prevention Flashcards
health status of older adult composed of:
number of chronic diseases
Underlying physiologic changes in aging
Susceptibility to acute illness and injuries
what are some dz’s that are major causes of mortality?
Heart disease cancers (esp. lung, colorectal, breast) lung disease cerebrovascular disease/stroke pneumona and influenza
what percentage of older adults have HTN?
40%
How many older adults have survived an MI or other heart problems?
1/3 have heart dz
what percentage of older adults have difficulty w/their everyday activities of daily living (ADL’s)
40%
what percentage o disability with ADL’s occur chronically/progressively? catastrophically (ie. hip fx)?
50%
50%
what are some precursors to disability?
difficult walking
cognitive impairment
visual impairment: affect ADL’s (taking meds) and walking
how do we modify the consequences of disease?
health habits screening: high risk for dz immunizations: decrease risk access to health care education: manage their own dz's community services: support
what is primary prevention?
intervention to prevent disease or injury occurrence
what is secondary prevention?
intervention for those with early condition to prevent progression into complications
what is tertiary prevention?
efforts to improve care to avoid later complications
Can involve rehabilitation to optimize function
what is a major health outcome of chronic disease?
disability
benefit of prevention dependent on what 2 factors?
Prevalence of the problem
Likelihood of an effective intervention
in the older adult, how does prevention differ?
Target is typically prevention of syndromes such as falls, dizziness, and functional decline
what is iatrogenic disease and is it a problem for older adults?
= illness caused by medical examination or treatment
YES
what are some examples of primary prevention?
vaccines BP monitoring smoking cessation exercise cholesterol NA restriction seat belts social support home environment eval med review
what are some examples of secondary prevention?
mammography FOB, colonoscopy hypothyroidism vison oral cavity TB skin care: hygiene/growths
what are some examples of tertiary prevention?
proactive primary care comprehensive geriatric assessment foot care denal care toileting efforts rehab/exercise dietary protein
what are the most feared outcomes of disability
loss of independence
recommendations from ACP and ASIM?
broad screening:
IADL/ADL, cognitive, health status eval
for pt’s who at risk for becoming disabled or losing independence to identify where the prob. might exist
recommendations from USPTF?
welcome to medicare visit
“periodic” screening in pt’s who are asxs w/out dz
persons 65+ y/o: screen, counsel, immunize
what is included in a medicare visit?
eval med/fam hx, current health conditions, rx’s
check BP, vision, wt., ht for baseline care
pt’s status w/preventive screenings, immunizations
order tests depending on pt’s general health/medical hx
give checklist w/medicare-covered screenings and preventive services they need
what is included in an annual wellness visit?
complete health risk assess
review list of providers
fam/med hx
depression, functional changes, safety
ht., wt. BMI, BP, cognitive status
written screening schedule
provide pt. education/refer
what are things you need to include in your visit in order to provide effective preventative care for older adults?
immunizations
cancer screenings
screening for identification of psychosocial problems
screening for cognitive impairment
A pt can achieve increased balance, stamina, Cardiovasc condition, strength, osteoporosis prevention, fall prevention through….
regular physical activity for a total of 150 mins (mod-intensity) weekly
what suggests poor nutrition?
low body mass index or unintentional weight loss of >10lbs in 6 mo’s
calorie needs ____ w/age, and nutritional requirements _____?
decline
remain the same
what tool can help you assess nutritional status?
MNA = mini nutritional assessment
what are ways to prevent osteoporosis and degenerative joint dz (DJD)?
pharmacologic, exercise, diet
walking: modest incr in skeletal load and limited benefit
strength training: effective for improving/maintaining bone mass
what factors influence prevention of disability?
genetics, health status, comorbidities, mood, cognition, and beliefs
what is the most preventable problem in the older adult?
iatrogenic prob’s
what are some iatrogenic problems in older adults?
underdiagnosis bed rest polypharmacy environment hazards transfer trauma delirium fluid overload, dehydration overuse of abx
what are some special risks of hospitals for older adults?
diminished reserves in cognitive, renal, and hepatic function
how can elective surgery result in sepsis and death?
postop oversedation with pain meds –> decline in respiratory function w/ need for mechanical ventilation –> ventilator-assoc. pna –> sepsis and death
how can hospital admission for pna or CHF lead to deconditioning, delirium, and sepsis?
lead to immobility –> UTI (catheter for monitoring UO) –> deconditioning, delirium, and sepsis
what are potential complications of bed rest?
Pressure ulcers Bone resorption Hypercalcemia Postural hypotension Atelectasis and pna constipation contractures depression/anxiety
what are potential complications of bed rest?
Pressure ulcers Bone resorption Hypercalcemia Postural hypotension Atelectasis and pna constipation contractures depression/anxiety thromboembolism
what are ways to prevent iatrogenic events?
Prescribe new medication only when necessary (Beer’s criteria)
optimize function and physical activity regardless of the environment
how many pt’s 65+ y/o living at home suffer a fall each year?
living in LTC facilities?
home = 1/3
LTC = 1/2
complications of falls in older pt’s
injuries fx's (hip, femur, humerus, ribs) subdural hematoma hospitalization disability
even if falling does not result in significant injury, significant disability may still result d/t…
the fear of falling, loss of self-confidence, and restricted ambulation
additional management for fall prevention?
PT/OT therapy
gait/muscle training for strength
eval for assistive devices for ambulation
use of hip protectors
