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 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

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 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

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– 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

– 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

– 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

– 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

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

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

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

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

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

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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