Community Health Promotion Project.

Posted: November 22nd, 2022

Community Health Promotion Project.

Community health promotion project

Population of interest

The population of interest has been identified as older adults who are 65 years of age or older and residing in South Charlotte, in Charlotte City, Mecklenburg County, North Carolina State. The project area has a population of 233,794 of which 122,399 are females while 11,395 are males. The median age is 38.8 years with the median age of males being 38 years while median age of females is 40 years. Employment data reveals that 47.48% of the population is unemployed while 52.52% are employed.Community Health Promotion Project. Of the employed persons, 5.81% 46.71% hold white collar jobs while 5.81 hold blue collar jobs. 5.85% of the population is self-employed, 39.01% work in the private industry, 3.6% work in the government, and 4.06% work in non-profit organizations. The life expectancy of males is 76 years while the life expectancy of females is 82.5. The infant mortality rate is reported at 7.5%. Approximately 50% of reported deaths are resultant of chronic conditions such as cancer, heart diseases, and stroke(Point2 Homes, 2020).

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The South Carolina community has 91,987 households of which 13.7% are family households while 25.65% are non-family households. Each household has an average of 3 persons. The average annual income for each household is $127,691.81 and median household income is $84,366.00. 7.5% of the population lives in poverty while the remaining 92.5% lives above the poverty level. Age reviews by incomeshows that persons less than 25 years of age have annual median earnings at $38,529, persons between 25 and 44 years of age have annual median earnings at $86,650, persons between 45 and 65 years of age have annual median earnings at $115,833, while persons over 65 years of age have annual median earnings at $58,231(Point2 Homes, 2020). The age dependency ratio for the population is 51.3 with dependency ratio of 15.2 reported for older age (older than 64 years) and dependency ratio of 36.1 reported for children (less than 15 years) (World Population Review, 2020). Older adults have been considered of interest because of their unique risk factors for complications during the post-operative recovery period. Of particular interest to the present project is the potential benefits from optimizing body mass index, A1C management and smoking as risk factors for complications in the post-operative recovery period.

Mortality and morbidity risk factors

Older adults represent a public health burden for South Charlotte community. That is because aging is a leading risk factor for major chronic medical conditions. Approximately 28% of this population are healthy while the remaining 72% have been diagnosed with one or more chronic condition. In fact, 7% have more than three coexisting chronic conditions, 11% have three coexisting chronic conditions, 21% have two coexisting chronic conditions, and 33% have one chronic condition. The most common chronic conditions are myocardial infarction, hypertension, diabetes, arthritis, cataracts, emphysema, chronic bronchitis, cancer, stroke, and congestive heart failure. Other chronic conditions of concern in include nephritis, pneumonia, influenza, cerebrovascular disease, chronic lower respiratory disease, and heart diseases (Liu et al., 2018).Community Health Promotion Project.

The increasingly higher life expectancy of the general population has been partly driven by reduced mortality among older adults. As is true among their younger counterparts, older adults report heart disease as the most common cause of death, with cancer coming second. The five leading causes of death among older adult populations are heart disease (30.4%), cancer (22%), Alzheimer’s disease (3.7%), chronic lower respiratory tract disease (6%), and cerebrovascular disease (7.4%). They account for 69.6% of all reported deaths. There is an exponential increase in heart disease, Alzheimer’s disease, and cerebrovascular disease incidences with Alzheimer’s disease presenting a sleeper increase. However, the mortality rates for lower respiratory tract disease and cancer do not have a steep increase, perhaps because they are mostly reported among smokers who die at younger ages. Also, diabetes rates do not show steep increases because diabetics disproportionately die at younger ages. Still, it is important to note that there have been remarkable declines in mortality rates resultant from chronic diseases, perhaps a reflection of major advances made in treatment and prevention approaches, as well secular trends. Unfortunately, the mortality rate for cancer continues to rise (Pilotto& Martin, 2018).Community Health Promotion Project.

Among older adults, the most common medical condition is hypertension, followed by stroke and coronary heart disease. Chronic joint symptoms and arthritis are also reported among the older adult population, and they have an impact on their overall quality of life and health although they do not appear in the list of most common conditions (Busby-Whitehead et al., 2016). Another unique health feature of older adult populations is the high comorbidity: co-occurrence of multiple chronic medical conditions. It is not uncommon for older adults to report more than one chronic condition. In fact, 39% of older adults report comorbidities. Heart disease remains the leading cause of hospitalization among the population, with congestive heart failure being more common than other heart disease manifestations. Other chronic diseases are also frequent causes of death and hospitalization, but so are the diseases typically not associated with mortality among other populations to include psychosis, chronic bronchitis, osteoarthritis, and fractures. That is because these diseases cause volume depletion and septicemia that is particularly burdensome for older adults experiencing physical declines as they are frail and at high risk of these diseases (Pilotto& Martin, 2018).Community Health Promotion Project.

Dementia is another condition of aging that occurs among older adults and for which incidence and prevalence rates are not readily available because of the complexities of diagnosis. Yet another concern is disability, a consequence of severe medical conditions such as heart disease and stroke on mental and physical functioning with effects on work ability and need for informal and formal care. Limitations present for basic tasks such as grasping, reaching and standing. Although not a measure of disability, these basic tasks represent the building blocks of functioning. Disability remains a powerful marker for predicting adverse outcomes among older adults as they can capture the presence and severity of impact for multiple pathologies to include psychological, cognitive and physical conditions. In effect, disability is a produce of disuse, sedentary lifestyle or the medical condition from which an older adult suffers, and physiological declines resultant from aging. Overall, it is important to note that disability status remains a relevant measure among older adults because it represents overall health status with complex disease patterns, and it has direct implications for health care needs (Kahn, Magauran Jr. &Olshaker, 2014).Community Health Promotion Project.

Although the leading causes of death among older adults are also some of the leading causes of death among other age groups, many of these medical conditions are treatable and preventable. It is important to understand these disease, how to delivery treatment, and how the older adult population can live with them to prolong health and life (Busby-Whitehead et al., 2016).

Health risk factors

Health risk factors refers to the set of circumstances that determine health outcomes through increasing the probability of disease occurrence. The first risk factor for older adults is increased age. As adults age, they become more susceptible to disability and diseases. In fact, aging among older adults is deleterious to their fitness. In addition, aging can evolve into a consequence of the declining force of natural selection attributable to the extrinsic survival hazards whereby aging presents as a side-effect of the accumulation of disease pressures that accumulate over time.Community Health Promotion Project. It presents as an accumulation of multiple forms of pathology and damage to different body systems resulting the integrity of the body maintenance pathways being compromised. To be more precise, there are several conserved mechanisms that are compromised by aging to include repair of damaged body tissues, DNA repair, energy and metabolic homeostasis, mitochondria, and nutrient sensing pathways. As such, as aging can be considered as the accrued effect of the finite number of biological pathways in the body and causes the disease burden of older adults to increase (Busby-Whitehead et al., 2016).

The second risk factor is obesity (BMI > 30). Persons who are obese, compared to their counterparts with health/normal weight, are at higher risk for developing serious health conditions and diseases to include stroke, hypertension and coronary heart disease. Unfortunately, obesity is now common among older adults with incidence at 25%. 27% of females and 24% of males are obese. Although the causes of obesity are multifactorial (to include social, environmental, psychological, physiological, nutritional and genetic causes), the main cause is excessive calories intake matched with limited energy expenditure. Obesity remains a serious risk factor among older adults due to the high prevalence, causal relationships with many disorders and diseases, increased mortality and morbidity, reduced quality of life, and accelerated aging. In fact, obesity has approximately the same association with chronic diseases as does 20 years of aging, greatly exceeding the associations reported for smoking. It increases the relative risk of premature death to 2 among women and 2.58 among males. The implication is that obesity is a health risk factor among older adults(Mattu, Grossman & Carpenter, 2016).Community Health Promotion Project.

The third health risk factor is diabetes. 25% of older adults suffer from diabetes, and aging among them is a significant driver for the medical condition. Among older adults diagnosed with diabetes, they either report the disease as an incident condition that developed in old age or as a long-standing conditions that developed at a young age. The disease has been linked to higher risk of institutionalization, reduced functional status and higher mortality among older adult populations. Also, older adults suffering from diabetes are at higher risk for chronic and acute cardiovascular and microvascularcomplications. However, the heterogeneity of health status of older adults shifts attention away from diabetes as a health risk factor and concern. Still, it is important to note that diabetes increases the risk of other health concerns to include higher rates of amputations of lower extremities, renal disease, visual impairment, and myocardial infarction. Deaths and emergency room visits resultant from diabetes are also significantly higher among older adult populations. Although type 1 diabetes occurs among older adults, type 2 diabetes is more common owing to the combined effects of impaired pancreatic islet functions, decline in islet proliferative capacity, and insulin resistance. These age related concerns are associated with physical inactivity, sarcopenia, and adiposity that are more common among older adults(Mattu, Grossman & Carpenter, 2016).Community Health Promotion Project.

The fourth risk factor is smoking. It increases the risk of developing chronic conditions such as peripheral vascular disease, stroke, coronary heart disease, and chronic obstructive pulmonary disease. These are medical conditions that target older adults to negative affect their social, psychological and physical health. Smoking is also associated with frailty, a condition linked to reduced physiological reserves and increased vulnerability to adverse health outcomes such as institutionalization, hospitalization, disability, fractures and falls. Given that smoking is a modifiable lifestyle factor that increases the risk of chronic conditions, reduced smoking among older adults has a high potential for interrupting the causal pathway (Pilotto& Martin, 2018).Community Health Promotion Project.

Health promotion activity

The health promotion activity for older adults has been identified as targeting obesity, diabetes and smoking as risk factors for adverse post-surgery outcomes among the population of interest. There is an acknowledgement that although heart diseases and reduced functionality are the strongest predictors of adverse outcomes during the post-operative period, obesity, diabetes and smoking are risk factors for these predictors. The health promotion activity anticipates that targeting older adults in South Carolina for health education on how to manage obesity, diabetes and smoking, will improve their awareness and healthy behaviors while helping in improving surgery recovery outcomes for this population. The promotion activity will seek to achieve three main objectives: maintaining and increasing functional capacity; maintaining or improving self-care; and stimulating education of health information that supports independence (Stanhope, 2016).Community Health Promotion Project.

The community under review has been identified as South Charlotte, in Charlotte City, Mecklenburg County, North Carolina State. The community is suffused by old-fashioned southern charm with a unique feel, culinary sophistication and culture. There are numerous green spaces with parks, water accesses, bike lanes transit tramand ample sidewalks. It has a population of 233,794 comprised of 122,399 females and 111,395 males. The median age of the residents is 38.8 years (Point2 Homes, 2020). South Charlotte is comprised of six distinct areas. The first area is Arboretum, located at the intersection of NC Highway 51 and Providence Road (Highway 16) with most buildings constructed in the 1980s and 1990s. The second area is Ballantyne that covers an area of 2,000 acres and located in the southern tip of Mecklenburg County. It was initially farmland and was recently converted into a residential area. The third area is Blakeney located to the south of I-485 and located at Rea and Ardrey Kell Road. It is a 300 acre development that includes upscale home, office parks, apartments, retail shops, and restaurants. The fourth area is Matthews. It was founded in the 1800s as a farming community that produced cotton. It is currently a residential area with 25,000 residents, schools, and enjoys lower taxes. The fifth area is Pineville, a shopping hub that houses major retail outlets. It has 6,500 residents and is located between York County and Charlotte. The sixth area is SouthPark, which occupies a 3,000-acre area. It was initially owned by North Carolina Governor Cameron Morrison but was later transformed into a live/work community (Reimax, 2020). Our community is supported with a broad spectrum of health care services and facilities, including but not limited to two major hospital systems, eight free or low-cost health clinics and a new community hospital and is still expanding resources.Community Health Promotion Project.

It has a population of 233,794 people comprised of 122,399females and 111,395 males. People are living longer, life expectancy in females is 82.5 and Men at 76 years old.  Also,Infant Mortality Rate (Deaths per 1,000 live births) is at 7.5%  with a steady live birthincrease at 7%. In 2016, there were 6,204 deaths reported in the county. Chronic conditions, such as Cancer, Heart Disease and Stroke account for nearly 50% of all deaths. The median age of the residents is 38.8 years with the median age for females being 40 years and median age for males being 38 years. 90.29% of the population are US citizens with the remaining 9.71% being non-citizens. With regards to occupational employment in South Charlotte, 47.48% of the population is unemployed while 52.52% is employed of which 5.81% hold blue collar jobs while 46.71% hold white collar jobs. 5.85% of the population is self-employed, 39.01% are employed by private companies, 3.6% are employed by the government, and 4.06% are employed by not for profit organizations (Point2 Homes, 2020). With regards to the number of households in the community, there are 91,987 households of which 25.65% are non-family households while 13.7% are family households. The average number of persons per household is 3. 30,729 (13.14%) households have children while 61,258 (26.2%) households are without children. A review of annual incomes reveals that the average household income is $127,691.81 with the median household income being $84,366.00. 212,171 people live above the poverty level while 17,499 live below the poverty level. A review of median income by age reveals that persons under 25 years of age earn $38,529, persons between 25 and 44 years of age earn $86,650, persons between 45 and 65 years of age earn $115,833, while persons over 65 years of age earn $58,231 (see figure 1; Point2 Homes, 2020).Community Health Promotion Project.

Number of Live Births by Year,

Figure 1. Graph  of Live Births by Year, Mecklenburg Residents

(Source: NC DHHS, Vital Statistics Data,2020)

Figure 2. Graph of median income per age group in South Charlotte (Source: Point2 Homes, 2020)

A review of the housing in South Charlotte reveals that there are 91.987 occupied housing units, of which 33,587 (14.37%) are renter occupied while 58,400 (24.98%) are owner occupied. 44,430 (19%) housing units have mortgages and 13,970 (5.98%) are without mortgage. The median value of the housing units with mortgage is $348,800.00 while the median value of housing units without mortgage is $295,900.00. The median housing cost per month in South Charlotte is $1,326.00 (Point2 Homes, 2020).

The education statistics for South Charlotte reveal that 1.99% (4,646 persons) of the population do not have high school education, 12.09% (28,261 people) have some high school education, 15.67% (36,631 people) have some college education, 4.98% (11,646 people) have associate degree education, and 28% (65,453 people) have bachelor’s degree education (Point2 Homes, 2020). A review of the marital status in South Charlotte shows that 54.489 (23.31%) of the population have never been married, 105,052 (44.93%) are married, 3,404 (1.46%) are separated, 8,578 (3.67%) are widowed, and 17,017 (7.28%) are divorced (Point2 Homes, 2020).

The most popular means of transport in South Charlotte is cars that are used by 102,886. 1,891 people use trolleys and buses, 474 people use the railroad, 157 people use bicycles, 112 people use motorcycles, 181 people use taxicabs, and 1,317 people walk (Point2 Homes, 2020).

Long known as “The City of Churches,” Charlotte is increasingly also becoming a city of mosques and temples. And English is no longer the only language you’ll hear at worship. Muslims in and around Charlotte pray in Arabic at about a dozen mosques. We have Vietnamese, Chinese and Cambodian Buddhist temples. Also, there is more than 700 churches and denominations.Community Health Promotion Project. Religious statistics for the community reveal that it has historically been Christian Protestant denomination. 52% of the population is religious affiliated. The population is expected to grow because of foreign immigration and return immigration because of the lower cost of living. The population density is approximately 1,100 people per squared kilometer. Population demographics reveal that Whites account for 49.54% of the population, African Americans account for 35.09%, Asians account for 6.54%, Native Americans account for 0.37%, Pacific Islanders (Native Hawaiians) account for 0.06%, and other races account for 8.4% (see Figure 2). Age dependency ratio revealed the ratio of dependents against working population between 15 and 64 years of age. Age dependency for the population is 51.3 dependency ratio for the whole population, 15.2 for old age dependency ratio and 36.1 child dependency ratio. A review of the educational attainments by race reveal that the Whites are most educated (see Figure 3). A review of earnings by educational attainment reveals that males generally earn higher than females for the same level of education (see Figure 4). A review of the language used by the community members reveals that 78.48% speak only English and 12.04% speak Spanish, 4.4% speak Indo-European languages, 3.6% speak Asian and Pacific Island languages, and 1.5% speak other languages (see Figure 5; World Population Review, 2020). Community Health Promotion Project.

Figure 3. South Charlotte population proportions by race

Figure 4. Educational attainment by race/ethnicity

Figure 5. Earnings by educational attainment and gender

Figure 6. Languages used by proportion

The aggregate of interest in the present survey is at risk older patients who are over 65 years of age and who would benefit from optimization of risk factors of increased body max, poor management of diabetic A1C,as well as smoking. The adults age 65 and older (“older adults”) are the fastest growing segment of the United States population, and their number is expected to double to 89 million people between 2010 and 2050. Based on these evolving demographics, it is expected that there will be a concurrent rise in the demand for a variety of surgical services. In fact, its mortality, co-morbidities and prevalence are higher among the elderly than among younger people. Population statistics reveal that 55% of all diabetes cases are reported among this population, with 80% of them reporting the condition at different stages. This is a concern since the elderly only account for 15% of the whole national population. Another concern is that approximately 69% of those with diabetes have been diagnosed and are receiving treatment, while the remaining 31% are yet to be diagnosed not to talk of receiving treatment.Community Health Promotion Project. Also, the factors raise another concern is that unlike their younger counterparts , elderly persons with  are likely to have other comorbidities (such as kidney and heart insufficiencies) that limit the prescription options for managing the condition (Huff, Kline & Peterson, 2015; United Health Foundation, 2020). This makes it clear that this population has a high risk for surgical procedures, perhaps the most alarming health concern among elderly populations with a need to not only ensure that they are diagnosed early on but are also offered the appropriate treatment. In addition, there is a need to offer health promotion and preventive services to preempt the diagnosis and management concerns.  In addition, the three criteria relate to diabetes, weight and smoking interventions that can be applied to the population.

As a nurse, I have always considered it my responsibility and duty to provide the appropriate and required care. I perceive the concept of caring as central to the nursing profession since it implies a true concern for patients with a focus on improving population wellness and health as the central goal. With regards to preoperative optimization among the elderly in South Charlotte, my interest is in improving management for the best care outcomesof all surgery patients. The strategies will be rationalized by tangible scientific evidence that can be verified so that stakeholders are motivated to invest in projects applying the strategies to targeted elderly populations in South Charlotte and other areas. The result will provide the population with resources and tools to prepare for managing diabetes, weight loss and smoking cessation.The needs as witnessed by patient interactions in the clinic support the need for more education on preventive services and practical resources and tools for a higher quality of life.Community Health Promotion Project.

Working with a community-based hospital, orthopedic surgeons and primary care health professionals. The goal of the capstone project is to use evidence and practice-based questions to identify how modifiable risk factors, when optimized improve out comes and decrease costs. The primary preoperative risk factor for poor post-operative outcome in older people is not age, but co-morbidity. Cardiac disease (especially heart failure and arrhythmia) and reduced functional capacity are the strongest predictors of post-operative problems, although pulmonary and neurological conditions are also significant (Dyrda, 2011). These risk factors are potentially modifiable, implying that careful preoperative assessment is the key to preventing adverse post-operative outcomes.

Also, I hope to learn of service gaps, clinical needs, and potential obstacles in elective orthopedic surgery for older adults in Charlotte, NC communities. The processes will be to review, interview and supply data that shows the benefits of optimization. tracking cancellations, emergency room visits, while measuring outcomes of non-optimized patients. In, the community addressing, obesity (BMI >40), diabetesmanagement(A1C >8.0), and smoking cessation within 30 days of surgery. The strategies promotion strategies for the elderly generally have three basic aims: maintaining and increasing functional capacity, maintaining or improving self-care, and stimulating education of health information that supports independence (Stanhope, 2016).Community Health Promotion Project.