Epidemiology Public health nursing allows nurses to encounter various vulnerable populations on a daily basis. In particular, the elderly make up a large portion of the population, and their vulnerability to the environment and other physical factors is a very important aspect of public health nursing. Epidemiology allows the public health nurse to study and assess vulnerable populations, including the elderly, and create interventions that maximize the health potential of all members of the public. Definition and Description of Epidemiology
Originally, epidemiology was a term that was used to describe the spread of infectious disease. Over the course of time, that definition has expanded considerably in order to accommodate the complexity of ever-changing populations, their environments, and increasing occurrences of disease. Epidemiology is now defined as the multidisciplinary study of various states of health, causal factors, how these states of health are dispersed across a population, and ways in which the knowledge gained from these studies can be used to promote health and wellness for the entire population (Stanhope & Lancaster, 2012).
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By using the scientific method of investigation, health care professionals, including public health nurses, are able to identify the various health needs found within communities and design interventions that specifically target meeting those health needs. Due to close contact with the community, public and community health nurses have an advantage with being able to identify local disease patterns and specific cases, as well as offer education designed to prevent or control specific diseases based on risk factors and other environmental factors (Wissman, 2007).
With the predicted growth of the older adult population in the United States, the study of the elderly population is especially important within the realm of epidemiology. The elderly population makes up the fastest growing portion of the population (Stanley, Blair, & Beare, 2005) . It is estimated that there will be more than 50 million people over the age of 65 living in the United States by the year 2020 (Abrams, Beers, & Beckow, 2000) .
Results from the 2010 census taken in the United States reflects that elderly people, or people over the age of 65, make up 12. percent of the total population (United States Census Bureau, 2012) . With cultural diversity also growing at rapid rates, and new health concerns always on the horizon, epidemiology, especially related to the elder population, becomes critically important (Stanley, Blair, & Beare, 2005). Steps and Methods Used in Epidemiology The epidemiological process is complex and consists of many steps. The first step is to identify the health related problem and determine its significance. At this stage, the public health nurse gathers data from all available sources and then uses that data to determine the range of the problem.
The next step in the process is to develop a theory exploring possible explanations based on the data that has been compiled. From this point, information is sorted and narrowed down, and the validity of the hypothetical possibilities is explored further. The fourth step involves developing a plan designed to control or put an end to the disease process that is being evaluated. During this phase, all influential factors related to the spread of disease are identified and evaluated, and prioritized goals are created in order to halt the sequence of the spread of disease.
The fifth step in the process is putting the plan into action by using all available resources. From there, relevant information is obtained in order to evaluate the effectiveness of the plan in preventing the spread of disease. The seventh and final step consists of creating a report of pertinent data, including evaluation of accomplishments and failures, and basing follow-up recommendations and interventions on this information (Wissman, 2007). Each year, seasonal influenza outbreaks threaten populations across the globe.
The already vulnerable elderly population is particularly susceptible to succumb to complications related to influenza, especially considering the fact that the average elderly person has an estimated three or more chronic illnesses that compromise an already weakened immune system (Blais, Hayes, Kozier, & Erb, 2006). According to the Centers for Disease Control and Prevention, “It’s estimated that 90 percent of seasonal flu-related deaths and more than 60 percent of seasonal flu-related hospitalizations in the United States each year occur n people 65 years and older “ (2011).
The CDC advises that the best way to prevent and control the spread of influenza each year is by the use of vaccinnations. In effort to control and prevent influenza epidemics, the CDC uses the epidemiological process to predict the strain of the virus that will be most relevant to the population and this data is used to formulate influenza vaccinations (Centers for Disease Control and Prevention, 2011).
Based on the information provided by the CDC and other agencies, as well as data gathered first hand through interaction within communities, public health nurses can advocate for the use of influenza vaccinations by elderly populations. While providing education related to preventive methods and the importance of vaccination, as well as administering vaccinations, public health nurses are key participants in the epidemiological process of seasonal influenza related to the elderly population.
In addition, data reported by front-line health care workers can be used by the CDC and other agencies to predict future episodes of influenza and plan for control of outbreaks. Epidemiological Triad A tool that has proven beneficial in field of epidemiology is the epidemiological triad. This triangle shows the relationships that exist between three interrelated factors in relation to the spread of disease: agent, host, and environment. The agent is identified as the disease causing object. The host is a living being that is able to be affected by the agent.
The environment is the surroundings inhabited by and further manipulating the host. According to the epidemiological triad, the interaction among the agent, the host, and the environment, all govern the way communicable diseases develop and spread. In addition, the relationship between these three factors also determines the way communicable disease will be prevented or stopped (Wissman, 2007). Disease causing agents can take on many forms. Infections agents include viruses, fungi, and bacteria. Physical agents include genetics, temperature, and trauma.
Chemical agents include drugs, toxins, and fumes. Agents affect hosts based on their susceptibility. Hosts that are not susceptible to disease causing agents are determined to be immune by either active means (natural or artificial) or passive means (natural or artificial). Environments consist of physical factors, access to health care, high risk working and living conditions, crowding, temperature, and many other examples (Baughman, 2004). The epidemiological triad can be applied to the elderly population in relation to influenza.
In this scenario, the agent is the influenza virus. The host is the elderly person who is either susceptible to the influenza virus or not susceptible after acquiring immunity through the vaccination process. The environment includes factors such as season, temperature, and crowding. Each of these three aspects of the epidemiological triad interacts to influence the ability of the influenza virus to cause disease and spread among the elderly population and subsequently to the population at large. Types of Epidemiology Epidemiology exists in two forms: analytical and descriptive.
Analytical epidemiology strives to determine the cause and origin of disease and also explores associations between disease and determining factors such as who is susceptible and why they are susceptible. On the other hand, descriptive epidemiology explores disease in regard to person, place, and time (Stanhope & Lancaster, 2012). Analytical epidemiology is used to study the susceptibility of elderly people to the influenza virus. Likewise, descriptive epidemiology is used to describe who is affected and the outcome of the disease.
Relationship of the Disease to Levels of Prevention Various levels of prevention exist in order to promote optimal states of health for individuals and populations. Three levels of prevention can be seen in the health care field and they are relevant in the discipline of epidemiology. The first level, or primary prevention, focuses on the prevention of the onset or initial incidence of illness or injury. Primary prevention can be seen in the form of community assessments, provision of immunizations, education related to communicable disease and hygiene, and also nutrition counseling.
The secondary level of prevention focuses on the early discovery of disease states and treatment. The goal of the secondary prevention level is to limit the severity of disease and minimize adverse effects. Secondary prevention methods include screenings for disease (cancer, diabetes, hypertension, etc. ), treatment of these diseases, and regulation of outbreaks of communicable disease. The third, or tertiary, level of prevention aims to make the most of rehabilitation following an illness or injury.
Examples of tertiary prevention include rehabilitative exercise programs (such as physical and occupational therapy), support groups, rehabilitative clinics (such as congestive heart failure clinics and cardiac rehab), shelters, and case management (Wissman, 2007). In relation to elderly patients and influenza, the levels of prevention are easily demonstrated. Primary prevention methods include education provided to the elderly population regarding the seriousness of the influenza virus, possible complications, and the necessity of vaccinations to protect against the disease.
In addition, providing the influenza vaccination to elderly clients is also a primary prevention method because it seeks to prevent disease from occurring. Once disease occurs, the secondary level of prevention can be observed through interventions such as screening to verify the existence of disease (influenza a swab), symptom control, and management of complications (including rehydration, antibiotics for resulting infections, and potential hospitalization).
Due to the likelihood of the existence of already weakened immune systems and aging of various organ systems, the elderly are more likely to suffer serious complications from the influenza virus. For example, many elderly patients develop pneumonia as a result of illness. Tertiary levels of prevention in this situation include interventions such as physical rehabilitation and strengthening exercises. Conclusion Epidemiology strives to identify health related events, causative factors, spread and control of disease, and potential eradication of disease.
As the elderly population grows exponentially, epidemiology becomes increasingly important in order to assist our older adults with achieving their greatest health potential. Influenza is a disease that has a heavy impact on the elderly sector of the population. Through the utilization of epidemiology, we have the ability harness the influenza virus and improve outcomes for the elderly, as well as the entire population.