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Population Health for Nurses

26.5 Older Adult Health

Population Health for Nurses26.5 Older Adult Health

Learning Outcomes

By the end of this section, you should be able to:

  • 26.5.1 Recognize major diseases affecting older adults.
  • 26.5.2 Examine major risk factors influencing the health of older adults.
  • 26.5.3 Create educational interventions to promote self-care for health promotion, illness prevention, and illness management of older adults.
  • 26.5.4 Identify Healthy People 2030 goals established for older adults.
  • 26.5.5 Describe health promotion and disease prevention actions designed to improve the health of older adults.
  • 26.5.6 Discuss strategies for integrating sociocultural and linguistically responsive health promotion and disease prevention interventions in clinical practice of older adults.

Thanks to advances in technology, improvements in health care services, interventions in public health, and research on the utilization of health services, people are living longer and healthier lives. Much improvement lies in reducing infectious diseases, which were major killers at the turn of the 20th century. U.S. life expectancy increased from 48.3 years for women and 46.3 years for men in 1900 to 79.3 years and 74.1 years, respectively, in 2000. In 2019, Americans’ life expectancy at birth was 81.4 years for women and 76.3 years for men (NCHS, 2023a). Since 2020, however, drops in life expectancy have occurred in the United States. In 2020, life expectancy at birth for women was 79.9 years and dropped further to 79.1 years in 2021. In 2020, life expectancy at birth for men was 74.2 years and dropped to 73.2 years in 2021 (NCHS, 2022b). These declines are largely due to the COVID-19 pandemic and drug overdose (NCHS, 2022b). Despite this decrease, the country will see continued growth in the older adult population, comprising those aged 65 and over. In 2030, the projected population will be more than twice as large as it was in 2000, growing from 35 million to 73 million and representing 21 percent of the total U.S. population (Federal Interagency Forum on Aging-Related Statistics, 2020). Also of note, nearly one in four older adults in 2019 were members of racial or ethnic minority populations (Administration on Aging, 2021).

As this group lives longer, society must meet their needs. The NCHS (2023d) reported that in 2021, 22.6 percent of noninstitutionalized persons aged 65 and over were in fair or poor health. In 2019, 16.6 percent of people aged 65 and over had one or more hospital stays. According to the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL, 2023), more than 800,000 Americans reside in assisted living communities. The Administration on Aging (2021) indicated that in 2019, only 1.2 million persons (1 percent of persons aged 65–74, 2 percent aged 75–84, and 8 percent aged 85 and over) lived in nursing homes. In 2022, 20.5 percent of men and 26.7 percent of women aged 65 to 74 lived alone, and 23.8 percent of men and 42.5 percent of women aged 75 and over lived alone (U.S. Census Bureau, 2022). Mechanisms of providing health insurance, supportive environments, healthy communities, and social safety nets, including health care provision, must be in place. Health promotion and disease prevention are essential parts of maintaining the older adult population’s health and well-being. Older adults must stay informed about healthy lifestyle choices and work with nurses and other health care professionals to create personalized plans for maintaining good health (Figure 26.6).

An older person washes vegetables in their kitchen.
Figure 26.6 Proper cleaning of fresh, uncooked produce is important when preparing a meal. The client in this photo is thoroughly cleaning carrots and radishes to prevent foodborne illness. (credit: Cade Martin/CDC, Public Domain)

Major Diseases Affecting Older Adults

A variety of diseases affect older adults.

  • Heart disease, cancer, and COVID-19 were the leading causes of death among persons ages 65 and over in the United States in 2021.
  • Obesity remains an issue for this population.
    • 41.9 percent of noninstitutionalized men aged 65 to 74 in 2015–2018
    • 31.8 percent of noninstitutionalized men aged 75 and over in 2015–2018
    • 45.9 percent of noninstitutionalized women aged 65 to 74 in 2015–2018
    • 36.1 percent of noninstitutionalized women aged 75 and over in 2015–2018
  • Hypertension is an even larger issue.
    • 66.7 percent of men aged 65 to 74 in 2015–2018
    • 81.5 percent of men aged 75 and over in 2015–2018
    • 74.3 percent of women aged 65 to 74 in 2015–2018
    • 86 percent of women aged 75 and older in 2015–2018 (NCHS, 2023d)

In 2019, leading chronic conditions for noninstitutionalized older adults included (Administration on Aging, 2021):

  • arthritis (48 percent);
  • physician-diagnosed and undiagnosed diabetes (29 percent in 2015–2018);
  • any cancer (25 percent);
  • coronary heart disease (14 percent);
  • COPD, emphysema, or chronic bronchitis (10 percent);
  • myocardial infarction (9 percent);
  • stroke (9 percent in 2017–2018); and
  • angina (4 percent).

According to the Federal Interagency Forum on Aging-Related Statistics (2020), in 2015, 7.4 percent of older adult men and 7.5 percent of older adult women not living in nursing homes had dementia.

Arthritis affects about one in every four adults in the United States. Its prevalence increases with age, and it is more common in women than in men, more common among adults with fair/poor health compared to those with excellent/very good health, and less common among adults who meet physical activity recommendations compared to those who are insufficiently active or inactive (CDC, 2021l). The prevalence of this disease is expected to increase, with projections indicating that an estimated 78.4 million adults will have been diagnosed with arthritis by 2040 (Figure 26.7) (CDC, 2021l). U.S. adults with arthritis are more likely to be obese or have diabetes or heart disease than those who do not have arthritis. For instance, 28.8 percent of adults who had arthritis in 2016–2018 were also obese, 47 percent of adults who had arthritis in 2013–2015 also had diabetes, and 49 percent of adults who had arthritis in 2013–2015 also had heart disease (CDC, 2022k).

A line graph shows the number of people diagnosed and projected to be diagnosed with arthritis from 2000 to 2040. In 2005, 46 million people were diagnosed with arthritis. The line steadily increases every five years, and by 2040, 78 million people are expected to be diagnosed with arthritis.
Figure 26.7 Estimated and projected number of adults with diagnosed arthritis in the United States. (data source: CDC, 2021l; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license).

While coronary heart disease and stroke were common in the adult population, diseases of the heart and circulatory vessels are also prevalent in the growing population of older adults. As people age, managing these diseases becomes more difficult for older adults with comorbidities related to cognition, sleep, physical balance, and strength factors (CDC, 2019a). Myocardial infarction, or a heart attack, occurs when the flow of oxygen-rich blood to a section of heart muscle becomes blocked, leading to a lack of oxygen, which may damage the heart muscle. Angina, a symptom of CAD, is chest pain or discomfort resulting from an area of heart muscle becoming starved of oxygen-rich blood (CDC, 2019a). The prevalence of coronary heart disease in 2019 was 11.4 percent of White people, 10 percent of Black people, 8.8 percent of Hispanic people, and 6.3 percent of Asians and Pacific Islanders. Prevalence was 16.5 percent for those with no high school diploma and 10.9 percent for those with some college or more.

Risk Factors Influencing the Health of Older Adults

The Federal Interagency Forum on Aging-Related Statistics (2020) considers the following six indicators as health behavior risks: lack of vaccinations, lack of colorectal cancer screenings, poor diet, physical inactivity, obesity, and cigarette smoking. In 2018, about 69 percent of older adults reported receiving an influenza vaccine in the past 12 months. This included 72 percent of non-Hispanic White people compared with only 60.4 percent of non-Hispanic Black people and 63 percent of Hispanic people. The percentage of people aged 50 to 75 who received colorectal cancer screenings increased over the last 8 years. Older adults completing the Healthy Eating Index—2015 had their highest component scores in Whole Fruits, Total Protein Foods, and Seafood and Plant Proteins. Their overall diet quality was 64 out of 100. In 2018, only 14 percent of older adults participated in leisure-time physical activity that met the Physical Activity Guidelines for Americans. The percentage of older adults with obesity increased from 22 percent in 1988–1994 to 30 percent in 2003–2006 and 40 percent in 2015–2018. Finally, the percentage of older adults who were current cigarette smokers has declined, as in 2018, 10 percent of older adult men and 7 percent of older adult women were current smokers (Federal Interagency Forum on Aging-Related Statistics, 2020).

Polypharmacy, the use of five or more medications, is another risk factor that impacts the health of older adults (WHO, 2019). As the population ages, people are more likely to experience comorbidities that require multiple medications. Older adults are at risk for adverse drug events (ADE) and drug interactions between these multiple medications. The most common ADE in older adults is impaired mobility, which can lead to falls, injuries, or death. Older adults are especially vulnerable due to age-related physiologic changes resulting from the absorption, distribution, metabolism, and elimination of drugs. Polypharmacy, in addition to frailty or any other condition that impacts mobility, markedly increases the risk of mortality (Parulekar & Rogers, 2018).

Sensory loss issues are another important risk factor for older adults. Hearing, vision, and touch can affect one’s enjoyment of activities and ability to communicate and stay involved with others (MedlinePlus, 2022). Sensory loss issues can also put the older adult at risk for falls, which can lead to injuries or death. Age-related changes in the ear can lead to balance difficulties. Reduced vision may also lead to injuries, and perception related to touch may be impaired, causing difficulties walking related to a reduced ability to perceive where the body is in relation to the floor (Medline Plus, 2022). Other difficulties related to touch include a reduced ability to detect pressure, which can lead to pressure ulcers, and a reduced sensitivity to pain, including temperature, which could lead to burns.

A fall risk assessment may benefit older adults in the population health setting. The assessment typically includes an initial screening with questions about overall health, history of previous falls, and current issues with balance, standing, and/or walking. It should also include a set of tasks or fall assessment tools to test the older adult’s strength, balance, and gait (MedlinePlus, 2021). One common approach to fall assessment is the use of the CDC’s (2021i) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) approach. STEADI provides screening, assessment, and intervention guidelines. Particular assessments included in STEADI are:

  • Timed Up-and-Go (Tug) test to assess gait,
  • 30-Second Chair Stand test to assess strength and balance, and
  • 4-Stage Balance test to assess balance.

STEADI Resource Algorithm assessment results illustrate the degree to which an older adult is at risk of falling and may indicate areas (gait, strength, and/or balance) to address.

Ageism, discrimination against older people because of negative and inaccurate stereotyping, is a risk factor for the mental heath of older adults (Weir, 2023). It is so deeply rooted in American societies that it is largely ignored. The negative effects of ageism on older adults’ physical and mental well-being include:

  • earlier death;
  • poorer physical health, affecting sexual/reproductive health and the ability to recover from disabiity;
  • increased risky health behaviors;
  • poorer mental health, including the onset of depression, increases in depressive symptoms over time, and lifetime depression; and
  • lower quality of life, social isolation, and loneliness (WHO, 2023a).

Educational Interventions to Promote Self-Care in Older Adults

Self-care is crucial for the well-being of older adults. Aging-related physical and cognitive changes can make it more difficult to take care of oneself. However, practicing self-care can help older adults maintain their independence, prevent or manage health problems, and improve their overall quality of life (Marques et al., 2019). Exercise, healthy eating, and proper medication management can help older adults maintain their physical health. Regular physical activity can help prevent chronic diseases, while a healthy diet can provide the nutrients needed to support overall health. Meditation, socializing, and hobbies can promote mental well-being and reduce the risk of depression and anxiety. Participating in social activities or volunteering can increase social engagement and reduce feelings of isolation or loneliness. Older adults who practice self-care may experience less stress and greater emotional resilience. Self-care practices such as getting enough sleep and managing chronic health conditions can improve cognitive function in older adults. These can help prevent or delay the onset of cognitive decline and dementia. Finally, self-care promotes independence for older adults. By taking care of themselves, they can maintain their independence and avoid relying on others for assistance with daily activities.

As with other age groups, health education classes can cover various topics useful for self-care of older adults, including nutrition, exercise, medication management, and stress management. Older adults can also benefit from one-on-one counseling sessions focusing on their self-care needs and goals. During such sessions, a nurse can provide guidance and support on healthy habits, medication adherence, and chronic disease management. Group support programs may also be beneficial, as they provide a sense of community and encouragement. The group may focus on a specific condition or a specific health behavior. Technology-based educational interventions may also be beneficial with older adult populations. Applications used on smartphones or websites may provide information on healthy living or assist in tracking of activities such as sleep or medication management. Finally, nurses may make home visits to older adults to provide education and support regarding self-care practices. This may be particularly useful for those who have limited mobility or live in rural areas.

Healthy People 2030 Goals for Older Adults

The overarching Healthy People 2030 goal for older adults is to “improve health and well-being for older adults” (ODPHP, n.d.-f, para. 1). Their prediction is that by 2060, almost a quarter of the U.S. population will be older adults. As such, the focus is on the issues this population experiences related to their health and SDOH.

Healthy People 2030

Older Adults

Healthy People 2030 older adult objectives are in a variety of categories and address topics such as physical activity, dementias, foodborne illness, infectious diseases, reduction of hospital admissions (for pressure ulcers, diabetes, urinary tract infections, pneumonia, and asthma), injury prevention related to falls or the use of inappropriate medications, oral conditions, osteoporosis, and age-related macular degeneration vision loss.

One focus area of Healthy People 2030 is falls in older adults. One in three fall annually, and falls are a leading cause of injury for this population. ODPHP (n.d.-h) has recognized that physical activity can help older adults prevent chronic diseases and fall-related injuries. Objectives related to increasing the proportion of older adults with physical or cognitive health problems who get physical activity, reducing the proportion of older adults who use inappropriate medications, reducing hip fractures among older adults, and increasing the proportion of older adults who get screened for osteoporosis can help to address falls. Unfortunately, fall-related deaths among older adults is getting worse. In 2018, there were 64.4 deaths per 100,000 caused by unintentional falls and 78 deaths per 100,000 in 2021. The target is a decrease to 63.4 per 100,000 (ODPHP, n.d.-h).

Health Promotion and Disease Prevention Activities to Improve the Health of Older Adults

Heath promotion for older adults often requires a multidisciplinary approach that includes nurses, other health care professionals, community organizations, and caregivers. Health promotion activities to improve the health of older adults should be geared toward the major diseases that impact them. Regular physical activity can help older adults maintain a healthy weight, increase their strength and flexibility, reduce their risk of falls, and improve their overall health and well-being. Activities promoting a balanced and healthy diet can help with healthy weight maintenance, reduce the risk of chronic diseases, and improve overall health. Other health promotion activities that can improve the health of older adults include:

  • Promoting clients to remain active, independent, and involved in their communities as long as possible
  • Providing resources to help caregivers of older adults stay healthy and deliver quality care
  • Providing resources for senior centers in communities
  • Promoting fall prevention programs in the home and in the community
  • Promoting maintenance of appointments with providers for medical management of chronic conditions

One example of a national health promotion activity is SilverSneakers (Tivity Health, 2023). This fitness program is available for older adults enrolled in Medicare Advantage Plans (Part C) at over 17,000 locations, including national gym franchises, community centers, and senior centers. SilverSneakers also offers online workout videos for those who prefer to work out at home or are homebound. Classes range from balance and stability lessons and gentle stretches to Pilates, cardio and strength, line dancing, and kickboxing. Yoga, mindfulness, meditation sessions, and a fitness application for smartphone use are also offered. Daily tips on the SilverSneakers blog provide information on nutrition, diseases and conditions, and physical activity tips.

Caregivers who assist older adults are essential members of public health care. While some caregivers are hired, informal or unpaid caregivers provide a substantial portion of long-term care in homes across the United States. These unpaid family members or friends are typically middle-aged or older adults who may perform a range of tasks, such as assisting with activities of daily living, helping to manage a chronic disease or disability, paying bills, shopping, providing transportation, or providing emotional support. Caregivers may initially have few responsibilities, but as the recipient’s care needs increase, additional responsibilities may increase, leading to a strain on the caregiver.

The need for caregivers is an important public health issue. In 2019, the CDC indicated that there were seven potential family caregivers per older adult, but by 2030, there will only be four potential family caregivers per older adult. According to the CDC (2019b), 22.3 percent of adults reported providing care or assistance to a friend or family member in the past 30 days. Among adults aged 45 to 64 years, 24.4 percent were caregivers, compared to 18.8 percent of adults aged 65 years and over. One in four (25.4 percent) women were caregivers, compared to one in five (18.9 percent) men. Black people comprised the largest percentage of caregivers (24.3 percent), followed closely by White people (23.1 percent), then 17.9 percent of Hispanic people and 10.2 percent of Asians/Pacific Islanders. One in three caregivers provided 20 or more hours per week of care, and over half provided care or assistance for 2 years or longer.

Caregiving can provide great satisfaction and strengthen relationships between families and friends. It can also negatively affect the caregiver’s ability to work, engage in social interactions and relationships, and maintain good physical and mental health (CDC, 2019b). Therefore, health promotion and disease prevention of older adults must be geared to the recipient of care and the caregiver. The CDC (2019b) recommends the following for health care professionals engaging in health promotion and disease prevention of the older adult population:

  • Increase messaging regarding the importance of caregivers and of maintaining their health and well-being
  • Educate about the importance of caregiving before caregivers begin
  • Provide caregivers with resources and supports
  • Be mindful of the health risks for caregivers, encourage them to use available information and tools, and make referrals to supportive programs and services as applicable
  • Assist with caregiver training and support programs
  • Advocate for awareness of and access to evidence-based programs and services that can help caregivers and care recipients
  • Encourage caregivers to get regular checkups, use preventive services, and engage in self-care to maintain their physical and mental health
  • Ensure that caregivers with a disability and/or chronic disease have access to self-management programs to maintain their health (para. 13)

Along with providing education and support for caregivers, population health nurses must be aware of potential elder abuse. Elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult and occurs in about 1 in 10 people aged 60 and older who live at home (CDC, 2021g). The abuse occurs at the hands of a caregiver or a person the elder trusts, and it can involve physical, sexual, emotional or psychological, or financial abuse; neglect; or a combination of these (see Table 26.12). Prevention of elder abuse can begin by understanding and addressing the factors that put them at risk for or protect them from violence. See Caring for Families for more information on preventing elder abuse.

Risk Factors for Perpetration of Elder Abuse
Individual Risk Factors
  • Current diagnosis of mental illness
  • Current or past misuse of drugs or alcohol
  • Current physical health problem
  • Past experience of disruptive behavior
  • Past experience of traumatic events
  • High levels of stress
  • Poor or inadequate preparation or training for caregiving responsibilities
  • Inadequate coping skills
  • Exposure to or witnessing abuse as a child
  • Social isolation
Relationship Risk Factors
  • High financial and emotional dependence on a vulnerable elder
  • Past family conflict
  • Inability to establish or maintain positive prosocial relationships
  • Lack of social support
Societal Risk Factors Specific characteristics of institutional settings, such as nursing homes and residential facilities, including:
  • Staffing problems and lack of qualified staff
  • Staff burnout and stressful working conditions
Protective Factors for Victimization
Individual Protective Factors
  • Emotional intelligence
Relationship Protective Factors
  • Having social support
Community Protective Factors
  • Sense of community, meaning, residents feeling connected to each other and being involved in the community
Mechanisms Nurses Can Use to Prevent Elder Abuse
  • Listen to older adults and their caregivers to understand their challenges and provide support.
  • Report abuse or suspected abuse to local adult protective services, long-term care ombudsmen, or the police. Use the National Center on Elder Abuse to find your state’s reporting numbers, government agencies, state laws, and other resources.
  • Educate about how to recognize and report elder abuse.
  • Educate on how the signs of elder abuse differ from the normal aging process.
  • Check in on older adults who may have few friends and family members.
  • Provide overburdened caregivers with support options.
Table 26.12 Elder Abuse (See CDC, 2020b; 2021g.)

Theory in Action

IHI’s Age-Friendly Health Systems

Evidence-based practice is important to health promotion and disease prevention for older adults. While the Institute for Healthcare Improvement’s (IHI, n.d.) Age-Friendly Health System initiative was designed originally for hospital and clinical settings, population health nurses can also use the concepts. In this video, Dr. Mary Tinetti, Chief of Geriatrics at the Yale School of Medicine and Yale-New Haven Hospital, describes the components of an age-friendly health system.

Watch the video, and then respond to the following questions.

  1. What does it mean that older adults become more heterogeneous as they age?
  2. Why were the 4Ms chosen as concepts in the age-friendly health system?
  3. What are the 4Ms in the age-friendly health system?
  4. What nursing interventions could be implemented to address each 4M?

Primary Prevention

Primary prevention strategies typically focus on maintaining the health of healthy older adults and preventing the development of chronic diseases and frailty. Examples of primary prevention (Lenartowicz, 2022) include:

  • Immunizations, such as the influenza, pneumococcal, tetanus, and zoster vaccines
  • Chemoprevention using aspirin for the prevention of coronary heart disease and stroke, if applicable
  • Lifestyle changes, such as smoking cessation, avoidance of trans fats, increased intake of fruits and vegetables, moderate physical activity, adequate calcium and vitamin D intake, and limited caffeine and alcohol intake
  • Specific recommendations for prevention of frailty including exercise and a low-fat, reduced sodium, high-calcium, high-fiber diet with calcium and vitamin D supplements

Secondary Prevention

Secondary prevention of disease in the older adult population aims to detect and treat disease or its complications before symptoms or functional losses occur. An older adult may have minimal or no chronic disease but require secondary prevention. The primary method of secondary prevention is screening. Multiple organizations publish screening guidelines, which can differ. The following are Medicare-covered preventive service guidelines for older adults (Highmark, 2023b):

  • Weight, height, and BMI monitoring annually
  • Blood pressure screening annually
  • Lipid panel every 5 years or as clinically indicated
  • Fasting plasma glucose in those who are overweight or obese annually
  • Mammography every 1 to 2 years until age 75
  • Chlamydia and gonorrhea screening for older women who are at increased risk for infection
  • Syphilis, HIV, and hepatitis B screening for those at increased risk for infection
  • Hepatitis C screening
  • Colorectal cancer screening until age 75
  • Bone mineral density screening of women aged 65 to 69 years and men aged 70 years and over every 2 years
  • Prostate cancer screening for men aged 55 to 69 years, if clinically indicated
  • Lung cancer screening for those aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years

Another secondary prevention important for older adults is screening for fall risk. As mentioned, the CDC’s (2023h) STEADI provides a coordinated approach for nurses and other health care providers to implement the practice guideline for fall prevention. Videos for health care providers and older adults can be viewed on the CDC website.

Client Teaching Guidelines

Environmental Safety for Older Adults

The community health nurse should teach older adults or their caregivers to do the following:

  • Keep emergency numbers at hand, including 911, poison control, a family member or friend’s number to call in case of emergency, and the health care provider’s office number.
  • Consider a special alarm that can be worn as a bracelet or necklace. The button can be pushed in case of a fall, and emergency services will be notified.
  • Try not to rush to answer the phone. Carry a cordless or cell phone when moving around the home, or let an answering machine pick up messages.
  • Wear nonslip footwear, such as slippers with rubber/no-slip bottoms or flat, thin-soled shoes that fit well.
  • Use a cane or walker, if needed, rather than relying on holding on to walls or furniture.
  • Make sure all hallways, stairs, and paths are well-lit and clear of any objects such as books or shoes.
  • Use rails and banisters when going up and down stairs. Never place scatter rugs at the bottom or top of stairs.
  • Tape all area rugs to the floor so they do not move when walking on them.
  • If there is a fire in the home, leave immediately and call 911. Do not attempt to put a fire out.
  • Do not wear loose clothes or long sleeves when cooking.
  • Replace appliances with frayed or damaged electrical cords.
  • Do not put too many electrical cords into one socket or extension cord.
  • Ensure smoke detectors are installed and batteries are changed twice a year.
  • Never smoke in bed or leave candles burning, even for a short time, in an empty room.
  • Make sure heaters are at least three feet away from anything that can burn, such as curtains, bedding, or furniture. Turn off space heaters when leaving a room.
  • Set the water heater thermostat no higher than 120°F to prevent scalding.
  • Have grab bars installed in the shower and near the toilet.
  • Put rubber mats in the bathtub to prevent slipping.
  • Consider a special tub/shower chair or raised toilet seat if there are difficulties with getting in and out of the tub, standing for long periods in the shower, or getting on or off the toilet.
  • Never try to heat the home with the stove, oven, or grill.
  • Place a carbon monoxide detector near all bedrooms, and test and replace the battery twice a year.
  • Keep all medications in their original containers to prevent mix-ups.
  • Ask the pharmacist to put large-print labels on medications to make them easier to read.
  • Take medications in a well-lit room so that labels can be easily seen.
  • Never mix bleach, ammonia, or other cleaning liquids together when cleaning.
  • Keep windows and doors locked at all times.
  • Never let a stranger into the home when they’re alone.
  • Talk over offers made by telephone salespeople with a friend or family member.
  • Do not share personal information, including Social Security number, credit card or bank information, or account passwords, when contacted by unknown individuals.
  • Always ask for written information about offers, prizes, or charities and wait to respond until the information has been thoroughly reviewed.
  • Do not feel pressured into making purchases, signing contracts, or making donations before discussing with a family member or friend.

(See Health in Aging Foundation, 2019.)

Depression screening is important in identifying social isolation in older adults. If clients feel lonely or isolated, they may benefit from assistance in increasing social contacts to prevent morbidity. Those who are depressed warrant appropriate intervention. Older adults should be encouraged to remain as productive as possible, engage in leisure activities, and maintain a sense of social connectedness in order to help prevent psychosocial problems and physical disability (Lenartowicz, 2022).

Tertiary Prevention

Tertiary prevention is designed to manage an existing, symptomatic, and typically chronic disease to prevent further functional loss. Older adults with the following chronic disorders can potentially benefit from tertiary prevention:

  • Arthritis to prevent progression or falls
  • Osteoporosis to prevent progression or fractures
  • Diabetes to prevent retinopathy, neuropathy, nephropathy, coronary artery disease, and foot ulcers or amputation
  • Vascular disorders to prevent disabling events such as myocardial infarction or stroke
  • Heart failure to reduce functional decline, hospitalization, and mortality
  • COPD to decrease the number and severity of exacerbations and the need for hospitalization (Lenartowicz, 2022)

As with the adult population, disease-specific care management programs are useful in addressing these disorders. Chronic care clinics and specialists may also be used with older adults. Interventions to address polypharmacy, mentioned earlier, are also considered tertiary prevention. Medication reconciliation is an excellent mechanism for preventing difficulties resulting from polypharmacy (Coppard et al., 2019).

Integration of Sociocultural and Linguistically Responsive Interventions for Older Adults

Integrating sociocultural and linguistically responsive interventions for older adults promotes health equity and improves health outcomes. This section has described the older adult population’s diverse ethnic backgrounds and recognized that health disparities exist among older adults, such as high rates of chronic diseases, particularly among older adults from certain racial and ethnic backgrounds. Access to care is often also impacted. While social isolation may be a significant concern for many older adults, it is particularly difficult for those from cultural minority groups. Additionally, older adults or their caregivers may have unique health needs related to their cultural backgrounds. By integrating sociocultural and linguistically responsive interventions, nurses can better address the needs of this population, improving their health outcomes and quality of life.

Sociocultural Interventions

Social connections and supports are essential for healthy aging, but these may be affected by the sociocultural environment, particularly a community’s values and beliefs. Howell (2020) performed a study to examine the relationship between the sociocultural factors that shape diet, physical activity, and nutritional status outcomes among Alaska Native and African American Alaskan older adults. The study found that participants’ diet and physical activity practices did not meet national recommendations. Howell (2020) also found that incorporating friends in interventions led to increased energy expenditure in participants, and family members influenced increased fruit consumption. Participation in cultural social events increased participants’ intake of fats and sweets. The media was also found to be a strong influencer of participants’ behavior, as 85.4 percent reported daily television watching, and was recommended as a way to reach older adults with socioculturally responsive programs to alleviate some of the barriers to healthy diet and exercise (Howell, 2020).

Older adults also frequently experience pain. Reis et al. (2022) described the importance of recognizing cultural factors’ influence on how individuals perceive, respond to, communicate, and manage pain. Pain education should be provided using different culturally appropriate examples, metaphors, images, and delivery methods. Reis et al. found that a culturally sensitive educational session require a good communicator who will listen to client concerns, recognize the legitimacy of their pain, and respect their culture, values, and preferences. Failure to do this negatively impacts the educational session. The nurse should assess a client’s beliefs about pain, as these may range from pain being a normal part of aging to being a punishment from a higher power for bad deeds. Reis et al. (2022) recommend using several different audiovisual aids, including those the client can take home to share with friends and family.

Linguistically Responsive Interventions

Language barriers can limit access to health care in any population. Older adults who speak a language other than English may face language barriers that limit their ability to understand their disease or even access health care services. The National Council on Aging (2022) spotlighted a senior center in Nebraska that served seniors with language barriers. The members of the Intercultural Senior Center (ISC) spoke over 15 languages, including Spanish, Korean, Nepali, Karenni, and Burmese, and ISC staff included individuals from at least 10 different countries who spoke a variety of languages. Specific services offered by ISC included linguistic and cultural accessibility, access to and navigation of legal and health services, transportation, and social engagement (National Council on Aging, 2022).

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