Health promotion in long-term care: a contradiction in terms?

While health promotion potentially could play a significant role in improving the health and quality of life of nursing home residents, several major changes must take place if this concept is to hold relevance for the elderly in the long-term care environment. First, interpretations of the concept of health promotion must be broadened to include a focus on macro- as well as micro-level change and on a diversity of target groups including, importantly, policy makers and providers. Second, the "youth bias" inherent in many conventional health promotion efforts must be overcome, so that goals such as decreasing functional dependence in the frail elderly are seen as legitimate and appropriate health promotion foci. Third, viable alternative to nursing home placements must be developed and adequately funded for the many frail elders who would be better served in less intense care environments. And fourth, the dependency producing nature of institutional long-term care must undergo major changes compatible with the goals of promoting individual autonomy and enhancing quality of life. Nutrition, drug use and misuse, mental health, and staff training and retention are four areas examined in a closer look at specific changes needed to create nursing homes amenable to health promotion. Such changes on the institutional level, coupled with a strong national commitment to nursing home reform, are in keeping with Green et al.'s broad definition of health promotion as encompassing a variety of interventions on multiple levels designed to facilitate behavioral changes conducive to health. It is within this larger context that health promotion is seen as holding considerable promise for improving the health and quality of life of the institutionalized elderly.