Understanding An Aging Population

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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
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Medical PerspectivesEpidemiological 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 US Department of Commerce Economics and Statistics Administration Global Aging into the 21st Century 2000 US Department of Commerce Economics and Statistics Administration Global Aging into the 21st Century 2000
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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
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Fall Risk In The Elderly
WISQARS injury report forms http//www.cdc.gov/n
cipc/default.htm
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Fall Risk Assessment
Occurrence Medical Expenses
1 in 3 65 / year 6 of all Medical Exp.
Mortality Morbidity
10,000/year 340,000 broken hips/year
Associated Press (2003) Researchers study why
elderly fall, ways to minimize damage. The
Winston Salem Journal
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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
Risk Factors

• Physical
• 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

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Risk Factors

• Medical
• Polypharmacy
• Orthostatic Hypotension
• Stroke or Myocardial infarction
• Parkinsons 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

15
Risk Factors

• Environmental
• 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

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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
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Fall Prevention Strategies

• Staff Education
• Evaluation
• Exercise
• Environmental Modifications

• Assistive Devices
• Supply or Repair Assistive Devices
• Change in Medication Regimen

Rubenstein Powers MacLean. (2001). Quality
indicators for the management and prevention of
falls and mobility problems in vulnerable elders.
Annals of Internal Medicine
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Choosing An Ambulation Aid
Sloan Haslam and Foret. (2001). Teaching the
use of walker and canes. Home Healthcare Nurse
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Aging Populations 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 feelings of safety while using assistive
  devices
• COST

Aminzadeh Edwards. (1998) Exploring seniors
views of the use of assistive devices in fall
prevention. Public Health Nursing
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Actual Responses Healthcare Workers and Seniors
Aminzadeh Edwards. (1998) Exploring seniors
views of the use of assistive devices in fall
prevention. Public Health Nursing
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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
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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
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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

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