1.
Background
The aging population is increasing. According to the World
Health Organization (WHO), it is expected that the number of people aged 60 or
above will increase in this coming 50 years. As shown in figure 1, this
situation will happen in both developed and developing countries.
src=”new_page_1_files/image002.jpg” v:shapes=”_x0000_s1116″>
Figure 1. Global trend of people aged 60 and over (WHO,2002).
There is no exception in Hong Kong. Figure 2 demonstrated
that percentage of people aged over 64 increased gradually from 1998 to 2003.
Oppositely, the proportion of people aged under 35 was decreasing.
width=312 height=209 src=”new_page_1_files/image004.gif” v:shapes=”_x0000_s1117″>Figure
2.
Mid year population by age group. (Census and Statistics
Department, 2005).
Meanwhile, there is an increasing trend in the life
expectancy as illustrated in figure 3. Although life expectancy is increasing,
it dose not mean that elderly quality of life can also be improved. Therefore,
elderly health was chosen in this health promotion program.
width=372 height=208 src=”new_page_1_files/image006.gif” v:shapes=”_x0000_s1118″>Figure
3.
Expectation of life at
birth by sex in HK.
(Census & Statistics
Department, 2005).
Due to the dramatic increase in the elderly population,
effort should be put on understanding and promoting health and well-being of
elderly and communities. According to WHO (1996), aging is a development issue.
Healthy older persons are a resource for their families, their communities and
the economy.
Lung Hang Community Centre was chosen for implementing this
health promotion project. The topics of recent health program, carried out in
this centre, were reviewed. It was surprise to find that they were mainly
related to physical health rather mental health.
According to WHO (2005), Mental well-being is included in the
definition of health. There is no health without mental health. Mental health is
more than the absence of mental illness. It is vital to individuals, families
and societies. Mental health and mental well-being are fundamental to the
quality of life and productivity of individuals, families, communities and
nations. Referring to WHO, mental and behavioral disorders were over one-tenth
of total disease burden in 1990. It was estimated that this disease population
will increase to 15% in 2020. Therefore, mental health is one of the important
health issues for exploration, especially in the population of elderly.
As shown in figure 4, suicidal rate of people aged 60 or
above remains the most recently. According to Chi, Yip, & Yu (1997), elderly
suicidal rate is one of the highest in the world. By referring to figure 5,
suicidal rates of Hong Kongers aged over 64 is high. It is even much higher then
the developed country likes Australia and New Zealand.
Age group
2001
2002
2003
0 – 19
2.1
1.8
1.9
20 – 59
16.4
17.8
18.8
60 or above
27.0
23.4
30.7
Suicide rate equals to number of suicide death per 100,000
population per year
Figure 4. Suicidal rate of Hong Kong by age. (The Samaritan
Befrienders Hong Kong, 2003).
Country
Year
Age ³
65
Hong Kong
2001
128.6
Australia
1999
59.2
New Zealand
1998
63.3
Singapore
2000
113.7
Japan
1999
162.9
Figure 5. Suicidal rate of people aged over 64 by country.
(Law, Law, & Yip, 2003).
Stress may exist in every body. But state of stress may be
different between each person. Van Praag (2004) stated that stress refers to
variety of behavioral states. This may or may not lead to psychiatric disorder,
and may result in more serious consequences finally e.g. suicidal behavior.
Elderly may have different sources of stress: due to 1)
change of lifestyle and financial status after retirement; 2) caring for their
grandchildren or sick spouse; 3) death of relatives, beloves or close friends;
4) deterioration of physical abilities and chronic illness; and 5) worries for
unable to live independently and institutionalization. People with stress may
present with insomnia, nightmare, loss of appetite, palpitation, frequent
urination, muscle pain, tiredness, restlessness, poor concentration,
forgetfulness, anxiety, fear, frustrated or depression.
Referring to Chi et al. (1997), most elderly are unaware and
unrecognized when they are facing stress. Only some of them complaint to
relatives or physician. Only some of them verbalized their suicidal idea. While
just a few do seek external help e.g. using telephone help-lines.
For relatives, they think that the negative emotional state
of elderly is normal. When elderly facing stress, relatives usually try to
comfort them instead of implementing any intervention. Therefore, elderly
complaints become routine, irrelevant and crisis are being ignored. Besides, due
to traditional Chinese culture, relatives think that they should take good care
of elderly. They feel ashamed and hesitate to seek external help even if it is
necessary.
Due to the phenomenon mentioned above, it is believed that
elderly mental health is important. The elderly mental health is chosen in this
health promotion project. While, stress management is focused.
2. Information of the health promotion program
Title. Elderly mental health was chosen in this health
promotion project. Stress management was focused. The title of this project was
“Happy aging”. The slogan was ‘開開心心過生活,快快樂樂渡晚年’.
Target group included elderly aged 60 or above. The
number of participant is around 30.
Aim of this program was to enhance the awareness of
the elderly on the importance of stress management during ageing.
Objectives of this program were enabling the elderly
1) to identify the sources of stress; 2) to identify the stress response; 3) to
point out the ways for reducing stress; and 4) to enhance the skills in
performing health promotion program among the group members.
Venue and Date. The program was held on the 15th
march, 2005, from 09:30 to 1200, at the Lung Hang Community Centre in Tai Wai,
New Territories.
Program preparation. A proposal of this project was
designed and given to the person-in-charge of the elderly centre. An invitation
poster with large fonts, colorful and attractive graphics was posted up in the
community centre 2 weeks before the program.
By the way, information of the health talk was collected from
different sources and media for enriching the health talk provided. Information
included : 1) definition of stress; 2) possible sources of stress in the
elderly; 3) signs and symptoms of stress including physical, emotional and
physiological responses; 4) consequences of being over-stressed; and 5) ways for
reducing stress e.g. communicate with others, doing relaxation exercise.
Role play was used for further introducing stress management
during aging process. In order to make the program to be more interesting,
several characters from the elderly popular radio program “十八樓C座”
was acted. Script of the role play was designed with those interesting elements.
Questions-and-answers (Q&A) game with prizes related to the
health talk and the role play was designed to facilitate active interaction. The
possible changes, stress and the methods to reduce stress of elderly were
further identified and emphasized in this section.
VCD of relaxation exercise was prepared and bought form the
Department of Health (DH). This exercise was done under an appropriate
environment, likes dim light, quiet and comfortable. This section could further
enhance active participation. It was also believed that one of the useful
methods for relaxing and reducing stress was presented to them practically.
Pamphlets with summarized information related to the health
talks were designed with colorful graphic and large font. It was given to the
participants at the end of the program for refreshing their memories. As support
form family is important, pamphlet was given in order to let them sharing that
information with their families. In the meanwhile, several existing telephone
help lines in Hong Kong were enclosed in the octopus card holder. This ensures
that they can access to those community resource and seek help whenever and
wherever it is necessary.
Evaluation form was designed for evaluating their
satisfaction towards this program. Moreover, souvenirs were donated by
volunteers from other charity centre. Digital camera and digital video camera
were prepared for recording the whole program, in order to extend their memory
related to this health program. Photos were developed and extra pamphlets were
posted on the board right after the program in the centre.
Program rundown is listed as follows
Time
Action
09:00
Decoration, arrangement of seat, preparation of power point, lighting and
sounding
09:30
Introduction and health talk
10:00
Role play
10:30
Q & A
games
11:00
Relaxation
exercise
11:30
Sharing &
evaluation
Delivery
of pamphlets, hotline information cards and souvenirs
Taking
photos
12:00
End of the
program
Removed
decoration
Develop
and post photo on the board
Self
evaluation
3.
In line with
WHO action strategies
According to the Ottawa Charter for health promotion (WHO,
1986), Health promotion is the process of enabling people to increase control
over, and to improve their health. In order to reach a state of complete
physical, mental and social well-being, an individual or group must be able to
identify and to realize aspirations, to satisfy needs, and to change or cope
with environment.
Five strategies are mentioned and set in the Ottawa Charter
for health promotion (WHO, 1986): 1) Build healthy public policy; 2) Create
supportive environments; 3) Strengthen community action; 4) Develop personal
skills; and 5) Reorient health services. ‘Develop personal skills’ is emphasized
in this project. Health promotion enhances personal and social development via
providing information, education for health and enhancing life skills. This
provided more choices for people to facilitate control over their own health and
environment. Therefore, information related to stress in the old age were
presented to participants in this project by different strategies, e.g. talk,
role play, Q & A game, pamphlets and relaxation exercise. It is hoped that this
enhances elderly to learn in their whole lives, and cope with stress in all
stages more effective.
Referring to the Mental Health Declaration for Europe (WHO,
2005), There is no health without mental health. Awareness of the importance of
mental well-being is highlighted. This action plan contains element that is
utilized in this project. It is ‘prevent mental health problems and suicide’.
WHO (2005)mentioned that people in many countries exposed to harmful
stress-inducing societal changes. This influences social cohesion, safe,
employment and may result in anxiety, depression and suicidal behavior finally.
Hence increasing elderly awareness of sources, symptoms and consequences of
stress, and ways for reducing stress are crucial. It is believed that at risk
group can be captured more easy. Besides, fully utilzation of community
resources, e.g. telephone help-lines, may facilitate mental health promotion.
4.
Theories
The precede/proceed model (Green & Kreuter, 1991) is applied
in this health promotion project. As this model stress initial emphasis on
outcomes rather than inputs, this model is suitable to this project and is
chosen as one of the guideline and theory basis for implementing this health
promotion project. Evaluation of this program is facilitated by performing
process and impact evaluation. For the process evaluation, there was high level
of attendance in this program. Number of participants increased from 30 to 39.
Besides, participants satisfied with the program, as shown by active
participation in the section of Q& A game and follow the relaxation exercise for
almost 30 minutes.
For impact evaluation, Staff of the community centre were
satisfied with our program. Miss Kwong, person-in-charge, showed good appraisal
and positive feedback. It is found that most of the objectives could be
achieved. 1) To enable the elderly to identify the sources of stress in the
aging process. During the games after role play, elderly could answer correctly
related to sources of stress. 2) To enable the elderly to identify the stress
responses in the ageing process. During the games, it was found that elderly
could point out the stress responses. 3) To enable the elderly to point out the
ways in reducing stress. During the games, elderly could point out the ways to
reduce stress. 4) To enhance the skills in performing health promotion program
among group members. This objectives can also be achieved. Our health promotion
skills are enhanced by breaking the ice, good time management for this project,
utilizing available community resources, and leading the group to participate
actively.
5.
Strengths and
weaknesses
Through evaluation, both strengths and weaknesses of this
project are illustrated. Date of program was appropriate for the participant.
Weekday was chosen rather then weekend; their family day won’t be disturbed.
This ensures that they were able to participate in this program, as evidence by
there was 9 people more then the quota for number of participants. Besides,
project was run in a smooth process with good time management. As preparation
was good and detailed before the project. The project also finished on time.
Moreover, role play is an attractive mode for presenting idea. It was effective
that the elderly could understand the content. In addition, Pamphlets delivered
were informative to the relatives. Colorful pictures were used on board,
pamphlets, PowerPoint. It was attractive and interesting. This enhanced
understanding of content easily. Positive reinforcement was used for encouraging
active participation. Furthermore, all available and accessible community
resources were utilized, like VCD of relaxation exercise from DH. Meanwhile, the
relaxation exercise is easy and safe for elderly. It provides a feeling of
comfort and relaxing to the participant. Additionally, information board,
pamphlets and VCD of the program and relaxation exercise were left in the
community centre for extending their memories. This strengthens the effect of
health education.
However, this project has several weaknesses, which require
further improvement. Pamphlet and hotline information card are not effective to
the illiterate elderly. Font size on the hotline information card is too small.
Elderly may not be able to read it. Moreover, the rating scale of the evaluation
is too difficult for elderly, especially for the illiterate elderly. This may
result in not accurate evaluation. Furthermore, the group size of participation
(39) is a little bit large. A large group may inhibit sharing of ideas and
experiences among the group. Difficulties and barriers existed in handling a
large group in this project.
6.
Barriers
Barriers do exist in this project. First, as this is only a
one off program, lacks continuous and assessment throughout health promotion.
Secondly, since weekday was chosen for carrying out this project, family members
and caregivers would not be able to participate. Last but not least,
participants involved are physically fit and active in the community. At risk
group may not be captured.
7.
Recommendations
There are several recommendations suggested for improving
this health promotion projects. Elderly especially for the illiterate, have to
be encouraged to bring pamphlets home for sharing information with family, care
givers, friends and neighbors. This enhances health promotion to varied levels
of people with different roles.
Besides, simple questions and answers have to be used in the
questionnaire rather than the difficult rating scale. Also, it is suggested that
questionnaires can be left to the person-in-charge of the community centre after
the program. Participants may complete the evaluation form without presence of
group members so as to prevent bias. The evaluate may then be reflected their
attitudes toward this program more accurate.
8.
Conclusions
Through handling this health promotion project, I gain a lot.
I treasure the opportunities to practice as a primary nurse in the community.
While this cannot be experienced in my full time job for working in an acute
hospital setting. I cooperate with my groupmate properly. Meanwhile, this
project can be carried out with knowledge and theories bases. Through making use
of those theories, worldwide guidelines and strategies, the health project can
then be implemented organize with evidence base. I do get certain extent of
satisfaction throughout this project. However, I hope that more resources (e.g.
time, human) can be allocated in this kind of health project, so that an
integrated health program can be implemented more comprehensively, with
continuous assessment and intervention can be carried out.
9. References
Census and
statistics department. (2005). Hong Kong statistics – Health. Retrieved April 8,
2005, from
http://www.info.gov.hk/censtatd/eng/hkstat/hkinf/health_index.html.
Census and statistics department. (2005). Hong Kong
statistics – Population and vital events. Retrieved April 8, 2005, from
http://www.info.gov.hk/censtatd/eng/hkstat/hkinf/population_index.html
Chi, I., Yip, P. S. F., & Yu, K. K. (1997). Elderly suicides
in Hong Kong. Retrieved April 8, 2005 from http://www.sps.org.hk/sps_pub.htm
Green, L. & Kreuter, M. (1991). Health promotion planning;
an educational and environmental approach. (2nd Ed.). Mountain
View; Mayfield Publishing Co.
Law, C. K., Law, Y. Y., & Yip, P. S. F., (2003). Suicide in
Hong Kong: epidemiological profile and burden analysis, 1980 to 2001. Hong
Kong Medical Journal, 9, 419-426.
The Samaritan Befrienders Hong Kong (2003). Annual Report
2003. Hong Kong: The Samaritan Befrienders Hong Kong.
UN. (2002). Population trend of age over 60 in the world.
Retrieved March 11, 2005, from WHO, Aging and life course web site: http://www.who.int/hpr/ageing/international_day_en.htm#WHO
Van Praag, H.M.(2004). Stress and suicide are we
well-equipped to study this issue? The journal of crisis intervention and
suicide prevention. 25(2), 80-85.
WHO. (1986). Ottawa charter for health promotion.
Geneva: WHO
WHO. (1996). Brasilia declaration on healthy ageing.
Retrieved April 11, 2005, from http://www.who.int/hpr/ageing/international_day_en.htm#WHO
WHO. (2004). Promoting mental health: Concepts – Emerging
evidence – Practice. Geneva: WHO.
WHO. (2005). Mental health action plan for Europe – facing
the challenges, building the solution. Helsinki: WHO.
Credit:ivythesis.typepad.com
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