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OSTEOPROSIS  IN  OLDER  ADULTS    

                     

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Osteoporosis  in  Older  Adults   Dean  M.  Seidman   Syracuse  University      

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The  public  health  concern  that  I  will  be  exploring  is  the  older  adult  population  that   is  suffering  from  osteoporosis.    More  specifically,  I  will  be  investigating  the  population  as  it   pertains  to  the  rural  community  with  moderate  to  low  income.    Osteoproisis  is  a  disease   that  generally  affects  older  adults  and  can  lead  to  an  increased  risk  of  fractures.    The   increased  risk  of  fractures  is  due  to  a  low  bone  mineral  density.    There  are  many  concerns   with  the  older  adults  that  have  osteoporosis,  one  of  them  being  that  they  have  limited   mobility  and  they  have  difficulty  doing  daily  tasks.    Simple  household  tasks  become  difficult   such  as  washing  the  dishes,  cleaning  the  floors,  and  doing  gardening.    The  reason  that  these   types  of  tasks  are  difficult  is  because  the  low  bone  mineral  density  makes  the  bones  very   brittle  and  can  fracture  very  easily.    Another  concern  that  older  adults  with  osteoporosis   have  is  that  they  are  usually  limited  in  the  amount  of  social  contact.    They  often  remain  in   their  homes  and  do  not  have  the  ability  and  energy  to  get  outside.    Having  adequate  social   interaction  improves  quality  of  life  and  ables  the  older  adults  to  converse  with  others.     Social  interaction  is  sometimes  overlooked  but  it  is  very  crucial  in  improving  the  daily  lives   of  older  adults  with  osteoporosis.    An  important  aspect  in  improving  the  condition  of   osteoporosis  among  older  adults  is  to  decrease  sedentary  activity  and  increase  physical   activity.    By  doing  this,  the  bones  are  being  stimulated  and  bone  mineral  density  can   improve.    A  combination  of  a  proper  diet  and  physical  activity  will  improve  the  condition  of   the  older  adults  with  osteoporosis.    Formulating  an  intervention  that  will  address  these   two  issues  is  crucial  to  the  improvement  in  the  older  adults.         Osteoporosis  is  a  condition  that  will  most  likely  affect  women  after  menopause.    

Men  can  develop  osteoporosis  as  well  but  it  is  not  as  prevalent.    Worldwide,  there  are  200   million  women  that  are  affected  by  this  disease  and  one  tenth  of  women  aged  60  are  

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affected.    After  women  reach  age  80,  two  fifths  of  the  female  population  are  affected.    In  the   year  2000,  there  were  about  9  million  osteoporotic  fractures  and  the  most  commonly   fractured  sits  include  the  hip,  forearm,  and  vertebrae.    9  million  fractures  annually  equates   to  an  osteoporotic  fracture  every  three  seconds.    This  high  amount  of  fractures  suggests   that  there  is  more  time  spent  in  the  hospital  than  many  other  diseases  including  diabetes,   cardiovascular  disease,  and  breast  cancer  (“Facts  and  statistics”).    Also,  following  a  fracture,   one  in  five  people  will  die  within  a  year  of  that  fracture  (“Facts  about  osteoporosis”).    All  of   these  facts  can  be  startling,  but  this  shows  that  osteoporosis  is  a  major  disease  that  should   not  be  ignored.    The  amount  of  people  it  affects  and  its  effect  on  health  is  profound  and   everything  should  be  done  to  reverse  the  effects.    The  broad  risk  factors  for  osteoporosis   include  being  female,  old  age,  being  Caucasian/Asian,  family  history  of  osteoporosis,  and  a   small  body  frame.    Menopause  is  another  serious  risk  factor  that  is  associated  with   osteoporosis.    There  is  a  reduction  in  estrogen  levels  after  menopause  and  this  leads  to  a   lower  bone  mineral  density.    Low  testosterone  in  men  is  also  another  hormone  that  is   associated  with  a  lower  bone  mineral  density.    Sex  hormones  may  have  the  greatest  affect   on  bone  mineral  density  but  thyroid  hormones  can  also  cause  bone  loss.    An  overactive   thyroid  would  be  a  risk  factor  for  osteoporosis.    One  of  the  most  important  risk  factors  for   osteoporosis  is  the  diet  that  the  individual  is  consuming    A  low  intake  of  calcium  is  highly   associated  with  osteoporotic  fractures.    Although  a  low  intake  of  calcium  is  associated  with   a  greater  risk  of  fractures,  the  effects  of  adding  calcium  to  the  diet  is  not  immediate.    A   lifelong  intake  of  calcium  is  best  for  preventing  osteoporosis  in  the  later  years.    Vitamin  D  is   also  a  key  nutrient  in  the  prevention  of  osteoporosis.    Along  with  a  low  intake  of  calcium   and  vitamin  D,  eating  disorders  can  also  pose  a  large  risk  for  osteoporosis  in  older  adults.    

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Anorexia  can  reduce  the  amount  of  food  being  taken  in  and  it  can  also  seize  menstruation   which  lowers  the  amount  of  estrogen  being  produced.    A  low  intake  of  calcium  and  vitamin   D  is  correlated  with  eating  disorders.    A  weight-­‐loss  surgery  can  also  be  a  risk  factor  for   developing  osteoporosis.    The  smaller  stomach  limits  the  amount  of  surface  area  available   to  absorb  nutrients,  two  of  which  being  calcium  and  vitamin  D.    Medications  can  interfere   with  the  body’s  ability  to  rebuild  bone.    These  types  of  medications  include  corticosteroids   such  as  prednisone  and  cortisone.    Also,  medications  used  to  prevent  seizures,  depression,   gastric  reflux,  cancer,  and  transplant  rejection  can  increase  the  likelihood  of  developing   osteoporosis.    Lifestyle  choices  can  also  highly  influence  the  risk  for  getting  osteoporosis.    A   sedentary  lifestyle  limits  the  amount  of  weight-­‐bearing  exercise  that  is  needed  to  stimulate   the  bone.    The  more  sedentary  activity  that  is  present,  the  greater  the  risk  for  developing   osteoporosis.    Excessive  alcohol  and  tobacco  consumption  can  also  be  a  indicator  for   developing  osteoporosis.    Two  or  more  alcoholic  drinks  per  day  can  increase  the  risk  of   osteoporosis  because  alcohol  intake  interferes  with  the  body’s  ability  to  absorb  calcium.     Although  the  physiological  processes  behind  tobacco  use  as  it  relates  to  osteoporosis  is  not   clearly  understood,  there  is  an  increased  risk  for  developing  osteoporosis  if  tobacco  is   used.    Preventing  osteoporosis  is  easily  done  by  avoiding  the  risk  factors  that  were   explained  above.    Many  people  try  their  best  to  avoid  these  risk  factors,  however,  most   people  do  not  even  know  if  they  have  osteoporosis  and  it  goes  undiagnosed.    The   symptoms  for  osteoporosis  include  back  pain,  loss  of  height,  stooped  posture,  bone   fracture.    These  symptoms  are  very  general  which  is  why  many  people  go  undiagnosed.    An   individual  should  see  their  doctor  if  they  have  gone  through  early  menopause,  experienced   a  loss  of  height,  taken  corticosteroids  for  a  long  period  of  time,  and  have  had  a  family  

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history  of  osteoporosis.    The  only  way  to  know  if  an  individual  has  osteoporosis  is  to   complete  a  dual  energy  x-­‐ray  absorptiometry  to  measure  bone  mineral  density  (Clinic   staff).     There  are  many  treatments  available  to  attempt  to  reverse  the  effects  of  

osteoporosis.    Medications  can  be  either  bisphosphonates  or  revolve  around  a  hormone   therapy.    Bisphosphonates  are  the  most  common  medications  that  are  used  for   osteoporosis  and  work  by  slowing  the  rate  of  bone  thinning  and  prevent  the  development   of  osteoporosis.    Hormone  therapy  involves  the  administration  of  estrogen  and  this  is   thought  to  increase  bone  mineral  density  and  reduce  bone  loss.    Calcitonin  is  another   hormone  that  is  commonly  given  to  individuals  suffering  from  osteoporosis.    Calcitonin   works  by  regulating  calcium  levels  in  the  body  and  directing  it  to  the  bone.    There  is  also  a   class  of  drugs  that  are  called  selective  estrogen  receptor  modulators,  which  deals  with   regulating  the  amount  of  estrogen  in  the  body  (Clinic  staff).    These  medications  do  work   and  are  widely  used  in  the  clinical  field  to  reverse  the  effects  of  osteoporosis.    Although   these  medications  have  their  place  in  the  health  industry,  lifestyle  changes  are  the  best   method  to  combat  osteoporosis.    An  increase  in  physical  activity  along  with  a  diet  high  in   calcium  and  vitamin  D  is  the  best  intervention  for  any  individual  that  has  osteoporosis.         The  environment  that  an  individual  is  apart  of  is  a  big  influence  for  developing  

osteoporosis.    Environmental  factors  can  include  availability  of  parks,  proximity  to  grocery   stores,  sunlight  exposure,  neighborhood  safety,  peer  interactions,  and  economic  status.     The  availability  of  parks  is  important  in  promoting  physical  activity  for  all  ages.    Not  only   are  parks  and  walking  trails  beneficial  to  the  older  adults  with  osteoporosis,  but  also  it  can   be  looked  at  as  a  preventative  measure  for  younger  individuals  in  delaying  the  onset  of  

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osteoporosis  later  in  life.    Rural  communities  generally  have  more  parks  and  walking  trails   than  city  areas  but  that  is  not  always  the  case.    Some  communities  are  less  developed  and   do  not  have  the  money  to  afford  building  a  park.    The  location  of  grocery  stores  is  another   environmental  factor  that  plays  a  role  in  the  condition  of  osteoporosis.    If  grocery  stores   can  not  be  easily  accessed  easily,  it  would  limit  the  amount  of  available  food  to  the   individual.    Older  adults,  and  especially  those  with  osteoporosis  have  a  hard  time  getting   out  of  the  house  and  to  the  grocery  store  to  buy  food.    A  low-­‐intake  of  food  is  correlated  to   an  increased  risk  for  osteoporosis.    Sunlight  exposure  is  important  to  general  health  as  well   as  stimulating  bone  health.    Some  areas  of  the  United  States  get  more  sunlight  than  others   such  as  Alaska  that  gets  limited  sunlight  and  New  Mexico  that  gets  daily  sunlight.    It  is   recommended  that  older  adults  aged  51-­‐70  should  get  400-­‐600  IU  of  vitamin  D  per  day.     Long  exposure  to  sunlight  might  increase  the  risk  of  getting  skin  cancer  so  it  is   recommended  that  older  adults  make  short  trips  outside  throughout  their  daily  routine.     100-­‐200IU  of  vitamin  D  should  be  provided  through  the  skin  (Fujiwara,  2005).     Neighborhood  safety  is  important  to  all  individuals  of  the  community  and  especially  older   adults  because  they  may  be  more  susceptible  to  robberies.    The  safety  of  the  neighborhood   is  crucial  to  the  amount  of  physical  activity  that  can  be  done  in  the  community.     Neighborhood  walks  can  become  scary  for  older  adults  if  there  is  high  crime.    Older  adults   will  tend  to  stay  inside  than  rather  deal  with  the  unsafe  neighborhood,  which  can  seriously   limit  the  amount  of  physical  activity.    Peer  interaction  does  not  directly  affect  the  condition   of  osteoporosis  however  it  is  important  in  improving  quality  of  life.    Social  isolation  can   lead  to  increased  sedentary  activity  and  depression,  which  has  negative  mental  health   consequences.    Having  a  good  network  of  friends  and  a  close-­‐knit  family  can  help  decrease  

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the  amount  of  social  isolation.    Having  peer  interaction  and  increased  social  contact  will   also  help  the  individual  in  the  case  of  an  emergency.    The  economic  status  of  an  individual   is  usually  correlated  to  their  health  status.    Lower-­‐income  individuals  will  typically  be  in   poorer  health  and  middle-­‐high  income  individuals  will  most  likely  be  in  better  health.     Individuals  with  low-­‐income  do  not  have  the  funds  to  buy  healthy  foods,  go  for  doctors   visits,  buy  osteoporotic  medications,  and  buy  gym  memberships.    The  combination  of  all  of   these  environmental  factors  can  highly  influence  the  negative  consequences  of   osteoporosis.    Although  some  of  these  environmental  factors  cannot  be  adjusted,   individuals  should  do  everything  in  their  power  to  prevent  osteoporosis.         There  are  not  many  programs  that  exist  that  deal  with  improving  the  condition  of  

older  adults  as  it  relates  to  osteoporosis.    Most  of  the  programs  are  ran  out  of  hospitals  and   older  adults  do  not  like  the  feeling  of  going  to  a  hospital.    There  is  a  lack  of  community   driven  programs  that  deal  with  improving  the  condition  of  osteoporosis.    Osteoporosis  is   one  of  the  few  diseases  that  can  be  reversed  quite  easily  with  lifestyle  changes.    For  an   intervention,  I  would  like  to  include  both  a  physical  and  educational  component.    For  the   physical  component,  I  would  like  to  implement  a  neighborhood  walking  program.    For  the   educational  component  I  will  provide  bi-­‐weekly  brochures  with  information  pertaining  to   the  important  aspects  of  osteoporosis.    The  intervention  will  be  community  driven  and   upon  success,  the  program  will  branch  out  to  other  local  communities.    The  idea  for  this   intervention  is  to  improve  social  contact  and  at  the  same  time  promoting  healthy  lifestyle   changes.    The  walking  program  is  available  to  all  individuals,  even  those  without   osteoporosis.    The  goals  for  my  intervention  are:   1. Promote  healthy  bone  changes  through  physical  activity  that  will  lead  to  an  increase   in  bone  mineral  density.  

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2. Minimize  social  isolation  by  conversing  with  peers  and  learning  about  osteoporosis.   The  objectives  for  my  intervention  are:   1. Increase  bone  mineral  density  by  10%  in  one  year  in  older  adults  with  osteoporosis   2. Decrease  number  of  fractures  by  30%  in  six  months  in  older  adults  with   osteoporosis  

  The  bone  mineral  density  will  be  reported  from  the  individuals  involved  with  the  walking   program.    They  will  get  the  bone  mineral  density  value  from  their  respective  doctor  when  

they  go  in  for  a  bone  scan.    Everybody  that  is  involved  in  the  program  will  not  have  access   to  a  bone  scan  so  only  the  individuals  that  have  access  to  a  bone  scan  will  report  their   values.    Fractures  will  be  reported  to  the  staff  and  recorded.    These  values  will  be  looked  at   over  time  and  hopefully  the  amount  of  fractures  will  decrease  after  the  start  of  the   intervention.    Once  an  individual  has  reported  a  fracture  the  staff  will  pay  close  attention  to   that  individual  to  ensure  safety.    The  goals  and  objectives  for  my  intervention  are  critical   and  the  intervention  will  revolve  around  focusing  on  these  specific  aspects.         The  walking  program  will  consist  of  daily-­‐guided  walks  Monday  through  Friday.    

The  daily  walks  will  take  place  at  3PM  and  again  at  6PM.    The  reason  for  having  two   different  times  is  to  optimize  the  amount  of  participants  by  avoiding  scheduling  conflicts   among  the  participants.    There  will  be  one  group  leader  that  will  lead  the  walks  to  ensure   safety  as  well  as  provide  educational  material  that  I  will  discuss  later.    The  group  leader   will  stimulate  conversation  to  promote  social  interaction  among  the  walkers.    The  topics   that  will  be  discussed  during  the  walking  trial  will  include  helpful  tips  for  living  with   osteoporosis  as  well  as  general  health  tips  to  improve  the  participants’  health  status.    The   conversations  that  will  take  place  during  the  walking  trail  will  require  the  participation  of   the  older  adults  in  the  intervention  to  promote  social  interaction.    The  individuals  that  are  

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new  to  the  program  might  be  quiet  during  the  intital  sessions,  however,  over  time  the   group  leader  will  attempt  to  include  these  people  in  the  conversation  to  promote  social   interaction.    This  is  a  crucial  component  to  the  intervention  because  peer  interaction  is   essential  to  improving  overall  quality  of  life.    The  mobility  limits  that  osteoporosis  poses  on   the  individual  can  limit  the  amount  of  time  that  they  get  to  socialize  with  their  peers  so  this   is  something  that  my  intervention  will  focus  highly  on.    The  walking  trail  will  be  through   the  community  and  the  route  will  change  every  week.    The  community  sidewalk  will  serve   as  the  walking  trail.    Removable  signs  will  be  placed  throughout  the  community  to  serve  as   a  map  for  the  current  route.    The  signs  will  have  mile  markers  on  them  as  well  as  helpful   one-­‐sentence  tips  for  living  with  osteoporosis.    Every  week  the  intervention  supervisor  will   relocate  the  signs  throughout  the  community  to  designate  the  current  week’s  route.    The   signs  will  have  large  lettering  so  the  older  adults  will  be  able  to  read  them  without  a   problem.    Since  vision  declines  with  aging,  it  is  essential  to  fabricate  the  signs  with  large   lettering.    The  group  leader  will  be  in  charge  of  the  safety  of  the  older  adults  in  case  of   emergency  and  will  be  wearing  a  bright  neon  shirt  to  clearly  designate  him/her.    A  walkie-­‐ talkie  will  be  provided  to  the  group  leader  so  there  is  adequate  communication  between   the  group  leader  and  the  intervention  supervisor  in  case  of  an  emergency.    The  older  adults   participating  in  the  program  may  have  trouble  walking  due  to  their  condition  so  it  is   pertinent  that  safety  is  a  number  one  priority.         High-­‐impact  weight-­‐bearing  exercises  are  recommended  for  stimulating  bone  

growth  because  these  exercises  load  the  bone  directly  and  promote  bone  remodeling.    If  a   fracture  has  already  occurred,  low-­‐impact  weight-­‐bearing  exercises  would  be   recommended.    Walking  would  be  considered  a  low-­‐impact  weight-­‐bearing  exercise,  

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however  our  intervention  chose  this  to  ensure  safety  among  our  participants.    High-­‐impact   weight-­‐bearing  exercises  would  provide  the  most  benefit  but  this  does  not  go  without  risk.     30  minutes  per  day  of  general  weight-­‐bearing  exercises  are  recommended  for  older  adults   and  this  is  the  approximate  length  of  my  intervention’s  walking  trail  (“Exercise  for  strong   bones”).    A  study  completed  in  1991  examined  a  one-­‐year  walking  program  and  increased   dietary  calcium  in  postmenopausal  women.    Participants  participated  in  a  supervised  walk   four  times  per  week  for  one  year  and  the  results  found  that  women  maintained  trabecular   bone  mineral  density.    Individuals  who  did  not  complete  the  walking  program  and  engaged   in  sedentary  activity  lost  bone  mineral  density  in  the  same  sites  where  it  was  maintained   for  the  walking  group.    This  study  suggested  that  women  should  be  encouraged  to  adopt  a   calcium-­‐rich  diet  and  weight-­‐bearing  exercise  to  maintain  skeleton  health  (Nelson,  1991).     A  similar  study  completed  in  2004  used  a  similar  study  design  and  found  that  moderate   walking  exercise  sustained  lumbar  bone  mineral  density.    This  study  also  reported  that   four  hours  per  week  of  walking  compared  to  one  hour  per  week  was  associated  with  a  41%   lower  risk  of  hip  fractures  (Yamazaki,  2004).    The  findings  from  both  of  these  studies   suggest  that  efficacy  for  my  intervention  program  is  valid  and  would  result  in  positive   outcomes.       Alongside  the  physical  component  of  my  intervention,  there  will  also  be  an  

educational  component.    The  educational  component  will  consist  of  bi-­‐weekly  brochures   developed  by  the  intervention  supervisor  and  volunteers.    These  brochures  will  consist  of   helpful  information  and  tips  for  older  adults  living  with  osteoporosis.    Since  calcium   supplementation  is  correlated  to  decreased  bone  loss,  this  will  be  a  major  topic  that  will  be   discussed.    There  will  be  recipes  that  have  high  amounts  of  calcium  will  be  easy  to  make  for  

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the  older  adults.    Easy  at-­‐home  weight-­‐bearing  exercises  will  be  suggested  and  encouraged   for  the  older  adults  to  complete.    Every  other  week  there  will  be  new  helpful  information  in   these  brochures  and  the  current  issue  will  always  be  available  form  the  group  leader.    A   book  club  will  also  be  started  to  stimulate  conversation  during  the  walks.    These  books  will   be  related  to  living  with  osteoporosis  and  general  health  for  older  adults.    A  study  done  in   2004  explored  the  effectiveness  of  brochures  containing  health  information.    The  results   revealed  that  the  implementation  of  a  single  behavior  change  in  a  brochure  could  have   substantial  health  benefits  as  long  as  the  information  is  suitably  formulated  (Jamison,   2004).    The  brochures  that  are  going  to  be  provided  by  my  intervention  will  be  a  crucial   component  in  making  behavior  changes  because  it  is  something  the  participants  can  take   home  and  study.         The  staff  that  will  be  working  for  my  intervention  will  consist  of  one  supervisor  and  

10-­‐15  volunteers  from  the  community  to  serve  as  group  leaders.    The  supervisor  will  be  in   charge  of  creating  routes,  ensuring  participant  satisfaction,  participant  safety,  collecting   data,  formulating  brochures,  and  formulating  tips  and  information  on  osteoporosis  for  use   by  the  group  leaders.    Group  leaders  will  need  to  have  proficient  knowledge  of  osteoporosis   and  have  a  sincere  desire  to  help  out  the  community.    Upon  being  a  volunteer,  a  crash   course  by  the  supervisor  on  osteoporosis  will  be  provided  to  ensure  that  the  volunteers   have  adequate  knowledge  of  the  disease.    The  group  leaders  will  be  responsible  for   stimulating  conversation,  ensuring  safety,  providing  tips  &  information,  providing   assistance  to  supervisor  on  developing  brochures,  and  developing  cohesion  among   participants.      

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One  of  the  benefits  of  my  intervention  is  that  there  is  a  minimal  cost  associated  with  

implementation.    Although  there  will  be  initial  costs  for  developing  materials,  overall,  this   is  a  low-­‐cost  intervention.    A  petition  for  funding  will  be  sent  to  the  local  township  to   acquire  a  grant  to  begin  the  intervention.    The  initial  costs  will  include  the  removable  signs,   office  space,  t-­‐shirts,  insurance,  waklie-­‐talkies,  and  office  supplies.    Having  a  low-­‐cost   intervention  will  be  beneficial  because  the  local  township  will  be  more  likely  to  approve  it.     The  combination  of  being  a  low-­‐cost  intervention  alongside  an  intervention  with   substantial  health  benefits  for  the  community  will  significantly  increase  the  chances  of   success  in  funding.         In  the  beginning  stages  of  the  intervention  process,  it  will  be  difficult  to  accumulate  

enough  participants  to  join  the  program.    To  help  get  my  intervention  started,  we  will   collaborate  with  the  local  hospital  outpatient  services.    Upon  diagnosis  of  osteoporosis  in   the  hospital  setting,  the  physician  or  assigned  doctor  will  recommend  our  walking   program.    It  is  something  that  is  easy  to  suggest  for  the  clinical  staff  and  will  provide  health   benefits  for  the  older  individual.    The  clinical  staff  will  also  report  bone  mineral  density   values  to  the  intervention  supervisor  for  the  participants  that  are  enrolled  in  our  program.     By  obtaining  these  values,  we  are  able  to  see  if  our  objective  of  increasing  bone  mineral   density  by  10%  among  participants  is  being  reached.    I  believe  that  the  local  hospital  will   be  more  than  willing  to  collaborate  with  our  program.    The  benefit  for  the  hospital  is  that   they  will  see  improvements  or  a  maintence  of  bone  mineral  density  among  their  patients.     The  benefits  for  my  intervention  will  be  an  increased  number  of  participants  being  referred   as  well  as  useful  data  to  confirm  the  success  of  the  intervention  over  time.      

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My  intervention  strives  to  be  as  successful  as  possible  in  improving  the  health  status  

of  older  adults  with  osteoporosis.    Evaluating  the  intervention  by  using  a  survey  will  ensure   that  what  we  are  doing  is  keeping  the  participants  satisfied.    A  survey  will  be  available  from   the  group  leader  and  will  be  available  for  all  participants  to  fill  out  at  any  time.    Some  of  the   topics  and  questions  the  survey  will  include  will  be  concerning  the  intensity  of  the   program,  current  health  status,  length  of  the  program,  effectiveness  of  the  educational   materials,  helpfulness  of  the  staff,  degree  of  social  interaction,  overall  desire  to  participate,   improvements  in  health,    and  additional  comments  and  suggestions.    The  intervention   supervisor  will  read  all  surveys  and  make  changes  if  there  is  a  strong  desire  for  a  certain   adjustment.    These  surveys  will  be  taken  seriously  because  we  want  to  make  sure  that  all   participants  are  happy.    A  potential  barrier  for  the  intervention  will  be  the  safety  of   participants.    Some  individuals  living  with  osteoporosis  are  not  able  to  walk  flawlessly  and   may  have  trouble  keeping  up  with  the  group  while  others  may  spring  ahead.    If  there  are   enough  participants  that  want  to  walk  at  a  slower  pace,  one  of  the  daily  walks  will  be  a   slower  group  while  the  other  will  be  at  a  moderate  pace.    Another  potential  barrier  would   be  getting  enough  participants  to  join  the  program.    While  some  individuals  are  highly   motivated,  depending  on  the  community  there  might  be  varying  levels  of  motivation,  which   could  affect  adherence  and  participation.    Collaboration  with  the  local  hospital  will   hopefully  alleviate  this  problem.    Upon  success  of  this  intervention  in  a  single  community,   we  would  look  to  branch  out  to  other  local  communities  following  a  needs  assessment  of   that  community.    If  success  continues  in  subsequent  communities,  we  would  look  to   become  a  state-­‐run  agency.    With  additional  funding  by  the  state,  there  would  be  a   substantial  expansion  of  funding,  qualified  staff,  and  educational  materials.    The  overall  

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goal  for  the  future  is  to  become  the  most  well  known  intervention  for  osteoporosis  and   establishing  a  first-­‐class  reputation.     Overall,  the  intervention  that  I  have  designed  will  help  maintain  and  improve  bone  

mineral  density  in  older  adults  that  are  suffering  from  osteoporosis  in  rural  communities.     The  combined  physical  and  educational  components  is  implemented  to  improve  the  health   condition  of  the  participants.    Studies  in  the  past  have  reavaled  positive  outcomes   associated  with  my  intervention  elements  so  there  is  a  high  chance  of  success.    Peer   interaction  is  a  big  emphasis  for  my  intervention  because  some  individuals  living  with   osteoporosis  have  limited  mobility  leading  to  limited  social  contact.    By  decreasing   sedentary  activity  and  increasing  the  amount  of  weight-­‐bearing  exercise  there  will  be   improvements  in  participants’  conditions.    With  an  improvement  in  the  participants’   condition,  simple  household  tasks  will  become  easier  which  will  help  improve  quality  of   life.    Osteoporosis  affects  millions  of  people  worldwide  and  starting  an  intervention  at  a   community  level  is  the  first  step  to  help  alleviate  the  effects  of  the  disease.      

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    References  

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Exercise  for  Strong  Bones.  (n.d.).  National  Osteoporosis  Foundation.  Retrieved  May  5,  2013,   from  http://www.nof.org/articles/238   Facts  about  osteoporosis.  (n.d.).  World  Osteoporosis  Day.  Retrieved  May  4,  2013,  from   http://www.worldosteoporosisday.org/facts-­‐statistics   Facts  and  Statistics  .  (n.d.).  International  Osteoporosis  Foundation  .  Retrieved  May  4,  2013,   from  http://www.iofbonehealth.org/facts-­‐statistics   Fujiwara.  (2005).  Osteoporosis  and  sunlight.  Radiation  Effects  Research  Foundation,  15(8),   1410-­‐2.  Retrieved  May  4,  2013,  from   http://www.ncbi.nlm.nih.gov/pubmed/16062013   Jamison,  J.  R.  (2004).  Prescribing  Wellness:  A  Case  Study  Exploring  The  Use  Of  Health   Information  Brochures☆.  Journal  of  Manipulative  and  Physiological  Therapeutics,   27(4),  262-­‐266.   Clinic  staff.  (n.d.).  Risk  factors.  Mayo  Clinic.  Retrieved  May  4,  2013,  from   http://www.mayoclinic.com/health/osteoporosis/DS00128   Nelson.,  Fisher.,  Dilmanian.,  Dallal.,  &  Evans.  (1991).  91178245  A  1-­‐y  Walking  Program  And   Increased  Dietary  Calcium  In  Postmenopausal  Women:  Effects  On  Bone.  Maturitas,   14(1),  84.   Yamazaki,  S.,  Ichimura,  S.,  Iwamoto,  J.,  Takeda,  T.,  &  Toyama,  Y.  (2004).  Effect  Of  Walking   Exercise  On  Bone  Metabolism  In  Postmenopausal  Women  With       Osteopenia/osteoporosis.  Journal  of  Bone  and  Mineral  Metabolism,  22(5),  500-­‐8.