The Older Adult: Implications for Nurse Practitioners Angela Phillips DNP, APRN, FNP-BC

Objectives Define successful aging Identify areas of concern in the elderly population Summarize changes in the elderly patient that relate to medications Provide recommendations for home safety Discuss end of life care

Good news America: We are living longer 13% of US population is 65 years old or older Current life span is 81.2 years for females and 76.4 for males Elderly population is projected to increase to > 83 million by 2050

Leading causes of death in the elderly Heart Disease Cancer Stroke COPD Pneumonia/influenza Diabetes

Successful aging Minimize risk of disease & disability Maintain cognitive & physical functioning Active engagement with life Forgotten factor: – Positive spirituality

Staying Healthy: Reducing risk factors for disease & disability Genetics Lifestyle factors – Environmental – Behavioral

Maximize functional status Predictors of Physical function – Upper & lower extremity, trunk movements – Balance and gait

Maximize functional status Predictors of Cognitive function – Education – Strenuous activity in and around the home – Peak pulmonary flow rate – Self-efficacy

Continuing engagement with life Interpersonal relationships – Lack of isolation Productive activities – Paid work – Volunteer work

Positive spirituality Sense of connectedness Reduce sense of loss of control Reduces stress Increases purpose and meaning of life

Areas of concern ADLs & IADLs Nutrition Pain Psychosocial risks Sleep Smoking & Alcohol use Home safety Elder abuse Medications

Areas of concern ADLs – Dressing, feeding, toileting, ambulation IADLs – Shopping – Cooking, transportation management – Using the telephone, computer – Paying bills, managing finances – Medication management

Areas of concern Nutrition – Serum albumin Pain – Acute vs chronic Psychosocial risks – Frailty – Loneliness

Areas of concern Sleep Smoking and alcohol use

Home Safety 1.5 million adults over age 65 years were treated for injuries Fall assessment – Modifiable and non-modifiable risks Accidents Smoking

Home Safety Encourage: lighting adhesive tape handrails no throw rugs escape plan life line buttons

Elder Abuse Physical abuse Emotional abuse Neglect Exploitation Abandonment

Areas of concern - Medications "Medications are probably the single most important health care technology in preventing illness, disability, and death in the geriatric population." J.Avorn, Health Affairs (2012) "Any symptom in an elderly patient should be considered a drug side effect until proven otherwise." -- J. Gurwitz, et al. Long-Term Care Quality Letter (2014)

Medications: A necessary evil – Crucial aspect of assessment – Polypharmacy – Collaborating with support system – Use of aids – Financial ability – Drug interactions – Updated list of medications

2015 Beers Criteria (BC) Update Updated list of potentially inappropriate medications – Strength and quality of each statement Added new areas of drug interactions 13 member interdisciplinary panel Ability for BC to be more individualized in practice across care settings

Health Promotion and Counseling Screening (cancer screening) -consider life expectancy, time to benefit and patient preference Vision and hearing Exercise Immunizations -pneumovax, influenza, zoster Depression screening Sexual screening

End of life care End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Medicare and Medicaid finance the vast majority of end of life care Disparity in some geographical areas

End of life: 6 principles Patient & family centered care Care is provided on the basis of need Access to needed services Care is evidence-based, safe & effective Care is integrated and coordinated Care is equitable

Patient and family centered care Partners in the provision of health care – Patients – Family members – Care givers Active involvement Goal setting

Care is provided on the basis of need Assessment Individualize needs of patient

Access to needed services Gaps between primary care & specialists Care close to home

Care is evidence-based, safe & effective Use of best available evidence care without experiencing preventable harm Effective partnerships between consumers and healthcare providers

Care is integrated and coordinated Seamless care

Care is equitable Equal access to health care

Health Care Advance Directives Advance Directives – generic term Living Will Durable Power of Attorney for Health Care (Health Care Proxy)

Thank you!