Goal
Improve the health, function, and quality of life of older adults.
Overview
As Americans live longer, growth in the number of older adults is unprecedented. In 2014, 14.5% (46.3 million) of the US population was aged 65 or older and is projected to reach 23.5% (98 million) by 2060.1
Aging adults experience higher risk of chronic disease. In 2012, 60% of older adults managed 2 or more chronic conditions.2
Common chronic conditions include:3
Chronic conditions can lower quality of life for older adults and contribute to the leading causes of death among this population.
Understanding the Health of Older Adults
Health Services
The Patient Protection and Affordable Care Act of 2010 includes provisions that added certain preventive services to Medicare, including cancer screenings and immunizations. These services can prevent disease or help to detect disease early, when treatment is more effective. Unfortunately older adults, especially those from certain racial and ethnic groups, underuse these services.4
Professionals, paraprofessionals, as well as paid and unpaid caregivers need basic and continuing geriatric education to improve care for older adults.5
Chronic Illness
Physical activity can help prevent disease and injury. However, less than 60% of older adults engage in physical activity and strength training.6
Federal efforts to improve chronic illness services for older adults include:
Injury Prevention
Falls, the leading cause of injury among older adults, are treated in emergency departments every 13 seconds and claim a life every 20 minutes. Every year, 1 out of 3 older adults fall, yet less than half tell their doctor.8
Falls-related injuries and deaths can be prevented by addressing risk factors.
Caregivers
Caregivers help people needing ongoing assistance with activities of daily living. The need for unpaid and paid caregivers will likely increase as the U.S. population ages.
Emerging Issues in the Health of Older Adults
Cognitive Impairment in Older Adults: Screening
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. This is an I statement, which means evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Falls Prevention in Community-Dwelling Older Adults: Interventions
The U.S. Preventive Services Task Force (USPSTF) recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. This is a B recommendation, which means the USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. In addition, the USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small (C recommendation). The USPSTF also recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older (D recommendation).
Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication
The U.S. Preventive Services Task Force (USPSTF) recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. This is a D recommendation, which means the USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. In addition, the USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in men and premenopausal women (I statement). The USPSTF also concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with doses greater than 400 IU of vitamin D and greater than 1000 mg of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women (I statement).
Statins to Prevent Cardiovascular Disease: Preventive Medication in Adults Ages 40 to 75 Years at Low Risk
Although statin use may be beneficial for the primary prevention of cardiovascular disease (CVD) events in some adults with a 10-year CVD event risk of less than 10%, the likelihood of benefit is smaller, because of a lower probability of disease and uncertainty in individual risk prediction. Clinicians may choose to offer a low- to moderate-dose statin to certain adults without a history of CVD when all of the following criteria are met: 1) they are ages 40 to 75 years; 2) they have one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 7.5% to 10%. This is a C recommendation, which means the USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
Time-Limited Home-Care Reablement Services for Maintaining and Improving the Functional Independence of Older Adults
Reablement is an approach to home-care services for older adults who are at risk of functional decline. Unlike traditional home care, reablement is frequently time-limited (usually 6 to 12 weeks) and aims to maximize independence through a multidisciplinary, person-centered intervention. This systematic review aimed to assess the effect of time-limited home-care reablement services for maintaining and improving the functional independence of older adults when compared to usual home care or a waitlisted control group. It identified 2 studies with 811 participants. It found very low-quality evidence that could not support or refute the effectiveness of reablement services. There is an urgent need for high-quality trials due to the increasingly high profile of reablement services in policy and practice in several countries.
Abdominal Aortic Aneurysm: Screening in Men Ages 65 to 75 Years Who Have Ever Smoked
The U.S. Preventive Services Task Force (USPSTF) recommends 1-time screening for abdominal aortic aneurysm by ultrasonography in men ages 65–75 who have ever smoked. This is a B recommendation, which means the USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
Abdominal Aortic Aneurysm: Screening in Men Ages 65 to 75 Years Who Have Never Smoked
The U.S. Preventive Services Task Force (USPSTF) recommends selectively offering screening for abdominal aortic aneurysm in men ages 65 to 75 years who have never smoked rather than routinely screening all men in this group. This is a C recommendation, which means the USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
Abdominal Aortic Aneurysm: Screening in Women Ages 65 to 75 Years Who Have Ever Smoked
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abdominal aortic aneurysm in women ages 65 to 75 years who have ever smoked. This is an I statement, which means evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Repositioning for Pressure Ulcer Prevention in Adults
Pressure ulcers (PUs) are common in older adults who are less mobile. Manual repositioning of patients in hospitals and long-term care facilities is a common prevention strategy. This systematic review aimed to assess the effects of repositioning on PUs, determine the most effective repositioning schedules, and determine the resources and costs associated with different repositioning regimens. It identified 3 randomized controlled trials and 1 economic study involving a total of 502 participants in acute and long-term care settings. It found no strong evidence of a reduction in PUs with a 30° tilt position compared with the standard 90° tilt, or of an effect of repositioning frequency. The economic study did not show whether repositioning every 3 hours using the 30° tilt is less costly or more effective than repositioning every 6 hours using the 90° tilt. There is a need for high-quality trials to assess the effects of position and optimal frequency of repositioning on PU incidence.
Abuse and Neglect: Screening in Elderly or Vulnerable Adults
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all elderly or vulnerable (physically or mentally dysfunctional) adults. This is an I statement, which means evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Vitamin D Deficiency: Screening in Adults
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. This is an I statement, which means evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Hearing Loss: Screening in Adults Age 50 Years and Older
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults age 50 years and older. This is an I statement, which means evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Interventions for Preventing Falls in Older People Living in the Community
About 30% of adults age 65 and older fall each year. This systematic review aimed to assess the effects of interventions to reduce the incidence of falls in older people living in the community. It identified 159 trials with a total of 79,193 participants. The most common interventions were exercise and multifactorial programs that assess fall risk and then address identified risks. It found evidence that group or home-based exercise programs and home safety interventions reduce fall risk and rates of falls. Multifactorial interventions reduce rate of falls but not fall risk. Tai chi reduces fall risk. Vitamin D supplementation may reduce falls in people who have lower vitamin D levels before treatment. While some medications can increase fall risk, medication review may be effective in reducing falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition that causes sudden changes in heart rate and blood pressure.
Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation
The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 and continuing until age 75 years. The risks and benefits of these screening methods vary.
Physical Activity: Community-Wide Campaigns
The Community Preventive Services Task Force recommends community-wide campaigns to increase physical activity and improve physical fitness among adults and children. Community-wide campaigns to increase physical activity are interventions that involve many community sectors; include highly visible, broad-based, multicomponent strategies (e.g., social support, risk factor screening or health education); and may also address other cardiovascular disease risk factors, particularly diet and smoking.
Physical Activity: Social Support Interventions in Community Settings
The Community Preventive Services Task Force recommends implementing efforts made in community settings to provide social support for increasing physical activity based on strong evidence of their effectiveness in increasing physical activity and improving physical fitness among adults. These social support interventions focus on changing physical activity behavior through building, strengthening, and maintaining social networks that provide supportive relationships for behavior change (e.g., setting up a buddy system, making contracts with others to complete specified levels of physical activity, or setting up walking groups or other groups to provide friendship and support).
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