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.
 Key Terms
Activities of daily Dietary Approaches Healthy People 2020
living (ADLs) to Stop Hypertension Instrumental activities
Adult protective (DASH) diet of daily living (IADLs)
services agency Eye opener Primary prevention
Annoyance Framingham Heart Secondary prevention
Chronic Disease Study Tertiary prevention
Self-Management Functional decline U.S. Preventive
Program (CDSMP) Guilt Services Task Force
Contracting Health promotion (USPSTF)
Cut down Health screening
 Health Promotion and Disease
Prevention Guidelines
• U.S. Preventive Services Task Force Healthy
People 2020
• Health promotion activities
– Primary prevention
• Designed to prevent disease from occurring
– Secondary prevention
• Early detection and management of disease
– Tertiary prevention
• Management of clinical diseases to prevent them from
progressing/avoiding complications
 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 to promote health and prevent
disability in the elderly client:
Physical activity Injury prevention
Nutrition Preventive medications
Tobacco use and immunizations
Health screening Caregiver support
 Self-Management
• Kate Lorig, MD
– Was instrumental in developing the concept of self-
management and outlining the role of the healthcare
provider in fostering the client ‘s self-management of
his or her chronic condition.
• The Chronic Disease Self-Management Program
(CDSMP) teaches patients to improve symptom
management, maintain functional ability, and adhere to
their medication regimens.
• Contracting
– Useful strategy to promote healthy behaviors
 Physical Activity
• Functional decline is partly attributable to
physical inactivity.
• Moderate activity
– 30 minutes of brisk walking 5 or more days a week.
• Barriers to physical activity
– Lack of access to safe areas to exercise, pain, fatigue, and
impairment in sensory function and mobility
• Nursing plays a part in promoting physical activity
– Goal setting
– Planning
– Follow-up
 Nutrition
• Signs of poor nutrition in the elderly
– BMI under 19
– Weight gain or loss
– Albumin < 3.4 g/dL
– Cholestolerol < 160 mg/dL
– Hgb < 12 g/dL
– Serum transferrin < 180
• Follow general dietary guidelines for older
adults.
 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 the 5 A’s for those that have expressed that
they are ready to quit smoking.
 Safety
• Falls are the leading cause of unintentional
injury death in older adults in the U.S.
• Nurses should provide a full multifactorial fall
risk assessment if the adult has experienced:
– More than one fall
– Injury requiring medical care
– Has difficulty with walking and/or balance
 Polypharmacy and Medication Errors
• Older adults are 12% 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)
• Screening Tool to Alert to Right Treatment
(START)
 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 Osteoporosis
Elder abuse and neglect Vision and hearing
Heart and vascular Prostate cancer
disease Breast cancer
Stroke Colorectal cancer
 Summary
• Screen older patients according to
USPSTF guidelines.
• Assess the older adults medication list and
be aware of polypharmacy.
• Compliance to drug regimens is essential
to improving medical diagnosis and
outcomes.