1. Chapter 8: Identifying and Preventing Common Risk Factors in the Elderly

2. Learning Objectives Discuss techniques for assessing and treating factors that lead to functional decline in the elderly. Describe recommended screening evaluations for the elderly population. Cite the expert recommendations for flu and pneumonia vaccines. Identify risk factors and signs of abuse in the elderly. Explain the protocol for reporting elder abuse.

3. Health Promotion and Disease Prevention Guidelines Health promotion can help prevent functional decline in the elderly “functional disability is not caused by aging, but related to unhealthy lifestyle decisions.” U.S. Preventive Services Task Force (USPSTF) –U.S. Public Health Service convened USPSTF to reviews evidence of effectiveness of clinical preventive services. Healthy People 2020 –An initiative of a Federal Interagency workgroup with input from many governmental and private agencies. –Sets of objectives developed by many experts to promote health and quality of life in Americans.

4. Health Promotion…(Cont.) Health promotion activities  Primary prevention Designed to prevent disease from occurring Ex) Immunizations  Secondary prevention Early detection and management of disease Ex) screenings, colonoscopy to detect polyps  Tertiary prevention Manage clinical diseases to prevent them from progressing/avoid complications Ex) rehabilitation,

5. Screening Health screening is a form of secondary prevention USPSTF endorsement –Level A (highly recommended) –Level B (recommended) –Level C (recommended for some) –Level D (not recommended) –Level I (insufficient data for recommendation) The screening tests should be noninvasive and acceptable to patients. Case Study 8-1

6. The Focus of Health Promotion Efforts Healthy People 2020 and the USPSTF suggest the following focus areas for nurses in order to promote health and prevent disability in the elderly client Physical activity Nutrition Tobacco use Health screening Injury prevention Preventive medications and immunizations Caregiver support

7. Self-Management Effective at preventing or delaying disability from chronic diseases The Chronic Disease Self-Management Program (CDSMP) teaches patients to improve symptom management, maintain functional ability, and adhere to their medication regimens: 17 hour course for chronic disease patients at Stanford School of Medicine.

8. Physical Activity Functional decline in the elderly is partly attributable to physical inactivity. 1/3 of adults age 65+ don’t engage in any leisure time physical activity. Older adults should engage in 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise per week. Box 8-1

9. Nutrition Signs of poor nutrition in the elderly –BMI under 19 –Weight gain or loss –albumin < 3.4 g/dL –cholesterol < 160 mg/dL –Hgb <12 g/dL –serum transferrin <180 Mini Nutritional Assessment (MNA) is a tool that can be used by nurses to assess nutritional risk.

10. Nutrition Risks of poor nutrition in the elderly due to –Multiple chronic illnesses –Tooth or mouth problems –Socially isolated –Economic hardship –Multiple medication need assistance with self- care

11. Tobacco Use Cigarette smoking is the leading cause of preventable death in the U.S. Older people benefit as much as younger ones from quitting smoking Quitting smoking can decrease chance of having a myocardial infarction or dying from lung cancer or heart disease Use 5As to help people quit smoking USPSTF-Level A recommendation

12. Tobacco Use (Cont.) - 5 A’s (assess the client’s willingness to quit) –Ask about smoking status at each health care visit –Advise client to quit smoking. –Assess client’s willingness to quit smoking at this time. –Assist client to quit using counseling and pharmacotherapy –Arrange for follow-up within one week of scheduled quit date - 5 R’s (for additional motivation before they are ready to quit) –Relevance: ask the client to think about why quitting –Risks of smoking are identified by the client –Rewards of quitting are identified by the client –Roadblocks or barriers to quitting are identified –Repetition of this process at every clinic visit

13. Safety Falls are the leading cause of unintentional injury death in older adults in the U.S. Full, multifactorial fall risk assessment if –more than one fall –injury requiring medical care –have difficulty with walking/balance

14. Polypharmacy and Medication Errors Older adults comprise 13% of U.S. population, but use about 1/3 of all prescription and OTC drugs Increased numbers of medications carry increased risks Beer’s Criteria for Potentially Inappropriate Medications in Older Adults Screening Tool of Older Persons’ Prescriptions (STOPP) – Box 8-6, p. 235

15. Immunizations Influenza (annual for age 65+) Pneumococcal pneumonia (one time for 65+) Tetanus and Diphtheria (booster every 10 years for all older adults) Herpes zoster (one time for age 60+)

16. Important Screenings Mental Health Alcohol Abuse (p. 245) Elder Abuse and Neglect Heart and Vascular Disease Stroke Thyroid Disease Osteoporosis Vision and Hearing Prostate Cancer Breast Cancer Colorectal Cancer

17. Screening tool for alcohol abuse CAGE questionnaire is a self-report screening instrument: Cut down: attempts by the client to cut down on drinking Annoyance: suggestions by friends or family to cut down on drinking Guilt: client guilt about drinking Eye opener: the need for a drink in the morning to get going

18. Important Screenings (Elder Abuse) Clues to abuse: –The presence of several injuries in different stages of repair –Delays in seeking treatment –Injuries which cannot be explained or that are inconsistent with the history –Contradictory explanations by the caregiver and the patient –Bruises, burns, welts, lacerations, restraint marks

19. Clues to Elder Abuse (cont’d): –Dehydration, malnutrition, decubitus ulcers or poor hygiene –Depression, withdrawal, agitation –Signs of medication misuse –Pattern of missed or cancelled appointments –Frequent changes in healthcare providers –Discharge, bleeding or pain in rectum or vagina or sexually transmitted disease –Missing prosthetic device(s), such as dentures, glasses, hearing aids

20. Guidelines for Elder Abuse treatment (cont’d): –Abuse and neglect should be reported within 48 hours of the time that you become aware of the situation. –Ensure that there is a safety plan and assess safety. –Assess the client’s cognitive, emotional, functional, and health status. –Assess the frequency, severity, and intent of abuse.

21. Summary Screen older patients according to USPSTF guidelines Polypharmacy is the prescription, administration, or use of more medications than are clinically indicated for a patient. Compliance to drug regimens is essential to improving medical diagnosis and outcomes.