consider the causes and implications of chronic disease more closely within a given population. For the purposes of this discussion, the chosen population includes adults over the age of 55 who come from a variety of backgrounds and ethnicities. Many members of this population face critical challenges with respect to health concerns that must be addressed in a timely manner to prevent permanent complications that may impact their quality of life. Therefore, disease prevention and health promotion for this population must focus on chronic diseases such as diabetes and hypertension to improve knowledge and behavioral outcomes for this group of adults, utilizing the knowledge and skills of expert stakeholders to improve the health of this population.

Body

Older adults often possess low health literacy skills that impact their knowledge of chronic disease and the behaviors that ultimately impact their health in different ways (Bostock & Steptoe, 2012). From this perspective, it is important to identify strategies that will improve health literacy for older adults through educational programs that specifically target this population and support a greater emphasis on behavioral modifications to improve wellbeing (Bostock & Steptoe, 2012). Many older adults possess multimorbidities that encompass two or more chronic diseases that require ongoing treatment and evaluation; therefore, it is important to recognize how these considerations influence healthcare outcomes and spending for the older adult population (Salive, 2013). The existence of multimorbidities reflects a greater need to acknowledge risk factors such as death and disability due to chronic disease states, and to determine how to focus on behavioral improvement to minimize these risks as best as possible (Salive, 2013).

Most importantly, the emergence of self-management education and guidance is critical to the improvement of health outcomes for many older adults with chronic diseases (Bauer, Briss, Goodman, & Bowman, 2014). From this perspective, older adults are likely to obtain information in an organized format that will support health improvements, rather than to detract from quality of life (Bauer et.al, 2014). It is believed that “The magnitude of the chronic disease challenge in the USA requires a sustained policy and programme focus on high-value prevention targets that draw upon strengthened links between public health and clinical care” (Bauer et.al, 2014, p. 48). Therefore, policy-based initiatives within community healthcare organizations must be in place that will serve to provide older adults with opportunities to ask questions and to receive education and training to improve disease self-management to minimize symptom risk and other complications (Bauer et.al, 2014). The ability to deliver education to older adults with chronic diseases requires a format that is easy to understand and which supports a dynamic of care and treatment that will have positive and lasting benefits for this population group. It is the responsibility of the educational provider to exercise flexibility in administering education and allow for a period of transition for those who are less familiar with technology-based tools and resources. Positive health outcomes for older adults are contingent upon the ability to support a resource-based framework that will benefit all older adults across many different skillsets in order to promote health as best as possible.

For older adults who are amenable to technology-based solutions, web-based tools are likely to provide numerous benefits with respect to chronic disease self-management (Stellefson et.al, 2013). The integration of these tools in older adult populations requires specific training and guidance in order to achieve the desired results, while also considering the factors which impact their level of literacy in this regard (Stellefson et.al, 2013). Many older adults use the Internet on a regular basis for other purposes, such as social media; therefore, education regarding self-management may provide an additional layer of support to their healthcare management needs (Stellefson et.al, 2013). Many persons with chronic diseases already possess experience with social networking sites and blogs that provide health-related information; therefore, self-management via websites would not be a difficult transition (Stellefson et.al, 2013). However, a diverse population may possess various levels of experience with technologies and would require a more user-friendly and simplified interface to manage their needs (Stellefson et.al, 2013). This type of intervention would support a positive interface that would transition less experienced users to the Internet without difficulty and provide a level of support that would encourage positive outcomes for patients who require self-management techniques on a regular basis (Stellefson et.al, 2013).

A chronic disease intervention at the community level requires an examination of key principles and factors that impact health for older adults. Nurses must play an active role in supporting a favorable intervention experience for this population groups through active engagement and disease management that emphasizes the minimization of symptoms and the overall development of factors related to positive health and wellbeing for patients with chronic diseases (Coburn, Marcantonio, Lazansky, Keller, & Davis, 2012). Nurses must support an active level of involvement in establishing standards of care and treatment for this population that include self-management and other techniques to accommodate patient needs effectively (Coburn et.al, 2012). Nurses must be active and engaged in the intervention in order to prevent lasting complications for patients and support behavioral changes to improve quality of life for older adults (Coburn et.al, 2012). One of the primary objectives of this type of program is to enable nurses to work collaboratively with clients in community-based settings to promote healing and minimize the risks associated with chronic disease, while also considering other factors that impact health over time. Nurses must consider local, regional, national, and global perspectives when making decisions regarding an educational curriculum that will have an optimal impact on the lives of older adults.

Older adults are a focus area of the Healthy People 2020 (2015) initiative and supports the need for further investigation regarding chronic diseases and the need for preventive care in this regard. There are a number of limitations that must be addressed within this population, and Healthy People 2020 aims to reduce these disparities and prevent disabilities and improve behavioral outcomes for this group (2015). The delivery of high quality care is contingent upon the ability of knowledge experts and clinicians to properly classify services and to promote greater support for these initiatives in managing the health and wellbeing of older adults (Goodman et.al, 2013). The appropriate legislation must be in place to support nursing practice objectives for older adults, accompanied by regulatory support that will positively influence decision-making. However, cultural barriers may be present that could impact how education is perceived by the older adult population; therefore, these barriers must be minimized to ensure that the target audience receives the desired level of information in the appropriate manner.

One area of programmatic development that is likely to have an impact on older adults is telemonitoring, whereby nurses support self-management practices and techniques that impact health in a positive manner and facilitate symptom monitoring for patients who possess multiple comorbidities (Takahashi et.al, 2012). Older adults who live in community-based settings are likely to benefit from telemonitoring because nurses are focused on providing them with an optimized experience in this regard that will improve their degree of symptom management and their overall ability to modify behaviors to support health-related improvements (Takahashi et.al, 2012). This process is instrumental in improving the health of older adults and in supporting a dynamic whereby they are able to effectively communicate with their healthcare providers on a regular basis to address concerns and other issues as needed (Takahashi et.al, 2012).

Implementing a health promotion and disease management intervention for older adults requires a specialized and focused effort on the specific needs of this population, including an examination of the different cultural needs and expectations that are likely to emerge within the group setting. From a cultural perspective, the diversity of a given community of older adults must serve as a critical emphasis in addressing key health disparities and other challenges that impact this population, as well as providing a level of cultural sensitivity that will have a lasting impact on outcomes (Henderson, Kendall, & See, 2011). In this context, it is evident that patient care needs are highly diverse in nature and require a level of specialized attention and focus from nurses to promote culturally competent care; however, it is also important to promote equality among healthcare services as much as possible to support favorable health outcomes for older adults (Henderson et.al, 2011). This process is essential to the discovery of new strategies to improve cultural knowledge and competence among healthcare providers that will enable the chosen intervention to achieve greater success and cooperation from the community to be served (Henderson et.al, 2011). The level of cultural competency must be higher in order to be successful in educating older adults to be proactive in supporting their own health concerns.

Health promotion and chronic disease management among older adults must coincide with the principles of healthcare practice that support positive behaviors to improve health. Different belief systems often govern the healthcare practices of older adults, and there is much diversity among these practices and the resources that are available (Jiminez et.al, 2012). From this perspective, it is necessary to develop strategies that will minimize barriers to health promotion and disease management/prevention among older adults and provide many opportunities to address specific cultural needs in a respectful and supportive manner (Jiminez et.al, 2012). Therefore, many of the same principles apply in managing the health of older adults, including those related to chronic disease. It is imperative to recognize health disparities and to be mindful of the challenges associated with healthcare practice in order to be effective in supporting older adults on a comprehensive basis to meet all of their healthcare needs (Jiminez et.al, 2012). Older adults must be provided with a support system within the healthcare continuum that will engage them in recognizing how their behaviors impact health and whether advanced tools that involve technology use might be helpful in supporting their needs on a regular basis. This is an important step in acclimatizing patients to new opportunities to improve their health and recognize how these tools will enable them to better understand their own health risks over time.

Conclusion

The healthcare needs of older adults are of critical importance in an era where individuals are living longer lives, yet face multiple comorbidities such as chronic disease. Therefore, nurses must collaborate with patients in different ways in order to provide them with the tools that are necessary to improve their health. This includes interventions that are often technology-based that support symptom management, self-care, and behavioral modifications that will address health concerns and reduce the risk of disease. Nurses must be mindful of their audiences and the level of technology-based expertise in supporting an intervention method. In addition, cultural diversity must also be considered in the context of the intervention in order to provide opportunities for all participants to receive a culturally competent approach to health promotion and disease management that will positively impact their health over the long term.

References

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Bostock, S., & Steptoe, A. (2012). Association between low functional health literacy and mortality in older adults: longitudinal cohort study. Bmj, 344, e1602.

Coburn, K. D., Marcantonio, S., Lazansky, R., Keller, M., & Davis, N. (2012). Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial. PLoS Med, 9(7), e1001265.

Goodman, R. A. (2013). Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Preventing chronic disease, 10.

Healthy People 2020 (2015). Older adults. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

Henderson, S., Kendall, E., & See, L. (2011). The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health & social care in the community, 19(3), 225-249.

Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & Alegría, M. (2012). Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry, 20(6), 533-542.

Salive, M. E. (2013). Multimorbidity in older adults. Epidemiologic reviews, mxs009. Stellefson, M., Chaney, B., Barry, A. E., Chavarria, E., Tennant, B., Walsh-Childers, K., … &

Zagora, J. (2013). Web 2.0 chronic disease self-management for older adults: a systematic review. Journal of medical Internet research, 15(2).

Takahashi, P. Y., Pecina, J. L., Upatising, B., Chaudhry, R., Shah, N. D., Van Houten, H., … & Hanson, G. J. (2012). A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Archives of internal medicine, 172(10), 773-779.