1 Running head: WOMENS HEALTH: 55 YEARS AND ABOVE

Womens Health: 55 Years of Age and Above Health Promotion Group #14: Brittney Kortz, Melissa Legowski, and Tanzi Tayyab Old Dominion University

Submitted in partial fulfillment of the requirements in the course Course # PT895: Topics in Physical Therapy I in the School of Nursing Old Dominion University NORFOLK, VIRGINIA Spring, 2014

WOMENS HEALTH: 55 YEARS AND ABOVE Womens Health: 55 Years of Age and Above A great portion of the healthcare focus today is on prevention. Providing people with knowledge so they are better equipped to make smarter choices for their well-being can ensure healthier lifestyles and prevent many diseases. This presentation will focus on health promotion of women ages 55 and above. The growing number of older women in the United States places a burden on the current health care system and new ways to improve health outcomes must be provided (Hain, 2013). It is important to focus on educating women during this transitional stage in their lives to increase their quality of life and minimize preventable diseases. The following health promotion proposal will include a description in the roles of each project coordinator, the program content, delivery method, and an evaluation of the program. Description of Roles Brittney Kortz is a Doctor of Physical Therapy student, Melissa Legowski is a Womens Health Nurse Practitioner student (WHNPs), and Tanzi Tayyab is a Family Health Nurse Practitioner student (FNPs). A Physical Therapist (PT) can diagnose and treat health-related conditions in people of all ages that limit their abilities to move and perform functional activities in their daily lives (APTA, 2014). A PT can help the target population by providing information to help improve movement and strength while decreasing pain and disability. A WHNP specializes in health promotion and maintenance for females from adolescence through menopause and beyond (Wysocki, 2013). The WHNPs role directly relates to the target population of women ages 55 and above and is an asset project team member. A family nurse practitioner can diagnose and manage acute and chronic conditions and emphasize health promotion and disease prevention (Nurse Practitioners, 2014 ). An FNP can aid the targeted population with general health issues.

WOMENS HEALTH: 55 YEARS AND ABOVE Program Content The program content will include risk factors related to menopause/postmenopause, general screening, nutrition, general physical activity, fall prevention, and bone health. Tools for measuring knowledge, questionnaires, and interactive activities will also be incorporated. Melissa Legowski will discuss the risk factors of menopause/post menopause, Tanzi Tayyab will explain general screening and proper nutrition, and Brittney Kortz will cover physical activity, fall prevention, and bone health specific to women ages 55 and older. Menopause is a normal physiologic change women encounter anytime between the ages of 50-60 years old or it can be induced by medication or surgery at earlier ages (Alexander & Andrist, 2013). Women ages 55 and above are either currently affected by menopause or are experiencing postmenopausal risks (Alexander & Andrist, 2013; Schuiling & Low, 2013). Women will be encouraged to discuss menopause with their healthcare providers and request diagnostic testing to rule out other possible causes of the absence of menses (Alexander & Andrist, 2013). The signs and symptoms of menopause will be discussed, including hot flashes, sleep disruptions, vaginal dryness, changes in sexual function, moodiness, headaches, and night sweats (Alexander & Andrist, 2013). The hormonal changes women encounter with menopause and decreased mobility/functioning with advanced age increase the risk of osteoporosis, cardiac disease, and depression (Juve, 2013; Hain, 2013). The topic of depression will be discussed and women will be encouraged to fill out the Patient Health Questionnaire (PHQ-9) depression tool to find out their depression score (Juve & Schadewald, 2013). They will be advised to contact their health care provider if they select 4 or more boxes in the shaded area and they will be encouraged to fill it out again in 2 weeks to recheck their score. Women with late menopause (after 55 years of age), genetic factors (BRCA1, 2 mutations), and a family history of breast

WOMENS HEALTH: 55 YEARS AND ABOVE cancer have an increased risk of developing breast cancer (Aliotta & Schaeffer, 2013). According to the American College of Obstetricians and Gynecologists, breast awareness through self-breast exam (SBE) and annual mammograms should occur at ages >40 years (Christinsen-Rengel, 2013). Women will be counseled regarding the breast screening recommendations and they will be encouraged to visit the following website to calculate their own risk for breast cancer: http://www.cancer.gov/bcrisktool/. Breast awareness, SBE, and the risks versus benefits of SBE will be discussed. Moving on, a family nurse practitioner can provide vital information for women 55 and older about their everyday activities. Some of these activities are as simple as cooking, grocery shopping and dining out. As mundane as these activities may seem, making the right choices with nutrition can help women prevent obesity, diabetes and heart disease, which is the number one killer of women today (Go red for women editors, 2014). The following nutritional information is recommended by the American heart association 2014 for adults consuming 2,000 calories daily. Per day it is recommended to have at least 4.5 cups of fruits and vegetables and at least three 1-ounce servings of fiber rich whole grains. Per week it is recommended to have at least 3.5- ounce servings a week of fish and at least 4 servings of nuts, legumes and seeds. Other dietary aspects to consider are to keep sodium less than 1,500 mg a day, not to consume more than 450 calories of sweetened beverages a week, not have more than two servings of processed meats a week and make sure saturated fat does not comprise more than 7 percent of total calorie intake (Go for red editors, 2014). These guidelines should assist in making better nutritional choices whether it is while preparing meals or dining out. Another important aspect for women 55 and older is screenings for possible disease. Preventative care is the key to staying healthy. Regular checkups and screening is important so

WOMENS HEALTH: 55 YEARS AND ABOVE that if there is a problem it can be handled early with a higher chance of positive results. Routine checkups that cover regular physical exams and screenings like body mass index and blood pressure should be done annually. There are different time periods to screen for cancers as well. To screen for colorectal cancer, starting at age 50 a colonoscopy should be done every 10 years or an annual fecal occult blood test (Preventive Screening, 2014). To screen for skin cancer an annual skin exam should be done at the discretion of the provider. Prevention methods should be in place like applying sunblock daily to protect the skin and keeping skin covered as much as possible while in the sun. Bone mass density exam should be considered and discussed with the provider especially after menopause. Eye exams to test for glaucoma should be done every 2-4 years and then every 1-2 years starting at age 65 (Preventive Screening, 2014). Hearing and vision testing should also be done at the discretion of the provider or sooner if a problem is noted. Immunizations are another important way to prevent illness. The flu shot should be given annually, pneumococcal should be once after 65 regardless of whether there was a previous one, a booster for tetanus and diphtheria should be given every 10 years and 3 doses are needed if there have been no previous immunizations (Preventive Screening, 2014). The Physical Therapist will provide tools and discuss the importance of engaging in regular physical activity for women over 55 in order to slow the natural process of aging and prevent disability. The effects of aging on the musculoskeletal system will be discussed, including bone loss, decreased muscle mass, impaired functional mobility, and increased risk of falls. It is important for women over age 55 to avoid inactivity and participate in some form of physical activity to improve quality of life and decrease the risks associated with early death, cardiovascular disease, stroke, high blood pressure, type 2 diabetes, breast cancer, falls, and depression. (US Dept of HHS, 2014). Guidelines suggest that adults over 55 should engage in a

WOMENS HEALTH: 55 YEARS AND ABOVE minimum of 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic activity per week, such as walking or swimming. Older adults should also engage in strength training exercises 2 or more days per week and perform exercises to improve balance and coordination at least 3 times per week in order to prevent falls (US Dept of HHS, 2014). The rate of perceived exertion (RPE) scale will be provided and discussed so that individuals with and without disabilities can determine their exercise intensity. Before beginning an exercise program, individuals should consult their physician to determine if it is safe. Another important aspect for women over the age of 55 is the prevention of falls and subsequent injury, such as fractures. To screen for falls risk, individuals will be encouraged to take the Activity-Specific Balance Confidence (ABC) Scale provided on the website to measure balance confidence. A thorough falls risk assessment can be performed at the discretion of the provider (Lajoie & Gallagher, 2004). Additional steps can be taken to decrease falls risk by making the home environment safe, such as getting rid of throw rugs, having adequate lighting, and keeping the floors clear of clutter to prevent tripping. After age 50 degenerative changes occur more rapidly in joints, causing pain and abnormal bone formation that can result in limited motion (Irion & Irion, 2010). Bone mass declines at a faster rate following menopause, which can lead to osteoporosis and an increased risk of fracture. Women should take steps to reduce risk of osteoporosis, including increasing physical activity, stop smoking, and decreasing alcohol intake. Signs/symptoms associated with osteoporosis are a loss of height, pain in the ribs, shortness of breath, protruding stomach, and incontinence during certain activities. Women over 55 should avoid high impact sports, such as football and soccer, and running and jumping exercises. The highest number of fractures occurs with activities that involve bending, twisting, and lifting, so body mechanics will be discussed.

WOMENS HEALTH: 55 YEARS AND ABOVE Delivery Method The program being offered will try to reach as many women ages 55 and older across the country. With this in mind the delivery method of our presentations will be through a video embedded on our website marketed through social media (eg., facebook and twitter). The website will also have a search engine, easy to read text, and large print. The clientele at the distance practice will be able to access the website at any time and view the educational videos. The equipment needed to participate in the program would be any computer, cellular phone or electronic tablet that has a picture, sound and internet ability. Since there is a wealth of knowledge to be shared, the program will continue on a long term basis and offer different topics every week. For example, each of our multidisciplinary providers will rotate every 3 weeks, presenting one topic at a time. The videos will show demonstrations and activities to that will help the audience understand the information better. There will also be a message board for participants to communicate with us through the website. Evaluation of the Program The effectiveness of the program will be evaluated by using the pre-test and post-test questionnaire. The questionnaires will include 5 questions. Individuals will be prompted to take the pre-test questionnaire upon entering the website to determine their current knowledge related to a healthy lifestyle. They will not be able to access the website unless they take the questionnaire. The pre-test will be promoted to ensure individuals will want to by saying, Test your knowledge about living a healthy lifestyle. What is your score? The effectiveness of the program can also be evaluated through the comment section of the website. The number of individuals leaving comments on the website can help determine the usefulness of the website.

WOMENS HEALTH: 55 YEARS AND ABOVE Overview of Our Experience/Communication Technology According to IPEC (2011), it is important to have effective interdisciplinary communication and knowledge of the roles of other professions. It was learned that the WHNP targets womens health, the FNP focuses on general health, and the PT specializes in mobility. If each profession worked separately, then patients would not receive the care they deserve--it is a reciprocal relationship among all members of the team. The technologies used for distance communication were blackboard blog, email, teleconferencing, google chat, texting, and google shared documents. It was unanimously agreed that google shared documents was an outstanding way for simultaneously updating the project while keeping other team members up-to-date. Teleconferencing was a quick and easy way to communicate; however, it was disappointing that video-conferencing was not an option of the utilized method. Overall, this team enjoyed working together, learned more about each other's professions, and communicated effectively/respectfully with the appropriate use of distance technology.

WOMENS HEALTH: 55 YEARS AND ABOVE Honor Code I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected viloators of the Honor Code. I will report to a hearing if summoned. Names: Brittney Kortz, Melissa L. Legowski, and Tanzi Tayyab Electronic signatures: Brittney Kortz/Melissa Legowski/Tanzi Tayyab Date: 23 March 2014

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WOMENS HEALTH: 55 YEARS AND ABOVE References Alexander, I. M. & Andrist, L. C. (2013). Menopause. In Schuiling, K. D., & Likis, F. E. (2nd ed.). Womens Gynecologic Health (pp. 285-328). Burlington, MA: Jones & Bartlett Learning Aliotta, H. M., & Schaeffer, N. J. (2013). Breast conditions. In Schuiling, K. D., & Likis, F. E. (2nd ed.). Womens Gynecologic Health (pp.377-401). Burlington, MA: Jones & Bartlett Learning American Physical Therapy Association. (2014). Role of a Physical Therapist. Retrieved from http://www.apta.org/PTCareers/RoleofaPT/ Christinsen-Rengel, L. (2013). Breast health. In Youngkin, E. Q., Davis, M. S., Schadewald, D.M, & Juve, C. (4th ed.). Womens Health: A Primary Care Clinical Guide (pp. 399423). Upper Saddle River, NJ: Pearson Education Inc. Go red for women editors. (2014). Eat well to prevent heart disease. American Heart Association. Retrieved from https://www.goredforwomen.org/live-healthy/first-steps-toprevent-heart-disease-and-be-heart-healthy/eat-well-prevent-heart-disease/ Hain, D. (2013). Assessing older womens health. In Youngkin, E. Q., Davis, M. S., Schadewald, D. M., & Juve, C. (4th ed.). Womens Health: A Primary Care Clinical Guide (pp. 99-115). Upper Saddle River, NJ: Pearson Education Inc. Interprofessional Education Collaborative (IPEC) Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative Irion, J., & Irion, G. (2010). Women's health in physical therapy. (pp. 583-611). Baltimore, MD: Lippincott Williams and Wilkins

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WOMENS HEALTH: 55 YEARS AND ABOVE Juve, C. (2013). The menopausal transition. In Youngkin, E. Q., Davis, M. S., Schadewald, D.M., & Juve, C. (4th ed.). Womens Health: A Primary Care Clinical Guide (pp. 425459).Upper Saddle River, NJ: Pearson Education Inc. Juve, C. & Schadewald, D. M. (2013). Selected screening tools for womens health. In Youngkin, E. Q., Davis, M. S., Schadewald, D. M., & Juve, C. (4th ed.). Womens Health: A Primary Care Clinical Guide (pp. 883-902). Upper Saddle River, NJ: Pearson Education Inc. Lajoie, Y., & Gallagher, S. (2004). Predicting falls within the elderly community: Comparison of postural sway, reaction time, the berg balance scale and abc scale for comparing fallers and non-fallers. Arch Gerontol Geriatr, 38, 11-26 Nurse practitioners in primary care. (2014). American Association of Nurse Practitioners. Retrieved from https://www.aanp.org/images/documents/publications/primarycare.pdf Preventative screening guidelines for healthy adults. (2014). Retrieved from https://www.bluecrossma.com/wps/portal/members/healthier-living/manage-myhealth/screening-guidelinesadults/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3i_YALMG93QwN__xBDA0_3YN_AMGcXQwNLY_2CbEdFAM_u-jA!/. Schuiling, K. D., & Low, L. K. (2013). Womens growth and development across the life span. In Schuiling, K. D., & Likis, F. E. (2nd ed.). Womens Gynecologic Health (pp. 21-38). Burlington, MA: Jones & Bartlett Learning US Department of Health and Human Services (HHS), Office of Disease Prevention and Health Promotion (2008). 2008 Physical activity guidelines for Americans. Retrieved from http://www.health.gov/paguidelines/guidelines/default.aspx

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WOMENS HEALTH: 55 YEARS AND ABOVE Wysocki, S. (2013). Nurse practitioners in womens health: Where is the future heading? In Youngkin, E. Q., Davis, M. S., Schadewald, D. M., & Juve, C. (4th ed.). Womens Health: A Primary Care Clinical Guide (pp. 3-7). Upper Saddle River, NJ: Pearson Education Inc.

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WOMENS HEALTH: 55 YEARS AND ABOVE

Project 2 Grading Rubric Content Introduction Description of Roles Program Content Delivery Method Evaluation of program Overview of your experience Overview of the Communication technology APA Cover and references 5/ Total = Points 5/ 10/ 40/ 10/ 10/ 10/ 10/ Comments