Lifestyle Risks

1
Lifestyle Risks Health Consequences

• NRSG 809
• Module 5

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Leading Health IndicatorsTen Major Public Health
Issues

• Mental health
• Injury violence
• Environmental quality
• Immunization
• Access to health care

• Physical activity
• Overweight obesity
• Tobacco use
• Substance abuse
• Responsible sexual behavior

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Leading Causes of Death

• AGE CAUSES OF DEATH
• lt 1 birth defects, prematurity, SIDS
• 1-4 injuries, birth defects, cancer
• 5-14 injuries, cancer, homicide
• 15-24 injuries, homicide, suicide
• 25-44 injuries, cancer, heart disease
• 45-64 cancer, heart disease, injuries
• gt64 heart disease, cancer, stroke

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Injury and ViolenceMotor vehicle deaths
homicides, US, 1998
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Motor Vehicle Crashes

• 50,000 deaths/year 5 million injuries
• Death rate highest in 15-24 y/o group, second
  highest in gt 74 y/o group
• 40 fatalities alcohol-related highest rates in
  21-24 y/o group
• Interventions, counseling
• Seat belts, helmets, intoxication

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Falls

• gt 13,000 deaths/year 2nd leading cause of
  unintentional injury-related fatalities
• Most common cause of childhood injury
• In children up to 20 deaths in some urban areas
  (1 - 4 nationally) most deaths from falls 3
  stories or higher
• Interventions
• Parent counseling, physical environment (vertical
  rails 4 apart, window guards, soft impact
  surface), community-awareness

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Domestic Violence Patient Care (2001)

• 1-4 million women affected/yr
• 1 in 4 women abused at some point
• 30 of female murders caused by dv
• Presentation
• Subtle, chronic symptoms HA, depression,
  insomnia, fatigue
• Universal screening
• How are things at home? Do you feel safe?
• Safety plan, documentation

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Theory synthesis from 13 studies Kearney (2001)
RINAH, 24, 270-82

• 282 women, 16-67 y/o, across SES, etc.
• Violence invisible accepted to preserve
  commitment stability
• ENDURING LOVE
• This is what I wanted (investing, doubt)
• The more I do, the worse I am (shrinking of self)
• I had enough (turning point, withdrawal)
• I was finding me (redefining self)

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Domestic Violence Aging WomenPhillips (2000)
Geriatr Nurs, 21, 188-93

• Not all abuse linked to family CG
• Domestic violence paradigm
• Added risk factors for older wives
• ? fall risk pushing, shoving, etc. can cause
  serious injury
• Abuse more hidden less likely to be employed or
  be outside home no representation on TV
• Assessment - SAFE
• stress/safety afraid/abuse
• friends/family emergency plan
• What happens when you and ____ disagree?

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Statistics

• Estimates vary, 1-2 million elders abused in US
  each year, but is underreported
• 1 in 20 persons gt 65 yrs abused/year
• 2/3 of victims are women
• Abuse crosses SES, cultures, countries
• Higher percentage among health social service
  agency community cases
• 2/3 perpetrators adult children or spouses

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National Elder Abuse Incidence Study (NEAIS), 1998

• 450,000 cases of reported abuse /or neglect for
  persons gt60 at home, 1996
• Another 101,000 victims of self-neglect usually
  depressed, confused, frail
• 4-5 times more were unreported
• 90 of incidents, perpetrator is known

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Defining Elder Mistreatment

• Physical abuse
• Acts that cause pain, injury, illness (hitting)
• Sexual abuse
• Non-consensual sexual contact
• Physical neglect
• withholding necessities of life (no food)
• Psychological abuse
• Conduct causing mental anguish (threatening)
• Financial exploitation
• Using persons assets (stealing money)
• Violation of rights
• Deprivation of liberty, privacy (evicting,
  stealing)

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Abuse Risk Factors

• Caregiver
• Substance abuse, emotional illness, inexperience
  in caregiving, abused as child, stressed,
  socially isolated, blamer, unrealistic
  expectations
• Care Receiver
• Older, female, dependent, alcoholic, socially
  isolated, history of past abuse, demanding,
  unrealistic expectations
• Reis Nahmiash (1998)

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Indicators of Abuse (IOA) ScreenReis Nahmiash
(1998) Gerontologist, 471-480
Abusive Caregiver Characteristics
Intra-personal
Abusive CG Characteristics Inter-personal
Abuse/Neglect Of Seniors
Care Receiver Unhappiness
Abused Care Receiver Characteristics
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Components of Model

• CG Intrapersonal Problems
• abuses alcohol, depressed, reluctant
• CG Interpersonal Problems
• poor relationship with care receiver
• current family conflict
• financially dependent on care receiver
• Abused Care Receiver
• abused in past
• lacks social support

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What to Look For

• Physical
• Frequent, traumatic injuries, delays in
  treatment, bruising, loss of hair, burns,
  dehydration, pressure ulcers, over or
  under-medication, broken dentures, glasses
• Psychological
• Depression, ambivalence, confusion, low
  self-esteem, anger, social isolation
• Financial
• Checks signed by others without authority,
  utilities turned off, little food in house,
  stacks of unopened mail, unpaid bills

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• 3x higher risk of death for abused or neglected
  elders
• 1.7x higher risk of death for self-neglected
  elders

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Intervention Strategies

• Primary prevent maltreatment
• Educational seminars, strengthening support
  networks of potential victims
• Secondary identification to limit injury
• Reporting abuse to appropriate agency, frequent
  visits to victims and abusers
• Tertiary rehabilitation recovery
• Family counseling, pursuing alternate living
  arrangements
• Hogstel Curry (1999) Jnl of Gero Nsg, 10-18

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Intervening in Dementia

• Previous studies linking dementia abuse
• Collaborative project in OH
• Alzheimers Assoc., Dept. of Senior Services,
  Adult Protective Services, College of Medicine
• Education re abuse, dementia
• Screening tool for identification of cases
• Referral protocol
• CG handbook to self-asses risk
• Collaborative model ? ? abuse reports
• Anetzberger et al (2000) Gerontologist, 40,
  492-497

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Current Research

• Older adults living in the community completed
  home interview
• 77 victims (physical verbal aggression,
  financial mistreatment neglect)
• 147 nonvictims
• Victims had more psychological distress
• Social support helped ? distress in Vs
• ? sense of mastery self-efficacy associated
  with ? distress in both groups
• Comijs et al. (1999) Jnl of Gerontology, Psych
  Sci, P240-P245

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Community CharacteristicsJogerst et al (2000)
JAGS, 48, 513-518.

• Demographics of counties in Iowa
• Risk factors r/t elder abuse
• For both reports substantiated cases, higher
  risk of abuse r/t
• Urban setting
• ? child abuse
• ? child poverty

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Risk Factors PreventionChoi Mayer (2000) J
Gero Soc Work, 33, 5-25

• Data from county Adult Protective Services
• Risk factors
• Alcohol/substance abuse by elder (sn)
• Living alone, fewer supports (fin ab)
• Health problems (ab, neg)
• Preventive strategies
• Case management
• CG support
• Substance abuse screening

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Interventions Phillips (2000)

• Take time to ask listen
• Dont allow beliefs of hopelessness
• Help woman find word for situation
• Document the abuse
• Offer concrete assistance in management of
  situation
• recognize patterns in situation
• rehearse approaches
• Describe services, make referrals, advocate

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Additional Resources

• Admin. on Aging, Elder Abuse Prevention
• http//www.aoa.dhhs.gov/
• National Center on Elder Abuse
• http//www.edlerabusecenter.org
• Kansas Dept. of Social Rehabilitation Services,
  Adult Protective Services
• http//www.srskansas.org
• 1-800-922-5330, 24 hrs/day, 7 days/wk

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Substance Abuse
Use of alcohol and/or illicit drugs, US, 199498
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Substance Use Abuse

• Assessment use coffee? alcohol, other drugs?
• CAGE questionnaire (yes to 2 or more test)
• Have you ever felt you ought to Cut down on your
  drinking?
• Have people Annoyed you by criticizing your
  drinking?
• Have you ever felt bad or Guilty about your
  drinking?
• Have you ever had a drink first thing in the
  morning (Eye opener) to steady your nerves or get
  rid of a hangover?
• Prevention
• Primary anticipatory guidance education
• Secondary brief intervention (share concerns,
  educate about effects, set goals review options
  for behavior change, plan f/u)

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Tobacco Use
Cigarette smoking, US, 199099
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Smoking in CollegeMartinelli (1999)

• Penders health promotion model - supported
• More HP behaviors associated with
• Increased self-efficacy
• Avoidance of environmental tobacco smoke
• Perception of self as healthy
• Female
• External internal health locus of control
• Interventions should promote SE, control of
  health, health status

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Tobacco Use

• Cigarettes kill gt 400,000/yr in US risk factor
  for gt 25 diseases (e.g., cancer)
• Leading cause of preventable death, gt alcohol,
  drugs, car crashes, homicides, suicides, AIDS
  combined
• 24 of adults smoke, highest rates in
• 25-44 y/o - 30
• American Indians, Alaska natives 31
• lt HS education - 32 Low income 33
• 36 of adolescents smoke
• smoking start after 13 y/o, quit more likely

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Intervening with Tobacco

• Ask all patients about smoking
• Do you smoke, are you still smoking?
• Advise smokers to stop
• I must advise you to stop smoking now.
• Assist their efforts with self-help materials, a
  quit date, possibly nicotine gum or patch
• Intervene according to readiness to quit
• Arrange follow-up