After many years of health promotion and disease prevention efforts being viewed by most health professionals as suitable only for the young and middle aged, attitudes are beginning to change. The degree to which health promotion is now recognized as relevant for older adults was evident at the Surgeon General's Workshop on Health Promotion and Aging in 1988. There, participants in nine working groups reviewed the state of current practice and research and made farreaching recommendations concerning the need for change in healthcare delivery systems and services, public and professional education, research priorities and strategies, and public policy concerning health promotion and illness prevention with older Americans. The broad scope of health promotion goals seen as appropriate for older adu/ts was reflected in the range of topics that the working groups addressed: alcohol, dental/oral health, physical fitness and exercise, injury prevention, medications, mental health, nutrition, preventive health services, and smoking cessation.
Among the recommendations emanating from the workshop were many concerned with strategies for achieving behavioral change toward more health-enhancing lifestyle patterns and increased use of preventive services among older people. Participants recognized the need for specific research efforts concerning the determinants of behavioral change and the effectiveness of interventions designed to facilitate such change. Nursing's interest and leadership in these areas has been evident in the organization of the National Center for Nursing Research to include a Health Promotion/ Disease Prevention Branch as one of its four major units. It is critical that gerontological nurse researchers take advantage of this and other sources of funding to conduct research that will further develop the knowledge base for health promotion practice with older adults.
It is also essential that gerontological nurses apply the growing knowledge base by incorporating advice and assistance regarding health behavior change into their practice in both community and institutional settings. Gerontological nurses know that older people generally are health-conscious and interested in what they can do to enhance their health and functional ability and to avoid or minimize illness and disability. In talking with older adults, it is clear that to them being healthy means a great deal more than not being sick - it also means being well. They are motivated not only by the fear of being incapacitated and impoverished by catastrophic illness, but also by the desire to remain independent and active, to continue to be productive, and to achieve fulfillment throughout their later years. What many gerontological nurses may not know is how to capitalize on older adults' motivation for health enhancement and illness avoidance.
Although lifestyle behavior change is possible, rewarding, and beneficial for older adults, it is a complex, difficult, and time-consuming process that requires not only motivation but also knowledge, skills, and support. To be able to facilitate such lifestyle change, it is vital that gerontological nurses possess the necessary competencies to serve as educators, counselors, and role models for older clients. Most gerontological nursing texts currently address content concerned with wellness and health promotion in a few pages or a single chapter at most. There is a need to include information about the components and benefits of a healthy lifestyle as well as the processes and methods for facilitating behavior change. Our textbooks and nursing education programs must reflect the growing body of knowledge about health promotion with older adults if gerontological nurses are to assume their legitimate leadership roles in this area within the health-care system.
Multidisciplinary gerontological organizations increasingly are incorporating health promotion focus into their structure and functions. For example, the National Council on the Aging created a Health Promotion Institute in 1990, and the Gerontological Society of America is establishing a Health Promotion Interest Group. Gerontological nurses have the opportunity to participate in and contribute their expertise to the work of these multidisciplinary groups, as well as to influence professional nursing organizations to incorporate activities concerning health promotion and aging into their agendas. As the American Nurses' Association revisits the Social Policy Statement, it will be crucial to ensure that health promotion is clearly and specifically encompassed within the scope of nursing practice.
Funding for preventive and promotive services is another concern, because few are covered by existing public health insurance programs. Although the recent addition to the Medicare program of coverage for mammograms to screen older women for breast cancer is encouraging, it is an isolated service among the many that could be funded. During the last session of Congress, a variety of proposals are being offered to increase access to health care while containing costs. Senator Tom Harkin (D-IA), chairman of the Senate appropriations subcommittee that funds the Department of Health and Human Services, notes that less than 1% of the $700 billion annually spent on health care in the US is devoted to disease prevention and health promotion. He advocates examining all health program proposals for their impact on disease prevention, and supports funding for exercise programs, smoking cessation classes, and other health promotion services for senior citizens.
As legislators consider these and other ways to revamp the nation's inadequate and increasingly expensive health-care system, the voices of gerontological nurses must be heard in favor of providing funding to help older Americans achieve access to better health through promotive and preventive services.
Health promotion and functional enhancement have always been at the core of gerontological nursing. Now more than ever, we are developing the body of knowledge to assist our clients to choose health, to provide them with the tools to achieve wellness, and to help them along the path to enhanced quality of life throughout their later years. Now more than ever, we must provide leadership in advocating funding for health promotion services and in delivering these services within the health-care system and the aging network.