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wk 1

· Briefly describe your community and then describe your practice setting.

· What are the determinants of health in your community? (https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health)

· What are the most prevalent health problems in your community or in your practice?

· Choose a population at risk and describe the health problem specific to that population. Remember that you will have to define the population’s age, culture, religious beliefs, foods, and traditions eventually as your project progresses.

I live in a small community located in northwest metropolitan Atlanta, Georgia. The population as of 2019, was 21,760 people. The breakdown of the population is 31% under the age of 18, 14.9% 65 years or older, 51.2% are women. 73% White, 20.8% Black/African American, 12.7% Latino/Hispanic. I am currently practicing at a privately owned hospice company where we provide services to adult patients in their homes and facilities in North Georgia.

Race is a major social determinant of health. African Americans have a higher rate of significant health problems and functional limitations. Economic resources are also a social determinant of health. As poverty increases, mortality rates increase. Economic resources are also needed to provide basic needs such as housing and food, and is required to obtain health care and medications. Social isolation and loneliness also are social determinants that have profound effects, especially during the COVID 19 pandemic.

As a hospice nurse, the majority of my patients are the geriatric population and the population at risk I am choosing to focus on for this project. The most prevalent health problems include heart disease, respiratory diseases, stroke, cancer, diabetes, and dementia. Depression is also a problem that occurs, leading to increased suicide rates of the geriatric patient. Injuries or death related to falls is a perpetual problem in the elderly. Malnutrition is widespread and seen in nearly every older patient, which is related to access to food, decreased physical ability to shop, cook, or eat. Malnutrition could also happen due to other comorbid conditions that the senior has such as dementia.

References

U.S. Census Bureau QuickFacts: Cartersville city, Georgia. (n.d.). Www.Census.Gov. Retrieved September 7, 2020, from https://www.census.gov/quickfacts/cartersvillecitygeorgia

Equity and Social Determinants of Health Among Older Adults | American Society on Aging. (n.d.). Www.Asaging.Org. Retrieved September 7, 2020, from https://www.asaging.org/blog/equity-and-social-determinants-health-among-older-adults#:~:text=Race%20long%20has%20been%20known%20to%20be%20a

10 common elderly health issues - Vital Record. (2018, June 25). Vital Record. https://vitalrecord.tamhsc.edu/10-common-elderly-health-issues/

Wk 2

· Describe the specific health problem and population you have selected.

· What data did you find to support your decision? Help each other further refine and clarify the problem and population.

· What useful health data and public health websites did you locate to support your position?

· What other evidence did you find? You can include scholarly articles in this discussion.

By Day 4

According to the CDC (FastStats - Hypertension, 2019), 63.1% of adults age 60 and over have high blood pressure, which is three times higher than adults aged 20-44. Georgia ranks #33rd in the nation. (Explore High Blood Pressure in the United States | 2019 Annual Report, n.d.). High blood pressure is one of the leading risk factors in heart attack and stroke.

As a person ages, the size of the liver decreases, and the blood flow is reduced, which reduces how quickly the liver metabolizes medication. Kidney size is reduced, and blood flow is less, resulting in low renal clearance (Beers Criteria: Some Medications to Avoid in the Elderly, 2012). Because of these physiological changes, controlling blood pressure in geriatric patients can be challenging. Cognitive impairments due to age-related dementia can result in medication noncompliance and not being able to recognize symptoms of hyper/hypotension. Physical limitations result in difficulty going to regular doctor appointments, regular physical activity, and not being able to cook a healthy heart diet, all leading to uncontrolled blood pressure.

The geriatric patient needs to be closely monitored due to drug sensitivity. Because of increased sensitivity to medication, orthostatic hypotension is a significant concern for the elderly population. Orthostatic hypotension can result in falls, syncope, or death. (Arik & Yavuz, 2014)

In looking for information for this discussion, I utilized Google Scholar for my search engine. I found much of my statistics through CDC website.

References

ARIK, G., & YAVUZ, B. B. (2014). Hypertension in Older Adults-Geriatrician Point of View. Journal of Gerontology & Geriatric Research, 03(05). https://doi.org/10.4172/2167-7182.1000182

Beers Criteria: Some Medications to Avoid in the Elderly. (2012). Tmc.Edu. https://www.uth.tmc.edu/HGEC/GemsAndPearls/medications_BeersCriteria.html

Explore High Blood Pressure in the United States | 2019 Annual Report. (n.d.). America’s Health Rankings. Retrieved September 13, 2020, from https://www.americashealthrankings.org/explore/annual/measure/Hypertension

FastStats - Hypertension. (2019). https://www.cdc.gov/nchs/fastats/hypertension.htm

Wk 3

· Provide a few examples of community resources that should be put in place to assist your population in resolving their health care needs. What gaps in service do you see that affect your population?

· Are there any cultural considerations that might inform your approach to caring for this population?

· Does your population have a genetic predisposition to the health care problem you have identified?

· Identify at least one evidence-based, culturally competent behavior change that would promote health for your selected population and for the specific health care problem you are addressing?

In looking for information for this discussion, I utilized Google Scholar for my search engine. I found much of my statistics through CDC website.

References

ARIK, G., & YAVUZ, B. B. (2014). Hypertension in Older Adults-Geriatrician Point of View. Journal of Gerontology & Geriatric Research, 03(05). https://doi.org/10.4172/2167-7182.1000182

Beers Criteria: Some Medications to Avoid in the Elderly. (2012). Tmc.Edu. https://www.uth.tmc.edu/HGEC/GemsAndPearls/medications_BeersCriteria.html

FastStats - Hypertension. (2019). https://www.cdc.gov/nchs/fastats/hypertension.htm

Wk 4

· dentify one evidence-based behavior change that would promote health in your selected population.

· Suggest one specific culturally sensitive, evidence-based, measureable intervention to address the health problem for your selected population.

· Think in terms of measuring outcomes. What outcomes would you expect to see once the intervention(s) are in place? Be specific.

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High blood pressure is a global public health issue. About 40% of people globally are estimated to have hypertension. The World Health Organization’s (WHO) global brief on hypertension states that 9.4 million deaths yearly are linked to hypertension complications (Lu, Tang, & Wang, 2015). High blood pressure increases the risk of heart attack and stroke. The elderly are at a high risk of having hypertension and thus need healthcare interventions to prevent and manage their blood pressure.

People need to adopt healthy lifestyles to prevent and manage hypertension. I would recommend the geriatric population to go for the DASH eating plan. Healthy meals and snacks, fruits, and vegetables imply taking foods rich in fiber, potassium, protein, low sodium, and low saturated fats. By making these healthy changes, the geriatric population can keep their blood pressure low and protect against other chronic diseases such as heart disease and stroke. The DASH eating plan is a key component of a heart-healthy lifestyle. It can be combined with other lifestyle changes such as physical activity to control an individual’s blood pressure and LDL-cholesterol for life (Anna, Morze, Mariusz, & Eufemia, 2020).

The top culturally sensitive intervention to address health problems of the elderly would be to ask the patient the preferred language and provide an interpreter service in the preferred language for any teaching (American Geriatrics Society, 2016). I would also identify the education level, cognition, and hearing acuity of the elderly patient to ensure understanding and determine if they will make their own decisions. When care is customized to a patient’s language and cultural preference, there is a higher possibility of obtaining positive health outcomes for the diverse population.

The expected outcomes for the geriatric patient include; increase in the proportion of older adults with normalized blood pressure, high blood pressure-related knowledge score, and adherence to healthy lifestyles. An increase in the percentage of older adults with normalized blood pressure would suggest a positive health outcome in hypertension management among the elderly population (Lu, Tang, & Wang, 2015). As a result, the percentage of the elderly population at the risk of hypertension or with hypertension would have reduced. A high score in hypertension-related knowledge would suggest that most of the elderly population understands the health problem and ways of managing it. Hence, there will a reduced number of older adults who are less at a risk of developing hypertension or having uncontrolled hypertension.

References

American Geriatrics Society . (2016). Achieving High-Quality Multicultural Geriatric Care. Journal of the American Geriatrics Society , 64 (2), 255-260.

Anna, D., Morze, D., Mariusz, P., & Eufemia, P. (2020). Association of the Dietary Approaches to Stop Hypertension, Physical Activity, and Their Combination with Semen Quality: A Cross-Sectional Study. Nutrients , 12 (1), 39-40.

Lu, C., Tang, S., & Wang, P. (2015). Community-based interventions in hypertensive patients: a comparison of three health education strategies. BMC Public Health , 15 (33), 1401-1406.

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HI Leslie,

Great job on your post. I like that you were specific and discussed the DASH diet for this population, a great choice. I agreed, I think with any population language and cultural considerations are important but with the elderly we do need to add hearing and cognition and not only determine if they will make their own decisions, but are they able to.

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