Assignment#4 Instructions

The purpose of this paper is to propose a plan for population specific health care. In order to accomplish this, assignment 4 integrates work from the previous 3 papers into: 1) A description of a population specific health problem and relevant theory to frame your health issue, 2) A community level assessment of the extent and context of the health problem based on the region/city/location you chose, 3) at least 2 metrics capable of assessing improved or declining health outcomes/trends in your patient population – PLEASE INCLUDE A COPY OF THE PEER REVIEWED TOOLS YOU USE IN AN APPENDIX, 4) potential individual and community level interventions that can be used to improve the problem within the population. Your interventions/recommendations must follow from the metrics you chose. For example, if you chose to measure nutrition with a metric, your intervention/recommendation should be how to improve nutrition based on the findings from your metric.
Be sure to incorporate the feedback you have received on the earlier papers to strengthen your overall product.
Make sure to add strong conclusion at the end of your paper.
15 pages of text, title page and references not included in page limit.

Rubric
Assignment #4
Assignment #4
Criteria Ratings Pts
APA Format
view longer description
Full Marks
2.0 pts No Marks
0.0 pts
2.0 pts
Integrated review of the literature with a clear description of the health concern in this patient population. Full Marks
3.0 pts No Marks
0.0 pts
3.0 pts
Paper is clearly written, flows logically and is grammatically and syntactically correct. Full Marks
1.0 pts No Marks
0.0 pts
1.0 pts
Clear plan to improve health/health care of population. Follows directly from the metrics chosen to measure changes/improvement/decline in health of patient population. Clearly incorporated what you learned from the “Targeted Health Outcomes” lecture into your plan. Full Marks
5.0 pts No Marks
0.0 pts
5.0 pts
Clearly reviewed previous assignments and rewrote 1, 2, 3, or all of previous assignments based on these comments. Integrated assignments 1, 2, and 3 in this paper in a logical fashion. Full Marks
3.0 pts No Marks
0.0 pts
3.0 pts
Theoretical perspective clearly noted, explained, and it is an appropriate theory for the population and research question of concern Full Marks
2.0 pts No Marks
0.0 pts
2.0 pts
At least 2 metrics to measure outcomes/progress in your patient population. At least one of these metrics are from a peer-reviewed scientific paper, a physiological, behavioral, or self-report tool with validity and reliability statistics. Other metric can be clinical. Have attached your peer-reviewed tool. Full Marks
4.0 pts No Marks
0.0 pts
4.0 pts
Provide relevant percentages, numbers, and/or means to describe the magnitude of the health concern or issue or potential issue based on changing demographics from your chosen region/community. Full Marks
5.0 pts No Marks
0.0 pts
5.0 pts
Total Points: 25.0

PLEASE FIND BELOW PREVIOUS ASSIGNMENTS #1, 2. & 3

Assignment #1
For any population, there are certain health risks and conditions that may can be greater or more prevalent. The purpose of this assignment is to focus on a specific population, health risks, correlating factors, and a specific health problem. In order to accomplish this, there are four parts of information that will be provided. The first section will identify and describe the population of focus. In the second section, the health risks for this population will be described. Third, the factors that increase or decrease the risks for this population will be identified. Finally, in the fourth section, a specific health problem for this population will be identified and described.
Population
The population of focus will be the elderly, and the location will be in Harford County, Maryland. In this county in Maryland, there were an identified 15.1 percent of residents who are elderly, which accounts for those who are 65 years of age and older, in 2015. This 15.1 percent of elderly residents was an increase from just five years prior. According to research from the 2010 census, there were 12.5 percent of the Harford County residents who were 65 years old and older (Census.gov, 2016).
Health Risks
Because the elderly are weaker and have weaker body systems than those who are younger, there are several health risks that they face. One of these health risks is arthritis. Arthritis is a rheumatic condition that “…can affect the joints and surrounding connective tissues (muscles, tendons, and ligaments). These conditions are usually characterized by pain, aching, and stiffness in and around the joint” (Hootman et al., 2012, p. 426). Arthritis is noted to be the leading cause of disability in the elderly (Hootman et al., 2012).

Another health risk for the elderly is falls. For the elderly, it is important to note that there are several reason why the falls occur. One of the reasons why the elderly can be more likely to fall is medication. What this means is that there are certain medications that can make an elderly person more disoriented, and such disorientation can cause the elderly person to fall after taking the medication (Huang et al., 2012).
When an elderly person falls, there are more health risks that can result because of the fall. One of the categories of health risks associated with the effects of a fall is the group known as urological implications. These urological implications can include things like nocturia and prostatic hyperplasia (Schimke & Schimke, 2014).
Factors
There are several risk factors that can increase the chances of an elderly person falling. One of the risk factors is age. What this means for the elderly is that the older that they get, the more likely they are to fall. This occurs because there are more health problems and conditions that can compromise an elderly person’s ability to stay steady and to not fall over. This can be the result of neurological conditions, disorientation, and weak bones, to name a few (Schimke & Schimke, 2014).
A second risk factor that can make an elderly person more likely to fall is gender. According to research, women are more likely to fall than men. A third factor is a person’s style of walking. Research indicates that a person with an abnormal gait is more likely than others to fall. A fourth factor is vision. If a person has impaired vision, that person is going to be more likely to fall. A fifth risk factor is cognitive decline, as there is a negative correlation between cognitive state and a person’s likelihood of falling. This negative correlation means that the more the cognitive state declines, the more likely it is that person will fall. On the other hand, the better or higher cognitive state the person is in, the less likely he or she is to fall (Schimke & Schimke, 2014).
A sixth risk factor is nocturia, which refers to urinating at night. For this condition, a person would have to continually get up to go to the bathroom. The greater number of times that a person has to get up to go to the bathroom, the more likely it is that the person will fall. Especially at night, when a person wakes up to go to the bathroom, there can be greater disoriented the person is going to be, and the more disoriented, the greater the chances that the person will fall (Schimke & Schimke, 2014).
A seventh risk factor for the elderly that increases that person’s chances of falling is the history of falls. What this signifies is that if a person has fallen, it is more likely that the person will fall again. For a person who does not have a history of falls, it is less likely that the individual will fall (Schimke & Schimke, 2014).
Specific Health Problem
A specific health problem that exists for this population is falling. Therefore, the health problem of falls within this elderly population will serve as the focus for this report and all of its subsequent parts. Falls in the elderly could include anything from an elderly person tripping over something or simply losing his or her bearings and grip and falling to the floor. Falls in the elderly are especially problematic because they can cause severe injury and can even result in death.
Even though falls are common and a prevalent problem in the population of the elderly, there are some who are more at risk than others. The way that I would identify cases of people who are especially at risk is
References
Census.gov. (2016). QuickFacts: Harford County, Maryland. United States Census Bureau. Retrieved from https://www.census.gov/quickfacts/table/PST045215/24025
Hootman, J. M., Helmick, C. G., & Brady, T. J. (2012). A public health approach to addressing arthritis in older adults: The most common cause of disability. American Journal of Public Health, 102(3), 426-433.
Huang, A. R., Mallet, L., Rochefort, C. M., Eguale, T., Buckeridge, D. L., & Tamblyn, R. (2012). Medication-related falls in the elderly. Drugs and Aging, 29(5), 359-376.
Schimke, L. & Schimke, J. (2014). Urological implications of falls in the elderly: Lower urinary tract symptoms and alpha-blocker medications. Urologic Nursing, 34(5), 223-229.

#2

Running head: Assessing the Community Context and Significance

ASSIGNMENT#2

Assessing the Community Context and Significance

Assessing the Community Context and Significance
Whenever there is a population that is living in a city, state, or region, it is imperative that there be adequate resources available for that population. The purpose of this report is to analyze a specific population in a certain region in the United States. The population of focus will be the elderly, and the location will be in Harford County, Maryland. For this population, there are five areas of information that will be provided. The first section will provide a description of the community, which is Harford County, Maryland. In the second section, there will be a demographic description of the population of the elderly in Harford County. Third, there will be a discussion of the opportunities and challenges associated with the elderly receiving care in Harford County. Fourth, there will be a discussion of the extent of the health problem that has been chosen for this community. The health problem of focus will be falls in the elderly population. Finally, the fifth section will explain how the environment in Harford County increases or decreases risk for this population.
Description of Community
There is various demographic data on Harford County, Maryland. The population for Harford County, Maryland, in 2015 was 250,025. This population for this county is predicted to increase into 2020 and 2025. According to projections, the population for 2020 is projected to be 258,670. The population for 2025 is projected to be 265,100 (HarfordCountyMD.gov, 2015). In the population as of 2015, the breakdown of age groups is important. According to research, 22.7 percent of the population in Harford County was people 18 years old and younger. This was a decrease of nearly two percent, down from the 24.7 percent of Harford County population of those who were 18 years old and younger. Of the entire population, 15.1 percent was 65 years of age and older. This was an increase of nearly 3 percent, up from the 12.5 percent of those 65 years of age and older that lived in Harford County in 2010 (Census.gov, 2016).
The majority of people living in Harford County, Maryland are educated. According to research, 92.9 percent of the county’ residents age 25 and older between the years of 2010 and 2014 were high school graduates. Also during this same period for those 25 years of age and older, 33.4 percent had a bachelor’s degree or higher (Census.gov, 2016).
To correlate with the population, there were 93,358 households in Harford County, Maryland in 2015. The projected number of households in 2020 is 97,892, and the projected number for 2025 is 101,689. Additionally, the median household income for Harford County, Maryland between 2009 and 2013 was $80,622 (HarfordCountyMD.gov, 2015).
Description of Population Living in Community
The population of focus is the elderly. According to research, 15.1 percent of the residents in Harford County, Maryland were 654 years of age and older, thus qualifying them as elderly (Census.gov, 2016).
Opportunities and Challenges to Receive Care
In Harford County, Maryland, there are several opportunities and challenges that are associated with the elderly population receiving care.
Opportunities
One set of opportunities for the elderly receiving care in Harford County, Maryland consists of the resources that are available to or accessible for them. In even just a preliminary research, there are ample resources that can be found. Some of the resources are as follows: American Association of Retired Persons (AARP), Adult Day Care Services, Bel Air Workforce Center, Chimes, Family and Children’s Services of Central Maryland, Getting There Ride Share, Gilchrist Hospice Care, Harford Community College, Harford County Office on Aging Department of Community Services, Harford County Office on Aging Senior Activity Centers, Harford Transit LINK, Hospital Outreach Program (HOP), Legal Aid Bureau Maryland Senior Legal Hotline, Legal Air Bureau Sixty Plus Legal Program, Maryland Foundation of Dentistry for the Handicapped, Maryland Pharmacy Program, Meals on Wheels, Medicaid Long-Term Care Program, Medical Assistance Transportation, and Senior Citizen Meal Programs (HarfordCountyMD.gov, 2015).
In Harford County, there are various facilities that the seniors can go to receive care and services. In terms of hospitals, there are UM Upper Chesapeake Hospital, UM Harford Memorial Hospital, and UMD Center for Diabetes and Endocrinology. There are also three senior centers: McFaul Activity Center, Highland Senior Citizens Center, and Edgewood Senior Activities Center (HarfordCountyMD.gov, 2015).
With the number of facilities and organizations that are available for seniors to receive care and treatment, it is up to either the seniors or a loved one of these individuals to find the resources. If the seniors do not know about the resources, then there is no way for them to effectively use them. But, if they are aware that these facilities and organizations exist, then can utilize them regularly. In addition to these numerous resources that are available to the elderly population to receive care, there is another opportunity that exists. This additional opportunity is that there can be more facilities established that are more of a one-stop shop for seniors. For example, there can be facilities just for seniors that provide them with a variety of services, such as health exams and dental services. If these services are just for seniors and are located in one facility, it can be easier for seniors to go and get all the services they need.
Even though there are numerous resources available to the seniors to receive care, there are also problems that exist in association with them. One of the major problems is transportation, meaning how the seniors get from point A to point B (Census.gov, 2016). There is a transportation service that the seniors can use so that they do not have to rely on friends or a family member to take them wherever they have to go, but some of the seniors may not even know that such a transportation service exists. Other seniors may know that the transportation service exists, but they just may not feel comfortable with a stranger or someone they do not know taking driving them where they have to go (Census.gov, 2016). .
A second problem that exists in association with the resources that are available is the cost. Of course, there is Medicaid, which can pay for many or most of the services that the seniors need, but Medicaid does not pay for everything. Therefore, whatever Medicaid or the health insurance company does not cover, the seniors will be responsible for paying for the treatment or services out of their own pockets. This can become very expensive for them. And, what makes this even worse is that most seniors do not have a source of income, for many of them are out of work and are retired.
Extent of Health Problem
As stated in the introduction, the problem of focus is patient falls in the elderly. This health problem is a very important one for this population. The reason why it is such a large problem is that, based on research findings, millions of senior citizens fall each year. Of those who fall, less than half are found to tell their doctors. Additional research indicates that once a person falls, especially a senior, that individual is twice as likely to fall again (CDC.gov, 2016).
In addition to patient falls being a major problem in the senior population because of the number of falls that occur in this population each year, there are other reasons. One of the reasons why the problem is so major is that when members of the elderly population fall, they are more likely than a younger person to have broken bones or head injury. Furthermore, research indicates that 2.8 million seniors are admitted to the Emergency Room (ER) each year for injuries related to falls (CDC.gov, 2016). In addition to ER visits, more than 800,000 senior patients are hospitalized each year because of head and other injuries from falls. There are also 300,000 seniors who are hospitalized each year for hip injuries related to falls. Statistically is understandable in conjunction with the research finding that 95 percent of hip fractures are (CDC.gov, 2016, p. 1). Moreover, in the year 2014, reported falls nationwide with injuries were 147,314 (CDC.gov, 2016).
Risks
Because older adults can be likely to fall, it is important to know what puts them at greater risk for falls. Research indicates that risk factors for falls in seniors include environmental hazards, stairways without handrails, dark & cluster hallways, area rugs, wet surfaces, having cognitive impairment, certain medications cause dizziness, computer cords and phone wires being waking pathway (NIH.gov, 2016). An older adults living at home faces many challenges for fall especially when no relatives or support system near bye. Some of those challenges that may cause them to fall are unarranged furniture, bathroom without grab bars, not having on non-skid stocks, trying to reach for things that are not in reach (NIH.gov, 2016). In addition, there are some seniors with weak (osteoporosis), acute or chronic health conditions and alcohol intoxication will trouble balance and causes fall for those older adults who drink (NIH.gov, 2016).
References
CDC.gov. (2016). Important facts about falls. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
Census.gov. (2016). Quick Facts: Harford County, Maryland. United States Census Bureau. Retrieved from https://www.census.gov/quickfacts/table/PST045215/24025
HarfordCountyMD.gov. (2015). Data & demographics. Harford County, Maryland. Retrieved from https://www.harfordcountymd.gov/564/Data-Demographics
https://www.nia.nih.gov/health/publi https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm#T2_downcation/falls-and-fractures
ASSIGNMENT #3

ASSIGNMENT # 3
Health Outcome Metrics for Older Adults at Risk of Fall

Health Outcome Metrics for Older Adults at Risk of fall
Falls and related risks remain an important impediment to the quality of life among the elderly in Harford County, Maryland. An intervention targeting reduction in falls among this demographic group must use evidence-based strategies of measuring its outcomes. As indicated in my previous assignments, the focus of the paper is of falls among the elderly. When analyzing the effect of an intervention for a specific population, it is essential to use standardized metrics. The following tools can be used to the assess risk of falling among the elderly.
Morse Fall Risk Scale
This 6-item index is used to identify risk of falling among the elderly. Although it is mostly used in assessing risks of falls among hospitalized individuals, it can also be used to assess the risks in home dwelling adults. The index consists of six items including, mental status, and gait, use of intravenous therapy, ambulatory aids, secondary diagnosis and fall history. The score can range from between 125 and 0, with a score of more than 16 being an indicator of high fall risk (Yoost & Crawford, 2015, p. 595). Adults who score high on the scale are likely to have a high risk of falling. Therefore, a reduction in the scoring represents better health outcomes. The evaluation can be conducted weekly or monthly to determine the progress of the patient. Validity and reliability of the instrument has been established, with the interrater reliability score being 0.96. Sensitivity and specificity is around 79% and 50% respectively (Yoost & Crawford, 2015). Thus, the item should be coupled with other instruments during risk assessment due to its low specificity (Foster & Prevost, 2012).
The Hendrich II Fall Risk Model
The Hendrich II Fall Risk Model is mostly administered to determine the risk of falling based on known fall risks. These risks include medications, dizziness symptoms, emotional status, mental status and gender (Foster & Prevost, 2012). The instrument is essential for assessing primary causes of falls and development of programs to reduce risk of secondary falls. It comprises of 11 items that are differently scored by the evaluator. It also consists of a balance and gait items designed to determine the risk of falls. When scoring, a score greater than five indicates high risk of falls. Positive health outcomes can be indicated by a decrease in total score. The tool is administered after a fall to determine the risk factor for consequent falls. It is highly specific and sensitive with scores of 73.9% and 74.9% respectively. The relationship between the items on the scale and risk factors is statistically significant (p<0.0001) (Foster & Prevost, 2012, p. 45).
Timed Up and Go Test
Another test that can be used to identify elderly people with high fall risk is the Timed Up and Go Test. An evaluator times (seconds) a patient when performing various maneuvers. The first maneuver involves “sitting, standing, walking three meters, turning around, walking back, and sitting again (Barry, et al., 2014, p. 12).” The second maneuver involves counting selected numbers backward while performing the first maneuver. The third maneuver requires a person to complete the first task while holding a cup full of water (Barry et al., 2014). The more time one takes to complete the tasks means that the person is more dependent and therefore at a high risk of falling, as functional mobility is correlated with task completion time. A decrease task completion time indicates that the health outcome of the patient is increasing. The test has a high interrater reliability (r=0.99), high specificity (87%) and high sensitivity (87%). Thus, the instrument can be used to identify elderly people who at high risk of falling (Barry et al., 2014).
Potential Individual and Community Changes to Reduce Falls
Interventions to reduce severity and number of falls among elderly in Harford County, Maryland, depend on the risk factors. In most cases psychotic medications, muscle weakness, fall hazards and age are some of the most important risk factors (Verma et al., 2016). The most important individualize intervention is exercise (Cannard, 2011). Exercise programs can be implemented to improve muscle strength in the elderly. This may involve the incorporation of exercise interventions such as Tai Chi that strengthens muscles. Other interventions include reduction in intake of anti-psychotic drugs, provision of vitamin D supplements and removal of fall hazards from the homes of the elderly. Fall rates can also be reducing by conducting comprehensive screening, fall education followed by interventions to remove hazards (Cannard, 2011). Educating elderly and family member about falls and having volunteers run errands for the elderly so that they do not have to do them themselves and using assistance device to walk are some intervention to reduce falls (CDC.gov, 2016)

Conclusion
With every intervention, there is a need for evaluation to determine the effectiveness of the intervention. As indicated earlier, the current paper was concerned with assessing health outcomes among elderly people, in relation to falls and risk of falling. Three items were identified, the Morse Fall Risk Scale, the Hendrich II Fall Risk Model and Timed Up and Go Test. These three tools have high levels of reliability and validity and can successfully assess fall risk among elderly living in assisted care facilities and community dwellings.
References
Barry, E., Galvin, R., Keogh, C., Horgan, F., & Fahey, T. (2014). Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatrics , 4 (14), 1-14.
Cannard, G. (2011). Fall prevention for older people: A survival guide. London, UK: Paragon Publishing.
Foster, J., & Prevost, S. (2012). Advanced practice nursing of adults in acute care. New York: FA Davis.
Verma, K., Willetts, J., Corns, H., Marucci-Wellman, J., Lombardi, D., & Courtney, T. (2016). Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States. PLOS ONE , 11 (3), e01150939.
Yoost, B., & Crawford, L. (2015). Fundamentals of nursing: Active learning for collaborative practice. New York: Elsevier Health Sciences.
https://www.cdc.gov/steadi/pdf/steadi_pocketguide_1in4-a.pdf

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