Transcript Chapter 8: Medications and lab values

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
“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.
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,
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
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
Injury prevention
Nutrition
Preventive medications
Tobacco use
Health screening
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: 17 hour course for
chronic disease patients at Stanford School
of Medicine.
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
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.
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 selfcare
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
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
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
Thyroid Disease
Alcohol Abuse (p. 245)
Osteoporosis
Elder Abuse and Neglect
Vision and Hearing
Heart and Vascular
Disease
Prostate Cancer
Stroke
Colorectal Cancer
Breast Cancer
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
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
• 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.
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.