Geriatric Assessment and Prevention PDF

z Geriatric Assessment and Levels of Prevention Nurs 6111 z Demographic predictions  One of the fastest growing populations in the U.S.  Over 40.4 million older adults in 2010  By 2020, one in six Americans will be elderly ...

z Geriatric Assessment and Levels of Prevention Nurs 6111 z Demographic predictions  One of the fastest growing populations in the U.S.  Over 40.4 million older adults in 2010  By 2020, one in six Americans will be elderly  By 2050, one in five (projected number of Americans 65+ is 89 million. z Healthy People 2030  By 2060, almost a quarter of the U.S. po pulation will be age 65 or older  Healthy People 2030 focuses on reducin g health problems and improving quality of life for older adults  z Functional Assessment - 2 levels ADLs (Activities of Daily Living) IADLs (Instrumental activities of daily living)  Feeding  More complex  Cooking  Bathing  Shopping  Dressing  Using the telephone  Reading  Ambulation  Writing  Toileting  Managing money  Traveling Functional Assessment – Katz Index ADL z  Lawton Scale for IADL z  Mental Status Assessment - MMSE z z MMSE scoring – (most common)  25-30 points: normal cognition  21-24 points: mild dementia  10-20 points: moderate dementia  9 points or lower: severe dementia z Mini Cog z Montreal z Levels of Prevention  Primary prevention - aims to prevent disease or injury before it ever occurs (health promotion)  Secondary Prevention - aims to detect diseases early (health screening) and prompt treatment to reduce the impact of a disease or injury that has already occurred (disease management)  Tertiary prevention – aims to decrease consequences or disability of an ongoing illness or injury that has lasting effects z Levels of Prevention Primary Prevention Secondary Prevention  Immunization  Hep C testing (1945-1965)  Pneumovax  Mammogram  Influenza vaccine  Colonoscopy  Herpes zoster  TD/Tdap z z CDC Adult Immunization Schedule  z Health Promotion -Healthy Lifestyle Counseling  Physical Activity  Nutrition  Aerobic activity – minimum 30 minutes/5 days wk  Healthy, balanced diet  Amer. Heart Assoc. and Amer. College of Sports Medicine –  My plate for older adults Age 65 and older and adults 50- 64 with chronic conditions  Ability to obtain, prepare and  Any type of activity that the afford food patient is able and willing to do.  Health benefits well documented (flexibility, balance, strengthening)  Community exercise programs  Before beginning an exercise program – Physical Exam  z Healthy Lifestyle Counseling  Safety  Prevention of injury is paramount to continuing functionality and quality of life.  driving  Two recommendations  Safe storage of firearms  Fall prevention  Sexual Behavior  Sexual history is important and facilitates counseling and interventions to promote healthy sexual behavior  z Healthy Lifestyle Counseling  Dental Health  Preventive Dental health/Dental check-ups  daily flossing, brushing, denture or dental implant care, oral screening for cancer, periodontal disease  Substance Use  Counseling about Tobacco, Alcohol, Drugs and injury prevention  Smoking is the leading cause of preventable death in the US  Adult Screening Guidelines z  Blood pressure  Annual >40 yo  Risk factors (increased frequency with risk factors)  Male, African American, Family History  Cholesterol  >35 in men, >45 in women with CVD risks, interval deoends on results and risks  All adults – every 5 years  ECG  Adults 40+  Frequency - annual only with cardiac risk factors  z Health Screening Recommendations – older adults Colon cancer 45-75 (Age changed to 45 by ACS in 2018)  Stool-based tests:  Highly sensitive fecal immunochemical test (FIT) every year  Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year  Multi-targeted stool DNA test (MT-sDNA) every 3 years  Visual exams:  Colonoscopy every 10 years  CT colonography (virtual colonoscopy) every 5 years  Flexible sigmoidoscopy (FSIG) every 5 years Age 76-85  Do not screen routinely  Adult Screening Guidelines z  Glaucoma screen  Adults 40+  Annual with risk factors  Myopia, DM, fam hx, African american >40  Dental  Annually  z Health Screening Recommendations – older adults Female  Mammogram – women 40+  Annual (ACS), Every 1-2 years (USPSTF)  Age 75 years or older*  Stop routine screening - Individualize  Decision to screen is based on risk factors, life expectancy (greater than 10 years), risk versus benefits  Cervical cancer - Age 65 year (or older)  Stop routine screening if history of adequate screening (and not high risk for cervical cancer)  Osteoporosis - women >65, men >70  Screening Guidelines z Prostate Cancer Screening  The discussion about screening should take place at: (ACS, 2016)  Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.  Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).  Age 40 for men at even higher risk (those with more than one first- degree relative who had prostate cancer at an early age).  PSA and DRE USPSTF (2018) - 55 to 69 years, the decision to undergo periodic PSA– based screening for prostate cancer should be an individual one. Not recommended >70 yo.  z Smoking Screening Guideline  Smoking – low dose chest CT scan  Asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years.  Screen annually for lung cancer with low-dose computed tomography.  Discontinue screening when the patient has not smoked for 15 years. z Health Screening  Depression screening  PHQ2  During the past month, have you been bothered by feeling down, depressed, or hopeless?  During the past month, have you been bothered by little interest or pleasure in doing things?  PHQ9  z Components of a Comprehensive Outpatient Geriatric Evaluation  Medical history and physical exam  Frequency of falls  Hx – most important part of  Cognitive status assessment, PE may be normal, even with disease  Emotional status  Medication and supplement review  Functional status (ADLs), (IADLs – Instrumental activities of Daily Living)  General assessment of dentition,  Balance and gait hearing and vision  Social history, alcohol use, home  Pain assessment environment (living situation, safety,  Bowel and bladder function financial)  Advance directive/health care proxy  Nutritional status  z Responsibilities of Primary Care Provider  Management of multiple chronic conditions  Polypharmacy  Coordination of care  Coordination of family needs  Increased sensitivity to medications  Preventative medicine  Home living conditions  End of life decisions