Education Of Health Protocol Implementation In The New Normal Era To The Elderly

Background: The community and the elderly, in particular, are expected to apply health protocols in the new average era to prevent the transmission of COVID-19. One of the efforts to prevent the transmission of Covid-19 in the elderly is to take promotive and preventive steps, including providing education to the elderly. Methods : The method of implementing community service activities with lectures and questions and answers about health protocols and efforts for healthy elderly, doing physical activity in the form of yoga relaxation exercises, and providing healthy supplementary food for the elderly. The counseling participants were elderly in RW 8, Kebakkalang, Kemiri Village, Kebakkramat District. Results: Counseling activities were carried out during September 2021 with 19 elderly participants. Participants can demonstrate directly the health protocols, such as steps to use hand sanitizer and washing hands. Participants also carry out yoga relaxation exercises for 30 minutes by keeping a distance between the elderly from one another. Conclusion : The results of this community service activity are expected to increase the knowledge of the elderly about preventing the occurrence of Covid-19 infection. The elderly can apply health protocols in every daily activity, improve physical fitness and become healthy and happy elderly.


BACKGROUND
The coronavirus  pandemic has prompted changes in world health and economic and political policies (Indrawati, 2021). Likewise, people's perspectives, attitudes, and behavior will also change. Such as the concept of a healthy living culture, work, school, shopping activities, and others. The Covid-19 pandemic has accelerated changes in habits, including health habits.
If previously people were a bit ignorant of health and neglected to maintain their immune system, this time, people consider this issue necessary and must be prioritized (Morse et al., 2021). Some time ago, the World Health Organization (WHO) issued a protocol for the new normal as long as a vaccine for Corona COVID-19 has not been found. People worldwide are asked to remain productive while carrying out the Covid-19 prevention protocol as long as a vaccine for this infection has not been found (Kemenkes RI, 2020).
The concept of a new life order or a new normal has become a new policy issued by the Government and has begun to be implemented even though it is still in the condition of the Covid-19 pandemic. With the new normal, people will be able to start their activities again, of course, according to the Covid-19 safety and health protocols. In the midst of the new normal facing the corona epidemic pandemic, the most crucial thing is synergy between all elements to work together (Zulbahraini, 2020).
The community needs comprehensive provisions to face the New Normal, including providing direct and accurate information from experts in their respective fields. The Government also regulates New Normal conditions through policies and rules regarding the current situation. Finally, of course, the support and high dedication of health workers who continue to fight at the forefront to help improve public health services (PKM Sungailiat, 2020).
The elderly are one of the groups or populations at risk that are increasing in number. The elderly are synonymous with various declines in health status, especially physical health status. Such conditions are very influential during this COVID-19 pandemic. Older adults are one of the groups that must receive more attention during the COVID-19 pandemic. This is because this group is most vulnerable to the coronavirus that causes Covid-19, especially if they have other diseases such as lungs and heart.
Vulnerability or frailty is one of the health problems that interfere with the elderly from being the ability to live a good quality of life, including during the current COVID-19 pandemic. Therefore, health experts remind those over 60 not to become old even though they experience decreased body function due to aging. The health status of the elderly, which declines with age, will affect their quality of life of the elderly (Jayani et al., 2021).
There is no guarantee that the Covid-19 pandemic will end. Therefore, new Normal life order was introduced. So that later, people can still move and continue their lives with strict health protocols. During the transition to the New Normal as it is today, education about health also needs to be improved, especially for those at risk or the elderly population. Education on maintaining physical and mental health to avoid disease (Pitanga et al., 2020).
Mainly to avoid the transmission of the coronavirus by implementing health protocols. In Indonesia, the Government makes guidelines and health protocols, which are more often called the 5M movement, to help prevent the transmission of the Coronavirus (Son et al., 2021). This community service aims to increase the knowledge and attitudes of the elderly regarding the application of health protocols and efforts for the elderly to be healthy during the Covid-19 pandemic.

LITERATURE
The new normal is a behavior change to continue to carry out everyday activities but with the implementation of health protocols to prevent the transmission of Covid-19. The main principle of the new normal itself is being able to adapt to the pattern of life (Kemenkes RI, 2020).
The new normal is a change in behavior or habits to continue to carry out activities as usual but by consistently implementing health protocols amid the COVID-19 pandemic. This government appeal recommends that we can live "side by side" with a virus that has claimed hundreds of thousands of lives around the world. The new normal is a scenario to accelerate the handling of COVID-19 in health and socioeconomic aspects (Sari & Daryanto, 2021).
As stated by the Head of the Expert Team for the Task Force for the Acceleration of Handling COVID-19, Wiki Adisasmita, the new normal is interpreted as a change in people's behavior to continue carrying out everyday activities. The new normal is also defined as a scenario to accelerate the handling of COVID-19 in health and socio-economic aspects. In the context of Indonesia, the Government announced plans to implement the new ordinary policy by considering the analysis of epidemiological studies and the readiness of each region. The main principle of the new standard plan that will be implemented is the adaptation of new habits with a lifestyle that will lead to the creation of new people's lives and behaviors until a COVID-19 vaccine is found. Furthermore, the new ordinary policy will be accompanied by strict implementation of health protocols.
The Ministry of Health released the New Normal health protocol on Monday, May 25, 2020. This health protocol was released with the Decree of the Minister of Health Number HK.01.07/MENKES/328/2020 concerning Guidelines for the Prevention and Control of Covid-19 in the Office and Industrial Workplace in support of Business continuity in a Pandemic Situation. This new lifestyle in a pandemic condition or the New Normal can be carried out while prioritizing health protocols in daily activities. The health protocols in question are maintaining hand hygiene, using masks when leaving the house, maintaining distance, and maintaining health by eating and exercising. In addition, health protocols also regulate procedures for gathering outside the home, eating in restaurants, and praying (Indrawati, 2021).
The health protocol is a series of rules issued by the Government through the Ministry of Health to regulate the safety of activities during the Covid-19 pandemic. The purpose of implementing health protocols is to help the community to be able to carry out activities safely and not endanger the health conditions of others. The COVID-19 Health Protocols implemented in the new average era are Wearing Masks Correctly, Washing Hands with Soap / Hand Sanitizer, and Keeping a Distance (physical distancing) (Kemenkes RI, 2020).

METHODS
Health education on implementing health protocols in the new average era was carried out from October-November 2021 at the community service instructor's house in Kebakkalang RT 3 RW 8, Kemiri Village, Kebakkramat District, Karanganyar Regency. The participants of the counseling activity were 19 older women, 1 posyandu cadre, and 4 students in the seventh semester of the Occupational Therapy Department. Pre and post-test using health protocol questionnaires.
Elderly participants and posyandu cadres came to the outreach activities by implementing strict health protocols such as wearing masks, maintaining distance, carrying hand sanitizers, and some participants using face shields. The day before, the student had been declared hostile for Covid with an antigen test. The stages in this outreach program are: Firstly, Implementers of community service activities start discussions with elderly posyandu cadres in October 2021. Posyandu cadres propose plans to reactivate the elderly healthy exercise program because the Government has issued a new policy or standard. From the results of the discussion conducted on October 17, 2021, it was found that healthy elderly gymnastics activities will be carried out again in November 2021. However, before the gymnastics activities are conducted, health education is related to the new regular order for the community, especially the elderly.
Second, By using the WhatsApp group, the discussion began at the end of October 2021, and the results were that most of the group members complained that the elderly for whom they were responsible had rarely participated in activities outside the home during the COVID-19 pandemic situation. The activities of the elderly are only sleeping, eating, and watching television at home. When further asked about healthrelated activities, they did not participate in the elderly posyandu for almost 2 years because posyandu activities were also abolished.
They did not do exercise independently at home. As a result, various complaints arise, such as boredom, tiredness, weight gain, excessive fear of COVID-19, and uncomplicated emotions. In the discussion, health cadres and extension workers surveyed whether they agreed to reactivate elderly gymnastics activities and whether all group members agreed to carry out these activities. The instructor distributed questionnaires about the health protocol as a pre-test for community service activities.
Third, In the last week of October 2021, the extension worker posted 3 leaflets entitled Protect the Elderly from Covid-19, Safe Guide from Covid-19 for the Elderly, Let's Protect Yourself and Family from Covid-19 and instruct group members to download, read and practice the information listed in the leaflet.
Fourth, In the first week of November 2021, the extension worker posted a video about the health protocol for washing hands. The video is taken from the youtube channel with the web address https://www.youtube.com/watch?v=HChg7g6oPjE with the title how to wash hands correctly according to WHO and the steps to use hand sanitizer. The instructor asked the group participants to download the video and practice the hand washing steps for family members (children, siblings, husband/wife), especially family members who are elderly.
Fifth, In the second week of November 2021, a direct meeting will be held to implement the health protocol. The counseling activity began with a lecture on the meaning of the new normal, the application of health protocols for the elderly, and a direct demonstration of hand washing activities distributed in the WA group. Then, the instructor directly practiced the implementation of 6 steps of hand washing and the use of hand sanitizer.
Several participants were appointed to demonstrate the activity directly. After the lecture, the 19 elderly were asked to fill out a knowledge questionnaire and apply the health protocol as part of the post-test of community service activities. This activity was assisted by students of the Occupational Therapy Department of the Health Polytechnic of Surakarta. The counseling session was closed with a joint exercise with the theme of relaxation yoga. The instructor uses Android TV to show videos on how to wash hands, use hand sanitizers and do yoga exercises.

RESULTS
Activities that were carried out during October-November 2021 went well. In terms of implementation, the activeness of the WA group participants was seen from the number of responses when the health cadres and extension workers asked questions. Enthusiasm was also seen when several participants admitted that the material distributed in the group had been printed out and pasted on the handwashing area.
During the face-to-face counseling on November 20, 2021, it was seen that the awareness of participants had implemented health protocols by wearing masks, keeping a distance by keeping a distance when sitting and during exercise, washing hands with soap before entering the house where the training was held, using hand sanitizer after filling out the list, present some even use face shield. The documentation of activities can be seen in Figures 1 and 2: counseling activities and yoga exercises for the elderly. At the same time, the extension results can be seen in Figures 3 and  4-questionnaire data on knowledge and application of health protocols in the new average era.
The results of community service activities showed that the results of increasing elderly knowledge about health protocols were seen from changes in the mean pre-test 6.5 and mean post-test 8.4. https://jurnalempathy.com/index.php/jurnalempathy/ | 26  The table above shows that the number of unskilled participants decreased from 73.6% to 2%, while skilled participants experienced an increase from 26.3% to 89.5%.

DISCUSSION
Providing information through health education can have a short-term impact so that it can produce changes and increase knowledge. The movement to implement a health protocol to counsel the elderly aims to promote a healthy living culture and leave unhealthy behavior behind. This is very important for the elderly vulnerable to Covid-19 (Perkasa et al., 2021). Health education for the elderly related to preventing the transmission of the coronavirus aims to provide knowledge to the elderly so that they can be aware of the transmission of Covid-19 (Gangsar et al., 2021).
Health promotion is an activity or effort to convey health information to the public, especially the elderly, so that they can increase their knowledge of the elderly about better health. The more knowledge about healthy elderly, the elderly will be healthy and happy. This manifests that the risk of Covid-10 transmission will be more avoidable and encourage better healthy behavior (Ibrahim, 2017).
The cadres take an active role and provide excellent support before and during the process of implementing community service activities (Sepang & Patandung, 2021). The enthusiasm of the elderly for this activity is the main strength for the smooth running of this counseling. The significant increase in knowledge and skills between before and after counseling and skills training for wearing masks, washing hands, and physical and social distancing shows that this counseling strategy is appropriate to increase public knowledge, including among the elderly. Health education provided to the community is an effort to help improve their ability to achieve optimal health (Jayani et al., 2021). The use of leaflet media can be a means of changing behavior and helping participants to make it easier to remember the information that has been conveyed (Sabarudin et al., 2020). Brochures or leaflets are very popular for conveying information because they can be stored and viewed at any time (Sari & Daryanto, 2021). Relaxation exercises in the form of yoga are beneficial for the elderly to maintain physical activity and health.
However, with the social distancing period in the last 2 years, the elderly have decreased physical activity and increased susceptibility to infection in the elderly (Docherty et al., 2021). Therefore, implementing gymnastics as a form of regular physical activity can be an effective strategy to fight the Covid-19 virus (Maulana & Bawono, 2021).

CONCLUSION & SUGGESTION
Knowledge and skills in implementing health protocols in the new average era for the elderly in RW 8 Kebakkalang, Kemiri Village, Kebakkramat District, Karanganyar Regency increased significantly after being given education and training on health protocols (wearing masks, washing hands, psychological and social distancing. With increased knowledge and skills of the elderly, It is hoped that the elderly will remain healthy and productive during the COVID-19 pandemic. This outreach or community service activity needs to hold regular meetings or online counseling through the WA group. In addition, health cadres can cooperate by sending information about other health protocols.

7.
ACKNOWLEDGEMENT Thank you to the elderly, elderly accompanying families, and health cadres in RW 8 Kebakkalang, Kemiri Village, for their active participation in community service activities in the form of counseling about the application of health protocols in the new average era as well as those who have assisted in the implementation of this activity.