Page 94 Complete Your CE Test Online - Click Here Breast cancer According to the American Cancer Society, breast cancer affects almost one in every 15 women over 60 years old. Risk factors include: age; family history of breast cancer; early menarche and late menopause; ingestion of hormonal contraceptives; use of hormonal replacement therapy for more than five years; never having been pregnant; first pregnancy after the age of ten; personal history of breast cancer; regular use of alcohol; history of ovarian cancer; and exposure to low-level ionizing radiation [9,13]. Recent controversy over screening recommendations from various healthcare groups has led to some confusion about the value of screening. General recommendations include yearly mammograms for women over the age of 40, monthly self-breast examination, and yearly breast examination by a healthcare profession [9]. There is some question about the value of mammography in very old women. Screening techniques and their value should be discussed with a woman’s healthcare provider. Treatment options should be discussed at length with a woman’s healthcare team. Ultimately, she must make the treatment choice, e.g. lumpectomy, mastectomy, or even refusal to have surgery. It is important that healthcare providers maintain an objective attitude. Breast cancer triggers not only fear of death, but also fear of disfigurement. Women are usually quite concerned with the cosmetic effects of breast cancer treatment. Reconstruction options should be presented to women undergoing mastectomy. EBP alert! Research indicates that yearly mammography for all females over the age of 40 decreases mortality from breast cancer. Women should be encouraged to undergo screening mammograms as part of their preventive health practices [9]. Nursing consideration: Lymphedema is a potential complication of lymph node removal. The patient must be taught to exercise her arm(s) and hand(s) to avoid the development of this potentially debilitating complication. The musculoskeletal system The musculoskeletal system includes the bones, muscles, ligaments, bursa, and joints. The bones or skeleton provide the form and support of the body. Muscles move the various body parts. Joints, the areas where two bones are attached, provide stability and facilitate mobility [9,14,53]. Changes in the musculoskeletal system may have adverse effects on mobility and decrease the independence of older adults. Normal age-related changes include [9,14]: ● ● Decreased range of motion of some joints. ● ● Loss of bone mass. ● ● Loss of height. ● ● Less fluid in joints, making them stiffer and less flexible. ● ● Arthritic changes of the joints. ● ● Decrease in muscle tone and contractility. ● ● Problems maintaining balance. ● ● Problems with the feet such as corns, bunions, and calluses. ● ● Muscles atrophy and there is greater muscle rigidity and loss of muscle tone. ● ● Bones become stiffer and brittle due to a decrease in vitamin D absorption, which decreases osteoblasts. These changes increase the risk of the following problems. Osteoporosis Osteoporosis is a metabolic bone disorder and is the most common metabolic disease affecting half of all women during their lifetimes. Although its occurrence is higher in women, men are also affected by the disease [9,13]. Osteoporosis occurs when the rate of bone resorption increases while the rate of bone formation decreases, leading to a loss of bone mass. The exact cause is unknown, but prolonged negative calcium imbalance is probably a contributing factor. The most common presenting symptom is back pain. A loss of height is common and the risk of fractures and falls is high [13]. There is no cure for osteoporosis. The goals of treatment are to slow or prevent loss of bone, avoid fractures, and reduce pain. Calcium and vitamin D supplements may also be recommended [9,13]. Assistive devices such as walkers or canes may be used to provide stability when walking. Patients should be taught safety precautions and measures to avoid falls. There are steps that can be taken to reduce the risk of osteoporosis. These steps may also be part of the treatment regimen for the disease. These steps include [13]: ● ● Ingest adequate amounts of calcium and vitamin D. ○ ○ Postmenopausal women and all women and men over the age of 65 should ingest 1,500 mg of calcium, and at least 800 international units (IU) of vitamin D on a daily basis. ○ ○ Vitamin D is necessary for the absorption of calcium and enhances muscle strength. Some older adults may understand the need for calcium supplements but fail to realize the need for vitamin D. ○ ○ Patient education should include an explanation of the need for adequate amounts of calcium as well as vitamin D on a daily basis. ● ● Limiting alcohol intake. Having more than two alcoholic drinks per day may decrease the formation of bone. Alcohol may also adversely affect the body’s ability to absorb calcium. ● ● Limit the intake of caffeine. No more than two to three cups of beverages containing caffeine should be consumed per day. Some patients may assume that caffeinated beverages only mean “coffee.” They should be educated that chocolate, colas, and teas also contain caffeine. ● ● Participate in an appropriate exercise program. Exercise helps to slow the rate of bone loss and increase bone strength. Weight- bearing exercises are important to help increase bone strength. Exercise programs should be designed and implemented under the supervision of the older adult’s healthcare provider. Osteoarthritis Osteoarthritis is the most common form of arthritis. It is a chronic disease that causes deterioration of the cartilage of the joints and development of new bone at the joints. Symptoms often begin after the age of 40 and progress with age [13]. Signs and symptoms include a deep, aching joint pain, morning stiffness, weather-related aching pain, joint instability, and poor posture [13]. Treatment is aimed at symptom relief and minimizing disability. Joint replacement surgery may be necessary. Assistive mobility devices and anti-inflammatory medications are also used [13]. Nursing consideration: Primary osteoarthritis is closely associated with the aging process. It is believed that aging is linked to a predisposition of cartilage degeneration that is commonly found in persons with osteoarthritis [13]. Nurses must educate patients and families on the importance of adhering to a healthy lifestyle to help minimize the adverse effects of the disease. Falls Falls are certainly not a disease condition. But they are a significant health problem of older adults. In fact, falls are the leading cause of death in persons over the age of 65 [13]. As age increases, so does the risk of falls, and subsequently, the death rate from falls. Fall prevention is a key goal of gerontological nursing. Some tips to prevent falls include [9,13]: ● ● Make sure patients wear glasses as needed. Assess the home environment for adequate lighting. ● ● Assess the home for safety. Remove small area and “scatter” rugs, which may cause the older adult to trip. ● ● Are there stairs in the older person’s home? If so, are there safety rails to support the older adult as s/he ascends and descends the stairs?