HEALTH AND ILLNESS Prof. P.

Karthikeyaprasath

Health
 As defined by the World Health Organization (WHO):
State Of Complete Physical, Mental And Social Well-Being, Not Merely The
Absence Of Disease Or Infirmity.
Characteristics
1. A concern for the individual as a total system
2. A view of health that identifies internal and external environment
3. An acknowledgment of the importance of an individual’s role in life
*A dynamic state in which the individual adapts to changes in internal and external
environment to maintain a state of well being
Models of Health and Illness
1. Health-Illness Continuum (Neuman) – Degree of client wellness that exists at any
point in time, ranging from an optimal wellnesscondition, with available energy at its
maximum, to death which represents total energy depletion.

2. High – Level Wellness Model (Halbert Dunn) – It is oriented toward maximizing

the health potential of an individual.This model requires the individual to maintain a
continuum of balance and purposeful direction within the environment.
3. Agent – Host – environment Model (Leavell) – The level of health of an individual
or group depends on the dynamic relationship of the agent, host and environment
 Agent – any internal or external factor that disease or illness.
 Host – the person or persons who may be susceptible to a particular illness or
disease
 Environment – consists of all factors outside of the host

4. Health – Belief Model – Addresses the relationship between a person’s belief and
behaviors. It provides a way of understanding and predicting how clients will behave in
relation to their health and how they will comply with health care therapies.
Four Components
 The individual is perception of susceptibility to an illness
 The individual’s perception of the seriousness of the illness
 The perceived threat of a disease
 The perceived benefits of taking the necessary preventive measures

5. Evolutionary – Based Model – Illness and death serves as a evolutionary function.

Evolutionary viability reflects the extent to which individual’s function to promote
survival and well-being. The model interrelates the following elements:
 Life events
 Life style determinants
 Evolutionary viability within the social context
 Control perceptions
 Viability emotions
 Health outcomes
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
6. Health Promotion Model – A “complimentary counterpart models of health
protection”. Directed at increasing a client’s level of well being. Explain the reason for
client’s participation health-promotion behaviors. The model focuses on three
functions:
 It identifies factors (demographic and socially) enhance or decrease the
participation in health promotion
 It organizes cues into pattern to explain likelihood of a client’s participation health-
promotion behaviors
 It explains the reasons that individuals engage in health activities

Illness
 State in which a person’s physical, emotional, intellectual, social developmental or
spiritual functioning is diminished or impaired. It is a condition characterized by a
deviation from a normal, healthy state.
3 Stages of Illness
1. Stage of Denial – Refusal to acknowledge illness; anxiety, fear, irritability and
aggressiveness.
2. Stage of Acceptance – Turns to professional help for assistance
3. Stage of Recovery (Rehabilitation or Convalescence) – The patient goes
through of resolving loss or impairment of function

Rehabilitation
1. A dynamic, health oriented process that assists individual who is ill or
disabled to achieve his greatest possible level of physical, mental,
spiritual, social and economical functioning.
2. Abilities not disabilities are emphasized.
3. Begins during initial contact with the patient
4. Emphasis is on restoring the patient to independence or regain his pre-
illness/predisability level of function as short a time as possible
5. Patient must be an active participant in the rehabilitation goal setting an
din rehabilitation process.
Focuses of Rehabilitation
1. Coping pattern
2. Functional ability – focuses on self-care: activities of daily living (ADL);
feeding, bathing/hygiene, dressing/grooming, toileting and mobility
3. Mobility
4. Integrity of skin
5. Control of bowel and bladder function
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Illness and Disease

Illness
 Is a personal state in which the person feels unhealthy.
 Illness is a state in which a person’s physical, emotional, intellectual, social,
developmental, or spiritual functioning is diminished or impaired compared with
previous experience.
 Illness is not synonymous with disease.
Disease
 An alteration in body function resulting in reduction of capacities or a shortening of
the normal life span.
Common Causes of Disease
1. Biologic agent – e.g. microorganism
2. Inherited genetic defects – e.g. cleft palate
3. Developmental defects – e.g. imperforate anus
4. Physical agents – e.g. radiation, hot and cold substances, ultraviolet rays
5. Chemical agents – e.g. lead, asbestos, carbon monoxide
6. Tissue response to irritations/injury – e.g. inflammation, fever
7. Faulty chemical/metabolic process – e.g. inadequate insulin in diabetes
8. Emotional/physical reaction to stress – e.g. fear, anxiety

Stages of Illness
1. Symptoms Experience– experience some symptoms, person believes something is
wrong 3 aspects –physical, cognitive, emotional
2. Assumption of Sick Role – acceptance of illness, seeks advice
3. Medical Care Contact– Seeks advice to professionals for validation of real illness,
explanation of symptoms, reassurance or predict of outcome
4. Dependent Patient Role
 The person becomes a client dependent on the health professional for help.
 Accepts/rejects health professional’s suggestions.
 Becomes more passive and accepting.
5. Recovery/Rehabilitation – Gives up the sick role and returns to former roles and
functions.

Risk Factors of a Disease

1. Genetic and Physiological Factors
 For example, a person with a family history of diabetes mellitus, is at risk in
developing the disease later in life.
2. Age
 Age increases and decreases susceptibility ( risk of heart diseases increases
with age for both sexes
3. Environment
 The physical environment in which a person works or lives can increase the
likelihood that certain illnesses will occur.
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
4. Lifestyle
 Lifestyle practices and behaviors can also have positive or negative effects on
health.

Classification of Diseases
1. According to Etiologic Factors
a. Hereditary – due to defect in the genes of one or other parent which is transmitted
to the offspring
b. Congenital – due to a defect in the development, hereditary factors, or prenatal
infection
c. Metabolic – due to disturbances or abnormality in the intricate processes of
metabolism.
d. Deficiency – results from inadequate intake or absorption of essential dietary
factor.
e. Traumatic– due to injury
f. Allergic – due to abnormal response of the body to chemical and protein
substances or to physical stimuli.
g. Neoplastic – due to abnormal or uncontrolled growth of cell.
h. Idiopathic –Cause is unknown; self-originated; of spontaneous origin
i. Degenerative –Results from the degenerative changes that occur in the tissue and
organs.
j. Latrogenic – result from the treatment of the disease

2. According to Duration or Onset

 Acute Illness – An acute illness usually has a short duration and is severe. Signs
and symptoms appear abruptly, intense and often subside after a relatively short
period.
 Chronic Illness – chronic illness usually longer than 6 months, and can also affects
functioning in any dimension. The client may fluctuate between maximal
functioning and serious relapses and may be life threatening. Is characterized by
remission and exacerbation.
 Remission– periods during which the disease is controlled and symptoms are
not obvious.
 Exacerbations – The disease becomes more active given again at a future time,
with recurrence of pronounced symptoms.
 Sub-Acute – Symptoms are pronounced but more prolonged than the acute
disease.

3. Disease may also be Described as:

a. Organic – results from changes in the normal structure, from recognizable

anatomical changes in an organ or tissue of the body.
b. Functional – no anatomical changes are observed to account from the symptoms
present, may result from abnormal response to stimuli.
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
c. Occupational – Results from factors associated with the occupation engage in by
the patient.
d. Venereal – usually acquired through sexual relation
e. Familial – occurs in several individuals of the same family
f. Epidemic – attacks a large number of individuals in the community at the same
time. (E.g. SARS)
g. Endemic – Presents more or less continuously or recurs in a community. (E.g.
malaria, goiter)
h. Pandemic –An epidemic which is extremely widespread involving an entire
country or continent.
i. Sporadic – a disease in which only occasional cases occur. (E.g. dengue,
leptospirosis)

Health and Wellness

Wellness is more than being free from illness, it is a dynamic process of change and
growth. “…a state of complete physical, mental, and social well-being, and not merely
the absence of disease or infirmity.” – The World Health Organization.

Definition
Health
 Presence or absence of disease
 Complete physical, mental, social well-being
 Ability to maintain normal roles
 Process of adaptation to physical and social environment
 Striving toward optimal wellness
 Individual definitions
Wellness
 State of well-being
Basic aspects include:
 Self-responsibility
 An ultimate goal
 A dynamic, growing process
 Daily decision-making in areas related to health
 Whole being of the individual
Well-being
 Subjective perception of vitality and feeling well
 Described objectively, experienced, measured
 Can be plotted on a continuum
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Dimensions of Wellness

Physical Dimension
 Ability to carry out daily tasks
 Achieve fitness
 Maintain nutrition
 Avoid abuses
Social Dimension
 Interact successfully
 Develop and maintain intimacy
 Develop respect and tolerance for
others
Emotional Dimension
 Ability to manage stress
 Ability to express emotion
Intellectual Dimension
 Ability to learn
 Ability to use information
effectively
Spiritual Dimension
 Belief in some force that serves to unite
Occupational Dimension
 Ability to achieve balance between work and leisure
Environmental Dimension
 Ability to promote health measure that improves
 Standard of living
 Quality of life

Models of Health
 Medical Model
 Agent-Host-Environment Model
 Health-Illness Continuum
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Medical Model
 Provides the narrowest interpretation of health
 People viewed as physiologic systems
 Health identified by the absence of signs and symptoms of disease or
injury
 State of not being “sick”
 Opposite of health is disease or injury

Agent-Host-Environment Model
 Each factor constantly interacts with the others
 When in balance, health is maintained
 When not in balance, disease occurs

 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Travi’s Health-Illness Continuum

 Measure person’s perceived level of wellness
 Health and illness/disease opposite ends of a health continuum
 Move back and forth within this continuum day by day
 Wide ranges of health or illness

Ardell’s Wellness Model- 5 Dimensions of Wellness

Nutritional Awareness
 Making healthy food choices on a regular basis.
Physical Fitness
 Regular exercise program.
Stress Management
Determining the stress factors in one’s life is one thing, but doing something about it is
another thing you could do to manage their stress levels
 Meditation
 positive visualization
 taking time out
 listening to music
 journal writing
 regular physical activity are all
Environmental Sensitivity
 Living lightly on the earth, helping in anyway you can to keep the planet healthy is
important as personal wellness depends on planetary wellness.
Self- Responsibility
 Ardell says, all dimensions of wellness are important, but self-responsibility seems
more equal than all the rest. Personal accountability for our own lifestyle is of
utmost importance

Bellin’s Model for Competency Improvement

 Bellin’s Health System, focus is health care delivery system
 is based upon the belief that outcomes are the results of processes that can be
improved through:
 Identification of success metrics,
 Setting of goals and the Plan Do Study Act (PDSA) change process.
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

 Statistical process control charts are used to track identified processes for stability
and response to improvement efforts. Measurement is focused on:
 Growth
 Effectiveness
 Efficiency
 Engagement
 Innovation
Iceberg Model
 The Iceberg Model shows us that our state of physical health or illness is only the

visible “tip” of the iceberg.

 In order to completely understand our physical condition, we need to look beneath
the surface to our
 Choices of lifestyle (our eating habits, exercise level, addictions to alcohol, food,
adrenaline, shopping, drugs, etc),
 Psychological beliefs (the thoughts, feelings, attitudes and beliefs we hold)
 Spirituality (our inner life, our belief in a higher power and our degree of
acceptance and love of self and others).

Factors Affecting Health Status, Beliefs, and Practices

Internal Variables
 Biologic dimension (genetic makeup, gender, age, and developmental
level)
 Psychologic dimension (mind-body interactions and self-concept)
 Cognitive dimension (intellectual factors include lifestyle choices and
spiritual and religious beliefs)
External Variables
 Physical environment
 Standards of living
 Family and cultural beliefs
 Social support networks
Factors Affecting Health Care Adherence
 Client motivation
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
 Degree of lifestyle change necessary
 Perceived severity of problem
 Value placed on reducing the threat of illness
 Difficulty in understanding and performing specific behaviors
 Degree of inconvenience of the illness itself or of the regimens
 Complexity, side effects, and duration of the proposed therapy
 Specific cultural heritage that may make adherence difficult
 Degree of satisfaction and quality and type of relationship with the
health care providers
 Overall cost of prescribed therapy
Illness
 A highly personal state
 Person’s physical, emotional, intellectual, social, developmental, or
spiritual functioning is diminished
 Not synonymous with disease
 May or may not be related to disease
 Only person can say he or she is ill
Disease
 Alteration in body function
 A reduction of capacities or a shortening of the normal life span
Acute Illness
 Characterized by severe symptoms of relatively short duration
 Symptoms often appear abruptly, subside quickly
 May or may not require intervention by health care professionals
 Most people return to normal level of wellness

Chronic Illness
 Lasts for an extended period
 Usually has a slow onset
 Often have periods of remissions and exacerbations
 Care includes promoting independence, sense of control, and wellness
 Learn how to live with physical limitations and discomfort
Parson’s Four Aspects of the Sick Role
 Clients are not held responsible for their condition
 Clients are not excused from certain social roles and tasks
 Clients are obligated to try to get well as quickly as possible
 Clients or their families are obligated to seek competent help
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Schuman’s Stages of Illness

Stage 1: Symptom experience
 Believe something is wrong
Stage 2: Assumption of the sick role
 Accepts the sick role and seeks confirmation
Stage 3: Medical care contact
 Seeks advice of a health professional
Stage 4: Dependent client role
 Becomes dependent on the professional for help
Stage 5: Recovery or rehabilitation
 Relinquish the dependent role – Resume former roles and
responsibilities

Impact of Illness on the Client

 Behavioral and emotional changes
 Loss of autonomy
 Self-concept and body image changes
 Lifestyle changes On the Family
 Depends on:
 Member of the family who is ill
 Seriousness and length of the illness
 Cultural and social customs the family follows
Impact of Illness: Family Changes
 Role changes
 Task reassignments
 Increased demands on time
 Anxiety about outcomes
 Conflict about unaccustomed responsibilities
 Financial problems
 Loneliness as a result of separation and pending loss
 Change in social customs
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Health Promotion Guidelines Across Lifespan

Intra-uterine
Oxygen
 To meet the fetal demands for oxygen, the pregnant mother gradually
increases her normal blood flow by about one-third, peaking at about 8
months.
 Respiratory rate and cardiac output increase significantly during this
period.
 Feta circulation travels from the placenta through umbilical arteries,
which caries deoxygenated blood away from the fetus.
Nutrition and Fluids
 The fetus obtains nourishment from the placental circulation and by
swallowing amniotic fluid.
 Nutritional needs are met when the mother eats a well-balanced diet
containing sufficient calories and nutrients to meet both her needs and
those of the fetus.
 Adequate folic acid, one of the B vitamins, is important in order to prevent
neural tube defects
 Folic rich foods are green leafy vegetables, oranges, dried beans and
suggest she take a vitamin supplement that contain folic acid.
Rest and Activity
 The fetus sleeps most of the time and develops a pattern of sleep and
wakefulness that usually persist after birth.
 Fetal activity can be felt by the mother at about the fifth lunar month of
pregnancy
Elimination
 Fetal feces are formed in the intestines from swallowed amniotic fluid
throughout the pregnancy, but are normally not excreted until after birth.
 Urine normally is excreted into the amniotic fluid when the kidneys
mature (16 to 20 weeks).
Temperature Maintenance
 Amniotic fluid usually provides a safe and comfortable temperature for
the fetus.
 Significant changes in the maternal temperature can alter the
temperature of the amniotic fluid and the fetus.
 Significant alter in temperature increases due to illness, hot whirlpool
baths, or saunas may result in birth defects.
 In the last weeks of gestation, the fetus develops subcutaneous fatty tissue
stores that will help maintain body temperature at birth.
Safety
 The body systems form during the embryonic period. As a result, the
embryo is particularly vulnerable to damage from teratogen, which is
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
anything that adversely affects normal cellular development in the
embryo or fetus.
 It is important for the nurse to inquire about possible pregnancy when
giving medications that are known teratogens and also ask when the
woman is scheduled for tests that involve radiography (x-ray).
 Smoking, alcohol, and drugs can affect the environment for the fetus.
Smoking has been associated with preterm labor, spontaneous abortion,
low-birth weight infants, and sudden infant death syndrome and learning
disorders.
 Fetal alcohol syndrome (FAS), a result of impaired mitochondrial
development, leads to microcephaly, mental retardation, learning
disorders, and other central nervous system defects.

Infants
Health Examinations
 Screening of newborns for hearing loss; follow-up at 3 months and early
intervention by 6 months if appropriate
 At 2 weeks and at 2,4,6, and 12 months
Protective Measures
 Immunizations: diptheria,tetanus, acellular pertussis (DTaP), inactivated
poliovirus vaccine (IVP), pneumococcal, measles-mumps-rubella (MMR),
Haemophilus influenzae type B (HIB), hepatitis B (HepB), varicella and
influenza vaccines as recommended
 Fluoride supplements if there is adequate water fluoridation (less than
0.7 part per million)
 Screening for tuberculosis
 Screening for phenylketonuria (PKU) and other metabolic conditions
 Prompt attention for illnesses
 Appropriate skin hygiene and clothing
Infant Safety
 Importance of supervision
 Car seat, crib, playpen, bath, and home environment safety ,measures
 Feeding measures (e.g., avoid propping bottle)
 Provide toys with no small parts or sharp edges
 Eliminate toxins in the environment (e.g., chemicals, radon, lead,
mercury)
 Use smoke and carbon monoxide (CO) detectors in home
Nutrition
 Breast-feeding to age 12 months
 Breast-feeding and bottle feeding techniques
 Formula preparation
 Feeding schedule
 Introduction of solid foods
 Need for iron supplements at 4 to 6 months
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Elimination
 Characteristics and frequency of stool and urine elimination
 Diarrhea and its effects
Rest/ Sleep
 Establish routine for sleep and rest patterns
Sensory Stimulation
 Touch: holding, cuddling, rocking
 Vision: colorful, moving toys
 Hearing: soothing voice tones, music, singing
 Play: toys appropriate for development

Toddlers
Health Examinations
 At 15 and 18 months and then as recommended by the primary care
provider
 Dental visit starting at age of 3 or earlier
Protective Measures
 Immunizations: continuing DTaP, IPV series, pneumococcal, MMR,
Haemophilus influenzae type B, hepatitis, hepatitis A, and influenza
vaccines as recommended
 Screenings for tuberculosis and lead poisoning
 Fluoride supplements if there is inadequate water fluoridation (less than
0.7 part per million)
Toddler Safety
 Importance of constant supervision and teaching child to obey commands
 Home environment safety measures (e.g., lock medicine cabinet)
 Outdoor safety measures (e.g., close supervision near water)
 Appropriate toys
 Eliminate toxins in environment (e.g., pesticides, herbicides, mercury,
lead, arsenic in playground materials)
 Use smoke and carbon monoxide (CO) detectors in home
Nutrition
 Importance of nutritious meals and snacks
 Teaching simple mealtime manners
 Dental care
Elimination
 Toilet training techniques
Rest/Sleep
 Dealing with sleep disturbances
Play
 Providing adequate space and variety of activities
 Toys that allow “acting on” behaviors and provide motor and sensory
stimulation
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Preschoolers
Health Examinations
 Every 1 to 2 years
Protective Measures
 Immunizations: continuing DTaP, IPV series, MMR, hepatitis,
pneumococcal, influenza, and other immunizations as recommended
 Screenings for tuberculosis
 Vision and hearing screening
 Regular dental screenings and fluoride treatment
Preschooler Safety
 Educating child about simple safety rules (e.g., crossing the street)
 Teaching child to play safely (e.g., bicycle and playground safety)
 Educating to prevent poisoning; exposure to toxic materials
Nutrition
 Importance of nutritious meals and snacks
Elimination
 Teaching proper hygiene (e.g., washing hands after using bathroom)
Rest/ Sleep
 Dealing with sleep disturbances (e.g., night terrors, sleepwalking)
Play
 Providing times for group play activities
 Teaching child simple games that require cooperation and interaction
 Providing toys and dress-ups for role-playing

School-Age Children
Health Examinations
 Annual physical examination or as recommended
Protective Measures
 Immunizations as recommended (e.g., MMR, meningococcal, tetanus-
diphtheria, adult preparation [Td])
 Screening for tuberculosis
 Periodic vision, speech, and hearing screenings
 Regular dental screenings and fluoride treatment
 Providing accurate information about sexual issues (e.g., reproduction,
AIDS)
School-Age Child Safety
 Using proper equipment when participating in sports and other physical
activities (e.g., helmets, pads)
 Encouraging child to take responsibility for own safety (e.g., participating
in bicycle and water safety courses)
Nutrition
 Importance of child not skipping meals and eating balance diet
 Experiences with food that may lead to obesity
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Elimination
 Utilizing positive approaches for elimination problems (e.g., enuresis)
Play and Social Interactions
 Providing opportunities for a variety of organized group activities
 Accepting realistic expectations of child’s abilities
 Acting as role models in acceptance of other persons who may be
different
 Providing a home environment that limits TV viewing and video games
and encourages completion of homework and healthy exercise

Adolescents
Health Examinations
 As recommended by the primary care provider
Protective Measures
 Immunizations as recommended, such as adult tetanus –diphtheria
vaccine, MMR, pneumococcal, and hepatitis B vaccine
 Screening for tuberculosis
 Periodic vision and hearing screenings
 Regular dental assessments
 Obtaining and providing accurate information about sexual issues
Adolescent Safety
 Adolescent’s taking responsibility for using motor vehicles safely (e.g.,
completing a driver’s education course, wearing seat belt and helmet)
 Making certain that proper precautions are taken during all athletic
activities (e.g., medical supervision, proper equipment)
 Parent’s keeping lines of communication open and being alert to signs of
substance abuse and emotional disturbances in the adolescent
Nutrition and Exercise
 Importance of healthy snacks and appropriate patterns of food intake and
exercise
 Factors that may lead to nutritional problems (e.g., obesity , anorexia
nervosa, bulimia)
 Balancing sedentary activities with regular exercise
Social Interactions
 Encouraging and facilitating adolescent success in school
 Encouraging adolescent to establish relationships that promote
discussion of feelings, concerns, and fears.
 Parents’ encouraging adolescent peer group activities that promote
appropriate moral and spiritual values
 Parents’ acting as role models for appropriate social interactions
 Parents’ providing a comfortable home environment for appropriate
adolescent peer group activities
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
 Parents’ expecting adolescents to participate in and contribute to family
activities
Young Adults
Health Test and Screenings
 Routine physical examination (every 1 to 3 years for females; every 5
years for males)
 Immunizations as recommended, such as tetanus-diphtheria boosters
every 0 years, meningococcal vaccine if not given in early adolescence,
and hepatitis B vaccine
 Regular dental assessments (every 6 months)
 Periodic vision and hearing screenings
 Professional breast examination every 1 to 3 years
 Papanicolaou smear annually within 3 years of onset of sexual activity
 Testicular examination every year
 Screening for cardiovascular disease (e.g., cholesterol test every 5 years if
results are normal; blood pressure to detect hypertension; baseline
electrocardiogram at age 35)
 Tuberculosis skin test every 2 years
 Smoking: history and counseling if needed
Safety
 Motor vehicle safety reinforcement (e.g., using designated drivers when
drinking, maintaining brakes and tires)
 Sun protection measures
 Workplace safety measures
 Water safety reinforcement (e.g., no diving in shallow water)
Nutrition and Exercise
 Importance of adequate iron intake in diet
 Nutritional and exercise factors that may lead to cardiovascular disease
(e.g., obesity, cholesterol, and fat intake, lack of vigorous exercise)
Social Interactions
 Encouraging personal relationship that promote discussion of feelings,
concerns, and fears
 Setting short-and long- term goals for work and career choices

Middle-Aged Adults
Health Test and Screening
 Physical examination (every 3 to 5 years until age 40, then annually)
 Immunizations as recommended, such as a tetanus booster every 10
years, and current recommendations for influenza vaccine.
 Regular dental assessments (e.g., every 6 months)
 Tonometry for signs of glaucoma and other eye diseases every 2 to 3
years or annually if indicated
 Breast examination annually by primary care provider
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath
 Testicular examination annually by primary care provider
 Screenings for cardiovascular disease (e.g., blood pressure measurement;
electrocardiogram and cholesterol test as directed by the primary care
provider)
 Screenings for colorectal, breast, cervical, uterine, and prostate cancer
 Screening for tuberculosis every 2 years
 Smoking: history and counseling, if needed
Safety
 Motor vehicle safety reinforcement, especially when driving at night
 Workplace safety measures
 Home safety measures: keeping hallways and stairways lighted and
uncluttered, using smoke detector, using nonskid mats and handrails in
the bathrooms
Nutrition and Exercise
 Importance of adequate protein, calcium, and vitamin D in diet
 Nutritional and exercise factors that may lead to cardiovascular disease
(e.g., obesity, cholesterol and fat intake, lack of vigorous exercise)
 An exercise program that emphasizes skill and coordination
Social Interactions
 The possibility of a middle crisis: encourage discussion of feelings,
concerns, and fears
 Providing time to expand and review previous interests
 Retirement planning (financial and possible diversional activities), with
partner if appropriate
Elders
Health Test and Screening
 Total cholesterol and high density lipid protein measurement every 3 to 5
years until age 75, Aspirin, 81 mg daily, if in high- risk group
 Diabetes mellitus screen every 3 years, if in high-risk group
 Smoking cessation, Screening mammogram every 1 to 2 years (women)
 Clinical breast exam annually (women), Pap smear annually if there is a
history of abnormal smears or previous hysterectomy of malignancy
 Older women who have regular, normal Pap smear or hysterectomy for
nonmalignant causes do NOT need Pap smear beyond the age of 65
 Annual digital rectal exam, Annual prostate-specific antigen (PSA)
 Annual fecal occult blood test (FOBT)
 Sigmoidoscopy every 5 years; colonoscopy every 10 years
 Visual acuity screen annually, Hearing screen annually
 Depression screen periodically, Family violence screen periodically
 Height and weight measurements annually
 Sexually transmitted disease testing, if high- risk group
 Annual flu vaccine if over 65 or in high-risk group,Pneumococcal vaccine
at 65 and every 10 years thereafter,Td vaccine every 10 years
 HEALTH AND ILLNESS Prof. P. Karthikeyaprasath

Safety
 Home safety measures to prevent falls, fire, burns, scalds, and
electrocution
 Working smoke detectors and carbon monoxide detectors in the home
 Motor vehicle safety reinforcement, especially when driving at night
 Elder driver skills evaluation (some states require for license renewal)
 Precautions to prevent pedestrian accidents
Nutrition and Exercise
 Importance of a well-balanced diet with fewer calories to accommodate
lower metabolic rate and decreased physical activity
 Importance of sufficient amounts of vitamin D and calcium to prevent
osteoporosis
 Nutritional and exercise factors that may lead to cardiovascular disease
(e.g., obesity, cholesterol and fat intake, lack of exercise)
 Importance of 30 minutes of moderate physical activity daily; 20 minutes
of vigorous physical activity 3 times per week
Elimination
 Importance of adequate roughage in the diet, adequate exercise, and at
least six 8-once glasses of fluid daily to prevent constipation
Social Interaction
 Encouraging intellectual and recreational pursuits
 Encouraging personal relationships that promote discussion of feelings,
concerns, and fears
 Assessment of risk factors for maltreatment, Availability of social
community centers and programs for seniors