Homelessness is a critical issue for all communities that impacts societies and nations worldwide. The aged are particularly vulnerable who have to live out their lives, staring into a bleak world which is no more what it used to be, and the youth have all but elbowed out the old like the proverbial baby with the bathwater.
For all practical purpose, anyone over 60 years of age is bracketed into the “aged” category, but this may not necessarily be so. There are those who having crossed 60, still continue to work briskly as if they are still in the prime of their youth and are enjoying it. There is a wide gap in the physical structure and mental capability between those who are 60 and others aged 90. Not everyone who is 60 disappears into oblivion right away. There are those enjoying exuberant health and actively involved well into their 90s. But not everyone, however, is so fortunate.
In the light of the fast economical changes taking place, the issue most important after environment is health care for the aged, particularly those who are left alone, and have nowhere to go. Fear of failing health and deteriorating physical abilities make them prone to fall and injuries. Morbid fear of being unable to move and look after oneself portentously lurk. The possibility of better handling the situation through counseling and improving balancing abilities through exercises must be explored and actively pursued. It will be a healthy world where the elderly are energetic and active so that their wisdom and experience could be put to good use for the society at large.
Given the opportunity, there could be no doubt the elderly would be only too happy to immerse themselves in activities which guide them in the art of health-promoting self-care behavior, self-efficacy, and self-care agency. Use of research instrument such as Health-Promoting Lifestyle Profile II Scale (HPLP II), Self-Rated Abilities for Health Practices Scale (SRAHP), Exercises of Self-Care Agency Scale (ESCA), provide invaluable inputs into the causes and effects and raise awareness and self-esteem of the anxious elderly.
Inter-personal health promotional behavior and activities among long-term elderly married couples, important and necessary in view of its ubiquity, to analyze relationship quality, perceived barriers, perceived self-efficacy, and social support by means of regression analysis to detect the factors that need to be addressed for better health.
A healthy aging social segment reflects good health for society in general.
The problem of homelessness originates with the individual as well as the social system. Individually the reasons for homelessness set in with any or all of the factors such as broken family background, domestic violence, level of education, ethnicity among others. Structurally, at the society level, lack of facilities, unemployment, poverty, poor income, lack of accommodation facilities, among other factors contribute to homelessness.
Homelessness is one of the debilitating causes for quicker deterioration of health for older adults. It is more common in urban situations where accommodation eludes those with little or no income. Biological factors contributing to physical changes begin to weaken the body muscles and joints leading to the fear of falling. In such situation, it is doubly damning if the individual is already beset with homelessness. At times, even standing up without support gives way and the person falls.
Health promotional concepts have been emerging ubiquitously with encouraging response from the people of all age groups. Pender’s Health Promotional Model (HPM) is particularly noteworthy because of it meticulous approach and provisions for treatment. Pender’s Health Promotional Model (HPM), introduced in 1987, seeks to identify individual characteristics and experiences before considering commitment to a plan of action for the older adult to inculcate self-care and self-efficacy practices in her daily routine.
Homeless women aged 18 to 60 (mean average 36 years), comprising white as well as African Americans from different shelters were examined and blamed relationship conflict as the primary reason for their state of homelessness. Most of them were well educated but unemployed.
To diagnose defects and prescribe measures for improvement in physical balancing among women aged minimum 60, tests were carried out using reach and mobility involving walking a distance of 4 meters and grip using a dynamometer. Data was also collected concerning the demography, viz. age, gender, occupation, and health of the participants.
Older adults financially sound and also possessing insurance health cover reported higher mean scores on HPLP II and SRAHP scales. These also had better support system and daily followed some religious routine. These tests relate to self-care, self-efficacy and self-care agency. Those who reported having college education also had better mean scores compared to others who reported having education up to high school level.
In relation to health state basic conditioning factors, socio-cultural basic conditioning factors, and other basic conditioning factors, the results showed that those who had medical disabilities and problems practiced healthy behaviors and self-efficacy principles but lacked self-care. Ethnicity and education too played a part in self-care agency. The whites who reported having sufficient income, practicing some religion, also reported observing health promoting behaviors, self-efficacy and self-care agency.
An interesting factor that emerged showed that married couples, as they age, became increasingly interdependent.
The Health Promoting Model examines the individual’s character and experience, and is ideal in diagnosing weaknesses and defects and providing means for improvement for the individuals in group settings. Its approach is multidimensional in that it goes into the physical, psychological and spiritual realms of the individuals. This model is behavior specific in that it goes into the aspects of the individual’s perceived benefits, perceived barriers, self-efficacy, fosters healthy interpersonal influences, and disciplines commitment to a plan of action. However, it has a limitation in that its process does not make any attempt to study an outcome at the family level. The individual’s family is kept conspicuous by its absence.
The HPM provides for a holistic approach that recognizes the capacity and need of every person to interact personally, mentally and physically with people and environment around her. It has the methodology to create an environment to promote better health behavior and activities. The methods comprise four instruments, viz. Health Promoting Lifestyle Profile II (HPLPII) formulated to measure the individual’s health promoting habits covering health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management; the Self-Rated Abilities for Health Practices (SRAHP) measures health self-efficacy covering physical exercises, psychological well-being, nutrition, and health practices; the Exercise of Self-Care Agency (ESCA) measures self-care agency covering self-concept, initiative, self-responsibility, knowledge and information seeking ability, and passivity; and the demographic questionnaire analyzes activities in relation to the older adults’ practices of healthy behavior, self-efficacy beliefs, and resources for self-care.
Relationship among Concept and Related Concepts
The concept of health promotion model is universal thanks to the various factors such as gymnasiums, health herbs, yoga, body massage, steam bath, botox, and facilities and equipment for home-based exercises such as treadmills, cycles, massage chairs, and so on. The craze for good health, muscular and trim body shape is compounded by feature films and television serials portraying muscular and shapely role characters.
However, concept on the line of Pender’s Health Promotional Model, is distinct in its treatment of health concepts by involving daily activities and habits of its practitioners. It includes the older adult for whom commercial health services may not be suitable because they do not address the exercise regimen holistically enough.
Please refer Annexure I
Any concept that benefits societies and provides individuals with information and facilities that enhance the quality of life must be allowed to filter down to the last household in undiluted form.
With availability of better medical and health care facilities, life span expectancy has improved the world over. This factor is responsible for a larger component of population of the aged, viz. those aged 60 and above. The HPM concept must be allowed to reach out to the general population through every outlet, public hospital, private hospital, medical institutions, para medical units, nursing home, chemist, social clubs, health worker and volunteer.
The sample study is highly complex and varied. Aged individuals come from background of all types, and have experienced situations, achievements, setbacks that have left deep and indelible impressions in their minds that are not likely to change for the rest of their lives. Individual identities, traits, weaknesses, must be observed and treated with respect. Two individuals possessing same traits in one aspect may totally differ in another. The study goes into ethnicity, education, age, social background, habits, health status, disease, disabilities, sickness, and so forth.
In such situation, it is not feasible to depend on group statistics. Further study is required to use statistics that is more individual oriented. This would necessary mean to group the individual’s traits after she has been tested. Simply put, the group must be formed only bring individuals together. For the purpose of statistics, the principles and parameters must be based on the law of averages rather than use of bar and pie charts.
1.Meg Wilson, PhD, RN, Health-Promoting Behaviors of Sheltered Homeless Women, Volume 28, No. 1, pp.51-63.
2.Robitaille Y, American Journal of Public Health, [Am J Public Health], November 2005, Vol. 95(11), pp.2049-56, PMID: 16195514, Section: Research and Practice, Moving Forward In Fall Prevention, An Intervention To Improve Balance Among Older Adults in Real-World Settings.
3.Donna Callaghan, DNSc, APRN, BC, Journal Of Community Health Nursing, 2005, 22(3), 169-178, Copyright 2005, Healthy Behaviors, Self-Efficacy, Self-Care, and Basic Conditioning Factors in Older Adults.
4.Cynthia A. Padula, PhD, RN, CS, and Mary Sullivan, PhD, RN, Journal of Gerontological Nursing, Long-Term Married Couples’ Health Promotion Behaviors.