Transcript UnderstandingAnAgingPopulation.ppt

Understanding An Aging Population
Keirsten D. Montgomery
University of Pittsburgh: School of Nursing
Spring 2003
Objectives

Demographics
– Understanding target population

Statistical Data
– Understanding scope of the problem

Risk Factors
– Falls

Prevention
– Related literature and data
The Aging Population

Dramatic increases in aging
population from 1996 to
projected 2025
– Age 60 – 64
• 1996: 70 million
• 2025: 100 + million
– Age 80+
• 1996: 30 million
• 2025: 80 million
US Department of Commerce: Economics and Statistics Administration
Global Aging into the 21st Century – 2000
The Graphic Triangle
US Department of Commerce: Economics and Statistics Administration
Age: 2000 – 2000 Brief
The Oldest Old

The oldest old has the
fastest growing
population trends
– 85+: 38% between
1996 and 2000
US Department of Commerce: Economics and Statistics Administration
The 65 years and over population – 2000 Brief
Geographical

Proportions of 65+ population by state
– Florida (18%)
– Pennsylvania (16%)
– West Virginia (15%)
– Iowa (15%)
– North Dakota (15%)
– Rhode Island (15%)
US Department of Commerce: Economics and Statistics Administration
Age: 2000 – 2000 Brief
The State Breakdown
US Department of Commerce: Economics and Statistics Administration
Age: 2000 – 2000 Brief
Medical Perspectives
Epidemiological Transition
1966
1981
1991
Pneumonia
Cancer
Cancer
Tuberculosis
Hypertension
CV Accidents
CV accidents
CV accidents
Senile disease
Infectious Dis.
Accidents
Pulmonary
US Department of Commerce: Economics and Statistics Administration
Global Aging into the 21st Century – 2000
Disability Statistics

1 in 5 Individuals will
suffer from some
kind of disability

Data shows that half
of senior 65 + have
a disability
US Department of Commerce: Economics and Statistics Administration
Disabilities Affect One-Fifth of all Americans – 2000 Census Brief
Fall Risk In The Elderly
WISQARS injury report forms – http://www.cdc.gov/ncipc/default.htm
Fall Risk Assessment
Occurrence
1 in 3 65+ / year
Mortality
10,000/year
Medical Expenses
6% of all Medical Exp.
Morbidity
340,000 broken hips/year
Associated Press (2003) Researchers study why elderly fall, ways to minimize damage. The Winston Salem Journal
Fall Risk Assessment
Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility
problems in vulnerable elders. Annals of Internal Medicine
Risk Factors

Physical
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Age
Cognitive impairments
Visual impairments
Muscle weakness
Gait and balance disturbances
– Fall History
1)
Jensen; Lundin-Olsson; Nyberg & Gustafson. (2002). Fall and injury prevention in older people living in
residential care facilities: A cluster randomized trial. Annals of Internal Medicine
2)
American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel
on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. The Journal of the American
Geriatrics Society
3)
Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and
mobility problems in vulnerable elders. Annals of Internal Medicine
Risk Factors

Medical
–
–
–
–
–
–
–
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Polypharmacy
Orthostatic Hypotension
Stroke or Myocardial infarction
Parkinson’s disease
Arthritis
Osteoporosis
Psychiatric conditions
Urinary incontinence
1)
Jensen; Lundin-Olsson; Nyberg & Gustafson. (2002). Fall and injury prevention in older people living in
residential care facilities: A cluster randomized trial. Annals of Internal Medicine
2)
American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopedic Surgeons Panel on
Falls Prevention. (2001). Guideline for the prevention of falls in older persons. The Journal of the American
Geriatrics Society
3)
Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and
mobility problems in vulnerable elders. Annals of Internal Medicine
Risk Factors

Environmental
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–
–
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Poor lighting
Loose rugs
Beds/toilets without handrails
Surface preparation
– Physical/perceived obstacles
1)
Jensen; Lundin-Olsson; Nyberg & Gustafson. (2002). Fall and injury prevention in older people living in
residential care facilities: A cluster randomized trial. Annals of Internal Medicine
2)
American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel
on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. The Journal of the American
Geriatrics Society
3)
Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and
mobility problems in vulnerable elders. Annals of Internal Medicine
Results of Falls
Hospitalization
 Premature Nursing Home Placement
 Increased dependency
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– Assisted living
– Self Imposed

Feelings of Inadequacy
Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and
mobility problems in vulnerable elders. Annals of Internal Medicine
Fall Prevention Strategies

Staff Education

Assistive Devices
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Evaluation

Supply or Repair
Assistive Devices

Exercise

Change in
Medication Regimen

Environmental
Modifications
Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility
problems in vulnerable elders. Annals of Internal Medicine
Choosing An Ambulation Aid
Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse
Aging Population’s Rejection of
Walkers and Assistive Devices

Emphasize qualities which they consider
demeaning to the person
– Aging, diminishing competence, dependence
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Believe falls are inevitable
No perception of need (Denial)
PRIDE
Lack feeling’s of safety while using assistive
devices
COST
Aminzadeh & Edwards. (1998) Exploring senior’s view’s of the use of assistive devices in fall prevention. Public Health Nursing
Actual Responses: Healthcare Workers
and Seniors
Aminzadeh & Edwards. (1998) Exploring senior’s view’s of the use of assistive devices in fall prevention. Public Health Nursing
General Characteristics of a Walker

Use
– Weak, elderly individuals who present with mild
balance problems
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Purpose
– Widens the base of support
– Transfers weight bearing to upper extremities
– Allows extra-sensory and proprioceptive feedback

Types
– Standard or two/four wheeled walkers
Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse
General Characteristics of a Walker
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Advantages
– Increased stability, support
– Elderly do not imply “age” stigma
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Misuses
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–
Improper Height
Improper Use
Improper sit – to – stand transfers
Improper Use on Stairs
Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse
Data on Injuries Related to Walker

Data found relates to malfunctioning apparatus
on walker
– Example: A PT FELL DUE TO A WALKER LEG BREAKING
DURING USE. THIS INCIDENT ALLEGEDLY RESULTED IN A
BROKEN HIP AND CRACKED RIB
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Data does exist to support suggestion that
walkers can be the obstacle
– Example: AN 81-YR-OLD, 150 LB, FEMALE PT TURNED
SIDEWAYS, FELL AND TIPPED OVER IN AMBULATOR. WAS
NOT BEING MONITORED AT TIME OF EVENT. PT WAS NOT
HURT AND DID NOT NEED MEDICAL HELP. PT HAS
ALZHEIMER'S. DEVICE NOT RETURNED. MFR DATE APPROX
5/93
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