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Running head: REALAGE PAPER

RealAge Health Promotion Paper

Lindsay A. Scholten
Ferris State University

REALAGE PAPER
Abstract
An online RealAge assessment was completed by the client which identified factors making the
client both younger and older than her actual age. Factors including physical and mental health,
relationships, diet, and fitness are discussed in depth. Areas of risk focus identified included
stress, anxiety, and sleep issues. Goals for reducing stress and anxiety, and improving sleep are
set, and interventions are implemented. An evaluation and reflection of the plan identifies
changes necessary for the client to reach her goals.

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Many factors contribute to aging including physical and mental health, lifestyle, habits,
relationships, diet, and fitness level (Sharecare, 2014b). Identifying risk factors detrimental to
health and aging is useful to change behaviors before the onset of disease. Prior to initiating
behavior change, the client must be assessed for readiness to change. The transtheoretical model
of change is used, since it is the best known health behavior stage model (Pender, Murdaugh,
& Parsons, 2015, p. 40). Once a client recognizes potential health issues, a plan can be put in
place to begin the behavior change process. Self-efficacy plays a major role in initiating change
and following through with a health promotion plan. Pender, Murdaugh, and Parsons (2015)
write that when clients believe they can overcome the obstacles, they are more likely to change
the behavior (p. 43). The health promotion model is a valuable tool when creating a plan. It
considers many factors that influence health behaviors, and emphasizes the importance of selfefficacy (Pender, Murdaugh, & Parsons, 2015). While the client is actively working toward
goals, evaluation and reflection are necessary for revision and to ensure continued participation
from the client.
Assessment
The client took the RealAge assessment and the results showed A.Ys RealAge is 28
years, compared to her actual of age 30 years (Sharecare, 2014b). The health factors negatively
impacting the clients age are an increased BMI of 29.7, low HDL cholesterol, lack of sleep, and
anxiety (Sharecare, 2014b). Extra weight increases risks for high blood pressure, increased
lipids, diabetes, and low back pain (Sharecare, 2014b). Her anxiety level and lack of sleep can
lead to heart disease, decreased concentration, and high blood pressure (Sharecare, 2014b). In
addition to the RealAge test, the client took the sleep and anxiety assessments, which further
evaluated her sleep patterns and anxiety level. She benefits from being an ex-smoker and

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regularly protecting her skin from the sun, which decreases her risks for several types of cancer
(Sharecare, 2014b).
The clients feelings negatively affecting her age are high stress levels and ineffective
coping (Sharecare, 2014b). Stress and ineffective coping can interfere with sleep, weaken the
immune system, cause weight gain, and speed up the aging process (Sharecare, 2014b). A.Y.
took the perceived stress scale assessment as well, to identify her feelings related to stress
(Cohen, 1994). Her feelings regarding finances, being married and friendships positively impact
her RealAge (Sharecare, 2014b).
Dietary concerns for A.Y. include not eating enough fruits, vegetables, and whole grains.
She eats breakfast regularly which provides an opportune time to incorporate more whole grains
and fruit (Sharecare, 2014b). Fueling up with the right food in the morning will provide energy
and maintain a stable blood sugar (Sharecare, 2014b). Eating plenty of fruits and vegetables will
lower blood pressure, LDL cholesterol, and risks for heart disease and cancer (Sharecare, 2014b).
The client eats nuts which provide the necessary omega-3 fats and other vitamins (Sharecare,
2014b). She should cut back on red meat, junk food, and add more fish to her diet.
A.Y. spends 455 minutes a week doing cardio and aerobic exercises, and 380 minutes a
week walking (Sharecare, 2014b). Her physical activity is making her heart stronger and
boosting her immune system (Sharecare, 2014b). She does not include enough strength training
into her exercise routine. She gets plenty of daily physical activity, but could improve it by
adding strength training and more intense cardio routines to increase her HDL cholesterol and
lower her BMI (Sharecare, 2014b).
After reviewing all the data, major areas of risk identified are the clients uncontrolled
stress, anxiety, and poor sleep (Sharecare, 2014b). The clients perceived stress scale score was

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26, double the average for her gender and age. On average, women score 13.7 and adults ages
30-44 score 13 (Cohen, 1994). Her high stress level is justified. She has a husband, two young
children, works in the intensive care unit and takes online classes. According to Cohens (1994)
perceived stress scale, the client frequently feels that she is unable to control the important things
in her life. She also feels she has little control over the irritations in her life (Cohen, 1994).
The client does feel like she is generally on top of things, even though she is highly stressed
(Cohen, 1994). The sleep assessment showed the clients sleep schedule is variable, stress is
affecting her sleep, and she has been medically diagnosed with insomnia (Sharecare, 2014c).
According to the transtheoretical model of change the client is in the action stage. She
currently attends counseling for her stress and anxiety, and is actively engaged in behavior
change (Pender, Murdaugh, & Parsons, 2015, p. 41). The Health Promotion Model addresses
the multidimensional nature of persons interacting with their interpersonal and physical
environments as they pursue health (Pender, Murdaugh, & Parsons, 2015, p. 35). The client is
juggling her internal feelings, stress and anxiety, and her physical environments, work, home,
and school. She knows the benefits of managing her stress, but continues to face the stressors
that impede achieving better health. A.Y. is ready to commit to a plan of action to reduce stress
and improve sleep.
Planning & Intervention
Uncontrolled stress and anxiety increases the risks for heart disease and heart attacks
(Sharecare, 2014b). Pender, Murdaugh, and Parsons (2015) list minimizing the frequency of
stress-inducing situations as one way to lower stress. The clients demanding life as a wife,
mother, student, and nurse, make it difficult to reduce her exposure to stress. She enjoys her job,
and is not ready to change departments at this time. According to the clients perceived stress
assessment she frequently feels like she is on top of things (Cohen, 2014). This exhibits a

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positive perception of self-efficacy. According to the Health Promotion Model her high selfefficacy will result in lower perception of barriers and increase her chances of achieving goals
(Pender, Murdaugh, & Parsons, 2015). She can increase her resistance to stress (Pender,
Murdaugh, & Parsons, 2015, p. 188) by promoting healthy behaviors, setting goals, and adopting
effective coping skills (Pender, Murdaugh, & Parsons, 2015).
The client and nurse set a goal to lower the clients perceived stress scale score to 20 or
below after one month of implementing coping methods. To address her stress and anxiety,
effective coping measures were discussed. Interventions to improve coping include continued
counseling, exercise, and journal writing. Exercise improves mental and physical health and
increases ones ability to combat stress (Pender, Murdaugh, & Parsons, 2015, p. 189). Journal
writing and discussing feelings with others are two forms of emotion-focused coping (Stanton &
Low, 2012). Emotional expression through writing can improve health and lessen the subjective
intensity of the feeling (Stanton & Low, 2012, p. 127). It also reduces physical responses to
thoughts or emotions (Stanton & Low, 2012, p. 127) about stressors, which promotes
improvements in perceived stress. Emotional expression is particularly helpful in situations that
are uncontrollable (Stanton & Low, 2012, p. 127) and when used by individuals who experience
intense emotions. A.Y. reports frequently feeling angry because of things that were out of her
control on her perceived stress assessment (Cohen, 1994). The client shows a readiness for
enhanced coping related to the clients current participation in counseling and commitment to
implementing new coping skills (Sparks & Taylor, 2013).
The second goal set by the client and nurse focuses on her sleep patterns. The client will
get at least seven hours of sleep, four nights a week. Currently, she has nights when she only
gets about one to two hours due to stress and anxiety. Getting enough sleep will increase mental

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and physical function, and decrease the risk of heart disease (Sharecare, 2014b). Sleep will help
the client manage her time and stressors better during the day. One intervention to achieve her
goal, is to adhere to a routine bed time every night (Sharecare, 2014b). The client will also spend
15 to 20 minutes before bed to unwind, using meditation and journal writing (Sharecare, 2014).
Studies show that five minutes of breathing through ones nose can help manage chronic stress
and its aging effects (Sharecare, 2014b). Discussing stressors with her spouse is another way to
not only reduce her anxiety and stress, but to hold her accountable to her health promotion plan
(Sharecare, 2014b). Pender, Murdaugh, & Parsons (2015) write that having a partner or support
person lowers psychological distress. The client shows a readiness for enhanced sleep related to
her acknowledgment of the issue, and by her action in taking the RealAge Sleep Health
Assessment (Sparks & Taylor, 2013).
Evaluation & Reflection
The client has been attending counseling, journaling, and doing yoga in efforts to reduce
her stress level (A.Y., personal communication, October 7, 2014). Interventions have been
implemented for one week. She reports that she is feeling better. After a few more weeks of
utilizing effective coping skills, the client will retake the perceived stress assessment to
determine if interventions have been helpful.
A.Y. has also been making progress with her goal to get more sleep. She is now sleeping
around five hours a night, which is a big improvement from her previous one to two hours. (A.Y.,
personal communication, October 7, 2014). Practicing yoga and journaling have also helped
with her sleep. She has sought professional help for her sleep issues, and is on several
medications. The client continues to struggle with anxiety and panic attacks. She depends on
medication and a lot of crying (A.Y. personal communication, October 7, 2014) to get through
those. Moving forward the client would like to focus on reducing panic attacks, and managing

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them with non-medicinal methods. A.Y. has been given feedback and a revised plan of action for
continuing her health promotion plan (see appendix).
For A.Y. to meet her goals, she will continue emotion-focused coping by attending
counseling and journal writing. Stanton and Low (2012) write that coping with a stressor
through emotional expression predicts improvements in life satisfaction and depressive
symptoms for young women (p. 126). To reduce anxiety and prevent panic attacks, slow deep
breathing was recommended when A.Y. begins to feel agitated (Sharecare, 2014a). She can also
use Mindfulness-Based Stress Reduction (MBSR), which requires being aware of ones body,
feelings, and actions (Pender, Murdaugh, & Parsons, 2015). One way for the client to practice
MBSR is by taking walks and listening to the inner chatter of the mind (Pender, Murdaugh, &
Parsons, 2015, p. 192).
The clients behavior change stage has remained action. She is actively pursuing better
health, with an end goal of managing stress, anxiety and improving her sleep. Stress is an
inevitable, unavoidable human experience (Pender, Murdaugh, & Parsons, 2015, p. 178). A.Y.
will never be free from stress, but she can learn how to more effectively cope with it. The
clients response to stress will impact her health in the future (Pender, Murdaugh, & Parsons,
2015). Sleep and coping have a reciprocal relationship. By effectively coping and managing her
stress, she will also reduce her anxiety and improve her sleep. Inversely, improved sleep will
improve her focus and ability to cope.

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References
Cohen, S. (1994). Perceived stress scale. Retrieved from http://www.psy.cmu.edu/~scohen/
Pender, N.J., Murdaugh, C.L. & Parsons, M.A. (2015). Health promotion in nursing practice (7th
ed.). Upper Saddle River, NJ: Pearson.
Sharecare. (2014a.). Anxiety assessment- do you have an anxiety disorder?. Retrieved from
https://www.sharecare.com/assessments/stress-anxiety-health-assessment
Sharecare. (2014b.). RealAge results & grow younger plan. Retrieved from
https://www.sharecare.com/assessments/realagetest/completed?recs=true&cu_rf=t,/login?
origin=http%3A%2F%2Fwww.sharecare.com%2Fassessments%2Frealagetest
%2Fcompleted%3Frecs%3Dtrue%26cu_rf%3Dt
Sharecare. (2014c.) Sleep health assessment. Retrieved from https://www.sharecare.com/
assessments/ sleep-assessment
Sparks, S. & Taylor, C. (2013). Nursing diagnosis reference manual. New York, NY: Lippincott
Williams and Wilkins.
Stanton, A.L. & Low, C.A. (2012). Expressing emotions in stressful contexts: benefits,
moderators, and mechanisms. Current Directions in Psychological Science,21(2), 124128. doi: 10.1177/0963721411434978

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Appendix
Health Promotion Plan Evaluation & Revision for A.Y.
Wellness Diagnosis- Readiness for enhanced coping
Goal # 1- Lower the clients perceived stress scale to 20 or below after one month of
implementing coping methods.
Progress- You have made great progress by attending counseling, journaling and doing yoga!
Keep up those practices. Exercise will improve your mental and physical health and make you
more able to cope effectively (Pender, Murdaugh, & Parsons, 2015). Expressing your emotions
through writing and confiding in others will reduce the intensity of your feelings and ultimately
lower your perceived stress score (Stanton & Low, 2012).
Revision- Continue doing what works for you. If something is not helpful, do not waste your
precious time on it. In 3 weeks retake the perceived stress scale to assess if interventions have
been effective in lowering your score.

Wellness Diagnosis- Readiness for enhanced sleep

Goal # 2- Get at least seven hours of sleep, four nights a week.
Progress- You have come a long way from 1-2 hours of sleep, to 5 hours a night! Seeking
professional help demonstrates that you are aware of and concerned for your own health. You
reported still feeling anxious and having panic attacks.
RevisionTry to set a consistent bed time, and stick to it. Spend time before bed relaxing by journal
writing or meditating. Confide in your spouse, or another support person to unload some of your
burdens.
To combat your anxiety, try deep breathing when you begin to feel agitated (Sharecare, 2014a).
Also try Mindfulness-Based Stress Reduction, be aware of your body, feelings, and actions
(Pender, Murdaugh, & Parsons, 2015). One way to be mindful is taking walks and listening to
the inner chatter of the mind (Pender, Murdaugh, & Parsons, 2015, p. 192).
Personal note: Most importantly, when things become too overwhelming, prioritize and give
something up. Your health is more important than accomplishing your to do list.
Even if something is left undone, everyone must take time to sit still and watch the leaves
turn Elizabeth Lawrence