prevention

Question 1

health status of older adult composed of:

Answer 1

number of chronic diseases

Underlying physiologic changes in aging

Susceptibility to acute illness and injuries

Question 2

what are some dz’s that are major causes of mortality?

Answer 2

Heart disease
cancers (esp. lung, colorectal, breast)
lung disease
cerebrovascular disease/stroke
pneumona and influenza

Question 3

what percentage of older adults have HTN?

Answer 3

40%

Question 4

How many older adults have survived an MI or other heart problems?

Answer 4

1/3 have heart dz

Question 5

what percentage of older adults have difficulty w/their everyday activities of daily living (ADL’s)

Answer 5

40%

Question 6

what percentage o disability with ADL’s occur chronically/progressively? catastrophically (ie. hip fx)?

Answer 6

50%

50%

Question 7

what are some precursors to disability?

Answer 7

difficult walking

cognitive impairment

visual impairment: affect ADL’s (taking meds) and walking

Question 8

how do we modify the consequences of disease?

Answer 8

health habits
screening: high risk for dz
immunizations: decrease risk 
access to health care
education: manage their own dz's
community services: support

Question 9

what is primary prevention?

Answer 9

intervention to prevent disease or injury occurrence

Question 10

what is secondary prevention?

Answer 10

intervention for those with early condition to prevent progression into complications

Question 11

what is tertiary prevention?

Answer 11

efforts to improve care to avoid later complications

Can involve rehabilitation to optimize function

Question 12

what is a major health outcome of chronic disease?

Answer 12

disability

Question 13

benefit of prevention dependent on what 2 factors?

Answer 13

Prevalence of the problem

Likelihood of an effective intervention

Question 14

in the older adult, how does prevention differ?

Answer 14

Target is typically prevention of syndromes such as falls, dizziness, and functional decline

Question 15

what is iatrogenic disease and is it a problem for older adults?

Answer 15

= illness caused by medical examination or treatment

YES

Question 16

what are some examples of primary prevention?

Answer 16

vaccines
BP monitoring
smoking cessation
exercise
cholesterol
NA restriction
seat belts
social support
home environment eval
med review

Question 17

what are some examples of secondary prevention?

Answer 17

mammography
FOB, colonoscopy
hypothyroidism
vison
oral cavity
TB
skin care: hygiene/growths

Question 18

what are some examples of tertiary prevention?

Answer 18

proactive primary care
comprehensive geriatric assessment
foot care
denal care
toileting efforts 
rehab/exercise
dietary protein

Question 19

what are the most feared outcomes of disability

Answer 19

loss of independence

Question 20

recommendations from ACP and ASIM?

Answer 20

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

Question 21

recommendations from USPTF?

Answer 21

welcome to medicare visit

“periodic” screening in pt’s who are asxs w/out dz

persons 65+ y/o: screen, counsel, immunize

Question 22

what is included in a medicare visit?

Answer 22

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

Question 23

what is included in an annual wellness visit?

Answer 23

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

Question 24

what are things you need to include in your visit in order to provide effective preventative care for older adults?

Answer 24

immunizations

cancer screenings

screening for identification of psychosocial problems

screening for cognitive impairment

Question 25

A pt can achieve increased balance, stamina, Cardiovasc condition, strength, osteoporosis prevention, fall prevention through....

Answer 25

regular physical activity for a total of 150 mins (mod-intensity) weekly

Question 26

what suggests poor nutrition?

Answer 26

low body mass index or unintentional weight loss of >10lbs in 6 mo's

Question 27

calorie needs ____ w/age, and nutritional requirements _____?

Answer 27

decline remain the same

Question 28

what tool can help you assess nutritional status?

Answer 28

MNA = mini nutritional assessment

Question 29

what are ways to prevent osteoporosis and degenerative joint dz (DJD)?

Answer 29

pharmacologic, exercise, diet walking: modest incr in skeletal load and limited benefit strength training: effective for improving/maintaining bone mass

Question 30

what factors influence prevention of disability?

Answer 30

genetics, health status, comorbidities, mood, cognition, and beliefs

Question 31

what is the most preventable problem in the older adult?

Answer 31

iatrogenic prob's

Question 32

what are some iatrogenic problems in older adults?

Answer 32

``` underdiagnosis bed rest polypharmacy environment hazards transfer trauma delirium fluid overload, dehydration overuse of abx ```

Question 33

what are some special risks of hospitals for older adults?

Answer 33

diminished reserves in cognitive, renal, and hepatic function

Question 34

how can elective surgery result in sepsis and death?

Answer 34

postop oversedation with pain meds --> decline in respiratory function w/ need for mechanical ventilation --> ventilator-assoc. pna --> sepsis and death

Question 35

how can hospital admission for pna or CHF lead to deconditioning, delirium, and sepsis?

Answer 35

lead to immobility --> UTI (catheter for monitoring UO) --> deconditioning, delirium, and sepsis

Question 36

what are potential complications of bed rest?

Answer 36

``` Pressure ulcers Bone resorption Hypercalcemia Postural hypotension Atelectasis and pna constipation contractures depression/anxiety ```

Question 37

what are potential complications of bed rest?

Answer 37

``` Pressure ulcers Bone resorption Hypercalcemia Postural hypotension Atelectasis and pna constipation contractures depression/anxiety thromboembolism ```

Question 38

what are ways to prevent iatrogenic events?

Answer 38

Prescribe new medication only when necessary (Beer's criteria) optimize function and physical activity regardless of the environment

Question 39

how many pt's 65+ y/o living at home suffer a fall each year? living in LTC facilities?

Answer 39

home = 1/3 LTC = 1/2

Question 40

complications of falls in older pt's

Answer 40

``` injuries fx's (hip, femur, humerus, ribs) subdural hematoma hospitalization disability ```

Question 41

even if falling does not result in significant injury, significant disability may still result d/t...

Answer 41

the fear of falling, loss of self-confidence, and restricted ambulation

Question 42

additional management for fall prevention?

Answer 42

PT/OT therapy gait/muscle training for strength eval for assistive devices for ambulation use of hip protectors