Understanding An Aging Population

1. Understanding An Aging Population Keirsten D. Montgomery University of Pittsburgh: School of Nursing Spring 2003

2. Objectives • Demographics • Understanding target population • Statistical Data • Understanding scope of the problem • Risk Factors • Falls • Prevention • Related literature and data

3. 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

4. The Graphic Triangle US Department of Commerce: Economics and Statistics Administration Age: 2000 – 2000 Brief

5. 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

6. 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

7. The State Breakdown US Department of Commerce: Economics and Statistics Administration Age: 2000 – 2000 Brief

8. Medical PerspectivesEpidemiological Transition

9. 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

10. Fall Risk In The Elderly WISQARS injury report forms – http://www.cdc.gov/ncipc/default.htm

11. Fall Risk Assessment Associated Press (2003) Researchers study why elderly fall, ways to minimize damage. The Winston Salem Journal

12. 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

13. Physical Age Cognitive impairments Visual impairments Muscle weakness Gait and balance disturbances Fall History Risk Factors • 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 • 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 • Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

14. Risk Factors • Medical • Polypharmacy • Orthostatic Hypotension • Stroke or Myocardial infarction • Parkinson’s disease • Arthritis • Osteoporosis • Psychiatric conditions • Urinary incontinence • 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 • 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 • Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

15. Risk Factors • Environmental • Poor lighting • Loose rugs • Beds/toilets without handrails • Surface preparation • Physical/perceived obstacles • 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 • 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 • Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

16. Results of Falls • Hospitalization • Premature Nursing Home Placement • Increased dependency • 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

17. Staff Education Evaluation Exercise Environmental Modifications Assistive Devices Supply or Repair Assistive Devices Change in Medication Regimen Fall Prevention Strategies Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

18. Choosing An Ambulation Aid Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse

19. Aging Population’s Rejection of Walkers and Assistive Devices • Emphasize qualities which they consider demeaning to the person • Aging, diminishing competence, dependence • 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

20. 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

21. General Characteristics of a Walker • Use • Weak, elderly individuals who present with mild balance problems • 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

22. General Characteristics of a Walker • Advantages • Increased stability, support • Elderly do not imply “age” stigma • Misuses • 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

23. 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 • 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 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmdr/search.CFM