Health risk assessment principles and methods

Case Study: Risk Assessment for 62 Year Old Diabetic Woman Health Screening: The patient in question is one who should be seen by a physician with great regularity. The multitude of conditions which are described as already present, the connection between these conditions and the presence of further health risks and the hereditary factors which also place the subject in a high risk group collectively suggest that the 62 year-old subject should receive regular screening in a number of categories. First and foremost are the conditions from which the patient already suffers. The patient's diabetes is the most pressing of issues, as this is connected to a host of other potential causative and resultant conditions. In addition to the treatment regimen which is dictated for the patient to follow independently, the scenario calls for regular monitoring of blood sugar levels and other vital indicators by a physician. Regular cholesterol testing and blood pressure monitoring should also be done to ensure that the patient is maintaining the proper lifestyle terms (discussed hereafter in the 'Treatment' section). Given a family history which includes a vulnerability to myocardial infarction, lifestyle terms and cholesterol will together constitute an important focus during health screening visits. Additionally, the patient is at a key age with respect to Breast Cancer, which is identified as also being a hereditary danger. This denotes the importance of regular mammography check-ups. Indeed, in spite of recent controversial research suggesting a diminished urgency for the mammography procedure for younger women, the age of the subject places her clearly in a demographic which is recommended to receive this screening with greater regularity. According to the United States Preventative Services Task Force (USPSTF), "there is convincing evidence that screening with film mammography reduces breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years." (USPSTF, 1) Given that the subject falls into the demographic receiving the greatest benefit, this should be an emphasis where screening is concerned.

Risk Factors: Given the family history and personal circumstances facing the patient, the array of risk factors justifies frequent screening and a clearly laid out health and lifestyle plan. Foremost among these risk factors is the patient's age. Entering into her senior years at the age of 62, the patient should expect a number of health changes to begin to take place. Many of these will subject her to a greater risk in the categories where she is vulnerable by virtue of her age alone. This is demonstrated by the risk imposed upon her by breast cancer specifically as a result of her age. Accordingly we find that breast cancer is the leading cause in the death of American women between the ages of 25 and 64. (Jibaja-Weiss et al, 123) Even with the remarkable effort at spreading information on the preventable nature of this condition where early detection is applied, and with the genuine declination in the population of those afflicted, there nonetheless remains a widespread breast cancer crisis in the United States. The reason, theoretical and research based evidence collectively suggest, is tied directly into the inversely proportional relationship between need for and access to medical attention. For those who suffer the consequences of this imbalance as a result of low income, a lack of access to insurance or the limited mobility which comes with advanced age, there is a highly elevated threat of failing to screen and therefore detect breast cancers. For those such as our patient, who are also evidenced to have a family history with the condition, this is a deeply important part of her individual health strategy. Other major risk factors are those conditions which are present but which can grow worse and which can lead to other complicating conditions. This is the case with Diabetes, which must be monitored carefully and daily. Diabetes is a significant, pressing and continually worsening public health problem. General research has drawn close connections between this public health problem and certain gender, racial and cultural factors. Additionally, research has recognized that diabetes is today one of the fastest growing public health problems due to the negative health behaviors which have become increasingly culturally prevalent in America. The 'junk food' culture that inclines Americans to consume fatty foods with limited nutritional value and to engage relatively sedentary lifestyles is creating a culture of heart-disease, obesity and diabetes. For the individual in question, these risks are deepened by the presence of high blood pressure and elevated cholesterol levels. The epidemic nature of diabetes has drawn a considerable degree of public concern for American society and public health in general. But for the elderly it is especially troubling because many of these lifestyle patterns are already deeply ingrained and difficult to adjust. For an individual of an advanced age to begin regular exercise, there are considerable health risks as well. This can stand in the way of the prevention of a worsening of the condition. The USPSTF indicates that risks associated with a failure to treat may be considerable. Accordingly, the report indicates that "diabetes is a leading cause of blindness, renal disease, and amputation and leads to increased mortality, primarily from cardiovascular events." (USPSTF1, 1). Among such cardiovascular events, the hereditary threat of myocardial infarction is only further magnified for the subject.

Intervention: Beyond the regular screening discussed above, the most important means of intervention will be that which defines the self-monitoring, diet, physical activity and other elements of lifestyle. According to a 2002 study by Gilliland et al, "lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time." (Gilliland et al, 78) This is suggestive of the most popularly proposed mode of treatment for the diabetes epidemic. Certainly, there is a core difficulty in demanding the behavioral changes which are connected to prevention of this condition. Accordingly, the true externalities relating to habits of diet, consumption and activity bear a great impact on elderly populations, who will sometimes lack the physical capability or health robustness to make such changes. In terms of this patient's diabetes, high cholesterol and elevated hereditary risk of myocardial infarction, there may be a distinct opportunity for timely intervention.

Recommendations: As stated here above, the patient is now on the threshold of an advanced age, denoting a series of health factor changes. This is the ideal moment at which to institute modes of physical activity and nutritional intake that can help to lengthen one's later years. The reverse is also true, which is to say that an absence of regular and effectively measured activity can result in a genuine and persistent loss of function. This is a reality which must be impressed upon this subject who is at risk of becoming sedentary. It is generally reported that "the frail health and loss of function we associate with aging, such as difficulty walking long distances, climbing stairs, or carrying groceries, is in large part due to physical inactivity." (AHRQ, 1) Thus, it must be seen as a priority for the subject's treatment plan. Evidence suggests that this has a promising array benefits to the patient if overseen with the proper care. Indeed, current research denotes that "elderly people who are physically active are much more likely to live longer than elderly people who are not physically active, according to a six-year study carried out by researchers at the US National Institute on Aging." (Nordqvist, 1) This is a compelling and immediate premise which drives the recommendations for the patient in question. At the very root of this recommendation is the opportunity to significantly improve longevity in the patient in spite of her relative health risks.