Chapter 8: Identifying and Preventing

Common Risk Factors in the Elderly

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.

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.

Health Promotion…(Cont.)• Health promotion activities

Primary preventionDesigned to prevent disease from occurring

Ex) Immunizations Secondary prevention

Early detection and management of diseaseEx) screenings, colonoscopy to detect polyps

Tertiary preventionManage clinical diseases to prevent them

from progressing/avoid complicationsEx) rehabilitation,

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 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

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.

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.

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.

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

Tobacco Use (Cont.)• Tobacco Use

- 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

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

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

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+)

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

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

• 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

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.

QuestionWhich 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 client’s right leg that she says she got from bumping into a table.3. The temperature in the house is 78°F.4. There are only peanut butter and jelly in the refrigerator.