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

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

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Health Promotion and Disease Prevention Guidelines

• Health promotion can help prevent functional
  decline in the elderly
• 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.

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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,

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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)

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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
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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.

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Physical Activity

• Functional decline in the elderly is partly
  attributable to physical inactivity.
• 1/3 of adults age 65 dont 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.

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Nutrition

• Signs of poor nutrition in the elderly
• BMI under 19
• Weight gain or loss
• albumin lt 3.4 g/dL
• cholesterol lt 160 mg/dL
• Hgb lt12 g/dL
• serum transferrin lt180
• Mini Nutritional Assessment (MNA) is a tool that
  can be used by nurses to assess nutritional risk.

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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

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Tobacco Use (Cont.)

• Tobacco Use
• - 5 As (assess the clients willingness to
  quit)
• Ask about smoking status at each health care
  visit
• Advise client to quit smoking.
• Assess clients 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 Rs (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

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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

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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
• Beers Criteria for Potentially Inappropriate
  Medications in Older Adults
• Screening Tool of Older Persons Prescriptions
  (STOPP) Box 8-6, p. 235

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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)

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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
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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

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• Clues to Elder Abuse (contd)
• 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

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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.

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Question

• Which of the following might cause the nurse to
  suspect elder abuse when making a home visit?

1. The client is wrapped in a large wool shawl.
2. There is a bruise on the clients right leg that she says she got from bumping into a table.
3. The temperature in the house is 78F.
4. There are only peanut butter and jelly in the refrigerator.