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Mon, 05/15/2023 - 00:12
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Jaime Piccola
Assessing Knowledge in Senior Citizens. Can Education Improve What is Important to Senior
Citizens in Regard to the Annual Wellness Visit
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Chapter 1
The thought of our health becomes increasingly important as we become elderly.
Remaining independent and enjoying life becomes a priority for seniors. Taking that into
consideration, preventative health should remain important to them. Preventative healthcare is
vital in maintaining one’s health. The Annual Wellness Visit (AWV) is a great example of
preventative care for senior citizens.
The AWV is for adults 65 and over who are Medicare eligible. This annual service
provides Medicare patients with a chance to create a prevention plan to stay healthy. It also
gives them an opportunity to talk to their health care provider and ask questions about their
health. The purpose of this study is to assess the knowledge of what senior citizens know about
an AWV by completing a pre- and post-test using my AWV survey. Can seniors learn what is
included in an AWV through an educational presentation, thus leading to an increase in
participation and possible improving of overall health?
Background
The AWV was mandated to be reimbursed for Medicare patients over 65 years of age
when the Affordable Care Act was implemented on January 1, 2011 (“MLN Matters”, 2016).
The Annual Wellness Visit includes:
establishment of an individual’s medical/family history, a list of current providers
who are involved in the individual’s medical care, measurement of height, weight,
BMI, BP, detection of any cognitive impairment the individual may have, review
of the individual’s potential risks for depression or other mood disorders by using
the appropriate screening instrument, review of the individual’s functional ability
and level of safety based on direct observation or screening questionnaire,
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establishment of a written screening schedule based on recommendations of the
United States Preventive Services Task Force (USPSTF) and the Advisory
Committee on Immunization Practices (ACIP), as well as the individual’s health
status, screening history, and age-appropriate preventive services covered by
Medicare, establishment of a list of risk factors and conditions for which primary,
secondary, or tertiary interventions are recommended, and furnishing of
personalized health advice to the individual and a referral, as appropriate, to
health education or preventive counseling services or programs aimed at reducing
identified risk factors and improving self-management, or community-based
lifestyle interventions to reduce health risks and promote self-management and
wellness, including weight loss, physical activity, smoking cessation, fall
prevention, and nutrition (“MLN Matters”, 2016, pp. 2-4).
The exam is very comprehensive and covers many different aspects of an individual’s health.
An AWV may or may not include a physical exam as its focus is on having a conversation to
address health prevention and screening.
Despite the benefits available in the AWV, many elderly patients do not take advantage
of this service. Although 2 million seniors qualify for Medicare every year, there are around
100,000 annual wellness exams that are billed (Fiegl, 2011). One reason is Medicare patients
may not know that preventive care is covered (Beran & Craft, 2015). Other reasons include
patients’ lack of understanding and perception of wellness visits being valuable (Beran & Craft,
2015). Most people think that the only reason to seek out a healthcare providers’ help is when
an acute problem arises.
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In 2011, a report was published called Enhancing Use of Clinical Preventative Services
Among Older Adults, Closing the Gap. The purpose of this report was to bring attention to the
preventative services available for older Americans over 65. The report described the challenges
older adults’ experience that can contribute to them not getting an AWV. Besides their lack of
education in not knowing what services are covered, other reasons include transportation
difficulties, language barriers, culture sensitivity, and disability (Centers for Disease Control and
Prevention, Administration on Aging, Agency for Healthcare Research and Quality, and Centers
for Medicare and Medicaid Services, 2011). Older adults count on their healthcare provider’s
expertise and recommendations. Unfortunately, because of a lack of time or forgetfulness,
healthcare providers may not tell their older patients which preventative services they should
receive (Centers for Disease Control and Prevention, Administration on Aging, Agency for
Healthcare Research and Quality, and Centers for Medicare and Medicaid Services, 2011).
These gaps in care can be reduced through education by increasing the knowledge about the
AWV.
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Chapter 2
Older adults are lacking the knowledge on health promotion and prevention. An example
of this is the underutilization of an AWV. This study involved health promotion and education
for the elderly. Health promotion is important for people of all ages, including the elderly.
There are many things that the elderly can choose to do to promote their health.
Evidence has shown that exercising, quitting smoking and limiting alcohol
consumption, participating in learning activities and integrating in the community
can help to inhibit the development of many diseases and prevent the loss of
functional capacity, thus improving quality of life and lengthening life expectancy
(Golinowska, Groot, Baji, & Pavlova, 2016, p. 367).
With advancing technologies in medicine and research, people are living longer. For the elderly,
there are three health promotion components that increase in importance with advancing age, and
these include functional capacity, self-care, and stimulation of their social activity (Golinowska,
Groot, Baji, & Pavlova, 2016). These three components play a large role in the elderly
remaining at home and being independent.
The conceptual framework that best fits this study is the Health Belief Model. “This
model was created to promote healthy behaviors in individuals by encouraging individuals to
utilize preventative care services” (Callaghan, Bieda, & Centopanti, 2013, para. 2). There are
four main components to consider in regard to people’s perceptions of their health. They are
“the severity of a potential illness, the person’s susceptibility to that illness, the benefits of taking
a preventative action, and the barriers to taking that action” (Nursing Theories, 2012, para. 4).
These components are described in detail below.
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Perceived Susceptibility: refers to a person’s perception that a health problem is
personally relevant or that a diagnosis of illness is accurate. Perceived
severity: even when one recognizes personal susceptibility, action will not occur
unless the individual perceives the severity to be high enough to have serious
organic or social complications. Perceived benefits: refers to the patient’s belief
that a given treatment will cure the illness or help to prevent it. Perceived Costs:
refers to the complexity, duration, and accessibility of the treatment. Modifying
factors: include personality variables, patient satisfaction, and socio-demographic
factors (Nursing Theories, 2012, para. 9-12 and 14).
The components are all related to people’s perceptions. Luckily, people’s perceptions can be
changed through education.
Patient perception is important to understand when trying to promote health screenings to
older adults. Familiarizing with the patient perceptions’ will help to establish what methods one
can use to provide education. For example, does verbal communication work better than written
communication? Understanding their perceptions will help with providing education on why
they need to get recommended screenings and vaccines.
Health promotion of screening exams such as mammograms, colonoscopies, FIT (fecal
immunochemical test) testing, eye exams, vaccines and DEXA scans are all topics discussed in
an AWV. These screening measures provide value to the older adult. They are all preventative
care measures. The lack of knowledge on the importance of these screening exams is one of the
reasons why elderly people do not partake in them.
For the older adult over 65, it is recommended that they receive an influenza, Herpes
Zoster, pneumococcal, and Tdap vaccines. The influenza (flu) shot is recommended annually.
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“In recent years, between 80 and 90 percent of flu-related deaths and more than half of flurelated hospitalizations have occurred in people age 65 and older, according to the Centers for
Disease Control and Prevention…”(Infectious Diseases Society of America, 2015, para. 4). The
pneumococcal vaccine is recommended once for older adults over 65 years. It is only
recommended that patients get it a second time if they have received the vaccine before the age
of 65 and five years have passed. The Shingles (Herpes Zoster) vaccine is recommended one
time for adults over 60. “Almost 1 out of 3 people in the United States will develop shingles
during their lifetime. About 1 out of 5 people with shingles will get post herpetic neuralgia or
PHN” (Centers for Disease Control and Prevention, 2016, para. 2). It affects the nerve endings
and can cause a burning pain (Mayo Clinic Staff, 2015). The risk of shingles increases with age.
“Approximately 1 to 4% of people who get shingles are hospitalized for complications. Each
year, about 96 shingles-related deaths occur in the United States. Almost all the deaths occur in
elderly people or those with a weakened or suppressed immune system” (Centers for Disease
Control and Prevention, 2016, para. 4 and 5). A shingles vaccine can reduce the complications.
A Tdap (tetanus, diphtheria, and pertussis) vaccine is recommended every 10 years. With a
decrease in the number of children getting vaccinated against whooping cough (pertussis), it is
important for older adults to protect themselves. They are at greater risk because of their
weakened immune systems.
The mammogram is also a valuable screening tool that is beneficial to elderly women. In
the United States, 21% of women over the age of 75 have breast cancer (Malmgren, Parikh,
Atwood, & Kaplan, 2014). Early detection can help to decrease that number. A 2014 study
conducted by Malmgren, Parikh, Atwood, & Kaplan showed that mammograms are still
effective in detecting breast cancer in women over the age of 75. “Mammography detection of
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breast cancer in women aged 75 years and older is associated with a reduction in advanced-stage
cancer, which has few acceptable systemic treatment options in the elderly” (Malmgren, Parikh,
Atwood, & Kaplan, 2014, para. 27).
The DEXA scan or bone density test is a simple and cost effective test that can help older
adults escape some of the injuries related to falling. A DEXA scan or bone density test is
another important screening tool as it can be helpful in diagnosing osteoporosis. Unfortunately,
it may not always be used. “A 2008 study using a 5 percent sample of all Medicare beneficiaries
revealed that from 1999 to 2005 only 30 percent of women turning 65 (and 4 percent of men)
had bone density tests (Span, 2012, para. 7)”. Another study conducted by Gourlay et. al, (2012)
suggest that a DEXA scan be completed during intervals and prior to treatment of osteoporosis
and a fracture of a hip or vertebrae.
Colonoscopies are an invasive procedure that requires people to undergo anesthesia. The
test involves a flexible scope with a camera attached to take a good look at the colon. According
to the American Cancer Society, “colorectal cancer is expected to cause about 49,190 deaths in
2016” (American Cancer Society, 2016, para. 3). “However, the average age of CRC (colorectal
cancer) diagnosis is 71 years, and 43% of CRC cases are diagnosed at age 75 years and older”
(Helwick, 2011, para. 5). Benefits versus risks need to be weighed when considering this test.
FIT stands for fecal immunochemical testing. It is a test that is used to detect blood in
the stool that visually cannot been seen. The FIT is a good test if patients are refusing a
colonoscopy. They are easy for adults to complete in the comfort of their own home.
The last screening exam to consider beneficial for older adults is the eye exam. Adults
over the age of 65 are at risk for macular degeneration and glaucoma. People who are diabetic
are also at risk for developing diabetic retinopathy. “The prevalence of blindness and vision
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impairment increases rapidly with age among all racial and ethnic groups, particularly among
people older than 75 years” (CDC, 2011, para. 2). Visual impairment can significantly affect the
older adult’s quality of life. “Research has shown that recommended eye care that addresses eye
diseases and refractive error may remediate 50% of vision problems” (CDC, 2011, para. 7).
Yearly eye exams can lead to early detection of vision problems which in turn can lead to early
intervention and improved outcomes. Education on vision loss can give people the opportunity to
try and prevent it.
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Chapter 3
Methodology
The aim of this quantitative study was to investigate if an educational presentation would be
effective in increasing the knowledge of what senior citizens consider to be important in an
AWV. Participants were recruited with the use of a flyer that described the topic of the study and
informed them that refreshments would be served (Appendix 3). A 10-question survey, which
includes a likert scale, was used to gather the data (Appendix 4). The study participants
completed the questionnaire prior to attending the educational presentation. They then attended
the presentation and completed the survey once again. Data from both surveys was collected and
analyzed. Prior to completing the survey, each participant was screened for any cognitive
impairment using the 6CIT. This test only takes 4 minutes to complete, has a high sensitivity,
and results that are easy to interpret.
Research Design
A non-randomized cross-sectional study with purposeful sampling was used to ensure all
participants were Medicare patients. The survey was administered twice, once before the
powerpoint presentation and verbal discussion on AWVs and then once after the presentation.
The pre- and post- surveys were differentiated by assigning colors, red for the pretest and green
for the post-test, and corresponding numbers.
Setting
The setting for this survey study included two senior citizen centers, the Etna Senior
Citizen, and the Lawrenceville Senior Center, both of which are located in the area of Pittsburgh,
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PA. Both centers are located in communities where senior citizens have the ability to come from
their homes and participate in various activities, as well as, have lunch. They were chosen based
on their response by email and phone calls to participate in the study.
Sample
The study sample was comprised of senior citizens over the age of 65, regardless of sex,
gender, religious affiliation, or cultural background, and who were found to be eligible to
participate in the study. The minimum sample size was determined to be 34 participants who
met the study criteria. This number was determined using the sample size calculator from Altherapy statistics (ALCTB, 2017). To determine eligibility for participation in the study, all
potential participants took the 6CIT, a test that is comprised of 6 questions and screens for
cognitive impairment. This was administered by the principal investigator, a DNP student and a
FNP with a MSN. The principal investigator read the questions to each potential participant
individually and recorded their answers, which were given verbally. The principal investigator
then scored each test based on the guidelines of the 6CIT. Senior citizens with a score higher
than 8 were excluded from the study.
There were 17 participants in the study, three of whom were male and 14 of whom were
female. Five participants were between the ages of 70 and 74 years, four were between the ages
of 85 and 89 years, three were between the ages of 65 and 69 years, and two were between the
ages of 80 and 84 years. There was one participant between the ages of 75 and 79 years and one
who was 90 years of age or older. The racial composition, socioeconomic status, or cultural
differences were not identified in this study. Please see the table below.
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Table 1
Description of the Sample
Characteristic
Gender
Male
Female
n
%
3
14
17.6
82.4
13
4
76.5
23.5
3
5
1
2
4
1
17.6
29.4
5.9
11.8
23.5
5.9
Site
Lawrenceville
Etna
Age
65-69
70-74
75-79
80-84
85-89
90 or older
Ethical Considerations
Institutional review board approval was obtained from Clarion University prior to the
start of the study. Because the senior citizen centers do not have an institutional review board, a
letter (appendix 1) was provided to the managers of the senior citizen centers outlining the
details of the study and asking permission for the study to occur in in their respective center.
Once permission was granted, study participants were recruited using flyers (appendix 3)
provided to the centers. The information on the flyer included the day the study would occur and
the fact that light refreshments and snacks would be available for all participants. Informed
consent (Appendix 2) from the potential participants was obtained by the principal investigator.
Participation was voluntary with no risks, benefits or compensation to and for the participants.
Privacy and anonymity was maintained by having participants only use their gender and age as
identifiable markers on the surveys.
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Instrumentation
The survey was specifically created by the principal investigator for the study. All of the
questions on the survey are specific to an AWV and are required by Centers for Medicare and
Medicaid Services (CMS) to be included on an AWV. Prior to the conduction of this research
study, the survey was piloted to test for sensitivity, specificity, and validity. The sample size for
the pilot study was 4 participants, which is about 4% of the actual study sample size. The 4
participants were senior citizens from the Lawrenceville senior center who did not want to
participate in the study, but agreed to complete the survey.
The survey (Appendix 4), which is comprised of ten questions, includes the gender and
age of participants as well as the name of the senior citizen center. The survey responses were
based on a three-point Likert scale which includes the responses of very important, less
important, and not important.
Reliability of Pretest and Posttest Items
Cronbach’s alpha coefficient was used to calculate the reliability of the pretest and
posttest questionnaire items. The reliability of the items at each administration of the
questionnaire was .71 (See Table 3). The reliability of the scales is considered to be adequate
(Tavakol & Dennick, 2011).
Table 2
Reliability of Items at Pretest and Posttest
Administration
Number of items in scale
Cronbach’s alpha coefficient
Pretest
10
.709
Posttest
10
.711
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Data Collection
After approval from the IRB at Clarion University was obtained and permission from the
senior citizen centers was given to the principal investigator, the study was conducted and the
data was collected. The principal investigator collected all pre- and post- test surveys from the
participants on the same day as the educational presentation was given. To assure that the data
reflected the correct information for each participant, each pretest was identified by having a red
dot on it, along with an assigned number and each post-test was identified by having a green dot
on it, along with the number that corresponds to the respective pretest. After all data was
collected from the two senior citizen centers, the principal investigator reviewed the results to
ensure all surveys were completed correctly. The data was then given to the statistician for
analysis of the results. Once the results of the study were analyzed and recorded they were
provided to the managers of the two participating senior citizen centers.
Statistical Analysis
Descriptive statistics were used to analyze the data. A paired samples t-test was utilized
to determine any differences in the pre- and post-survey answers. Central tendency measures
were used to look at the average age of participants and their gender. A post hoc analysis using
G*Power was also used to look at the sample size and the effect of their results .
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Chapter 4
Results
This study was conducted to determine if an educational presentation was effective in
increasing the knowledge of an AWV for senior citizens. The 10-item questionnaire was
administered to a total of seventeen participants, 3 males and 14 females between the ages of 65
and 98 years with the average of 78 years, before and after the they attended the presentation.
At pretest, six of the 10 items were considered very important to 88% or more of the participants.
At posttest, eight items were considered very important to 88% or more of the participants (See
Table 3 below). Two items, depression and functional assessments, were considered less
important to the participants at both pretest and posttest (See Table 4 below).
Table 3
Pretest and Posttest Responses to Questionnaire Items
Level of importance
Pretest
Item
Very*
Posttest
Less
Not
Very
Less
Not
Has a list of my providers
100
0
0
100
0
0
Aware of family medical history
100
0
0
100
0
0
Complete a depression screening
47
41
12
59
35
6
Complete a functional assessment
65
39
6
77
23
0
Know height, weight, BMI
94
6
0
100
0
0
Complete cognition assessment
82
12
6
88
6
6
Discuss referral options
82
18
0
94
6
0
100
0
0
94
6
0
88
12
0
94
6
0
Discuss recommended vaccines
Discuss recommended screenings
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Discuss advanced directives
94
6
0
88
12
0
* Percentage of respondents
Table 4
Difference in Level of Importance at Pretest and Posttest
Test
n
M
SD
Pretest
17
1.17
.20
Posttest
17
1.12
.17
t
1.35
p
.20
Data Analysis
The participants responded to the 10 pretest and posttest items using a 3-point Likert
scale that ranged from 1 (very important) to 2 (less important) to 3 (not important). A mean
score, level of importance, was calculated for the participants based on their Likert responses to
the 10 items. The level of importance score could range between 1 (very important) to 3 (not
important). A paired-samples t test was conducted to determine if the participants’ responses
were significantly different from pretest to posttest (See Table 4). The mean at pretest was 1.17
(SD = .20), indicating many of the participants rated the items as very important. The mean at
posttest (M = 1.12, SD = .17) was even closer to 1 (very important), indicating that even more of
the participants rated the items as very important. However, there was not a statistically
significant difference (t = 1.35, p =.20) in the participants’ level of agreement from before the
educational presentation and after the educational presentation.
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Chapter 5
Summary and Conclusions
The purpose of this study was to investigate if an educational presentation would be
effective in improving what is important to senior citizens in regard to the annual wellness visit
through the completion of a pre and post-test. The sample size consisted of 17 seniors over the
age of 65. The setting was comprised of two senior citizen centers, both near Pittsburgh, PA.
Seventeen participants viewed an educational presentation about the annual wellness visit
provided by Medicare. The participants responded to a questionnaire asking them to indicate the
level of importance they placed on components of the AWV. After the educational presentation,
the same participants were asked to respond again to the questionnaire. An analysis of their
responses found that the seniors considered six of the components of the AWV very important at
pretest, but after the educational presentation they indicated eight of the components were very
important. Before the presentation, the participants had considered the following components
important; has a list of my providers, aware of family medical history, know height, weight,
BMI, discuss recommended vaccines and screenings, and discuss advance directives. After the
presentation, the participants considered the following components important; has a list of my
providers, aware of family medical history, know height, weight, BMI, complete cognition
assessment, discuss referral options, discuss recommended vaccines and screenings, and discuss
advance directives. Although there was positive change in knowledge after the educational
presentation, the statistical analysis of the change was not significant.
Several reasons may have provided a lack of statistical significance. First, the
participants indicated many of the items on the AWV were very important before the
educational presentation. Therefore, the analysis could not find a statistically significant change
in knowledge after the presentation because the participants’ knowledge was already high at
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pretest. Another possible reason for lack of significance could be low sample size. A post hoc
analysis using G*Power found the power of analysis with 17 participants was low at .25.
The results revealed a positive change in knowledge after the educational presentation.
However the statistical analysis of the change was not significant. Prior to the educational
presentation, 88% of seniors viewed six out of the ten items on the survey as very important.
These six items included the following: that their healthcare provider: 1) has a list of all their
other providers, 2) is aware of their family medical history, 3) knows their height, weight, and
BMI, 4) can provide recommendations for vaccines, 5) can provide recommendations for
screenings, and 6) could have a discussion on advance directives.
The educational presentation included a discussion on all ten of the survey items. After
the educational presentation was completed, 88% of seniors viewed eight out of ten items on the
survey as very important. The two additional items seniors felt important are a completed
cognition assessment and discussion of referral options.
Recommendations For Further Research
For the future, education on AWVs should continue despite the age of the
population. Health care providers need to utilize any opportunity that arises to provide education
on the benefits of preventive health care. AWVs are one method of addressing the preventative
health care needs in the elderly.
Despite the small sample size, results did indicate a positive change in what is viewed as
important by senior citizens as to what is important in an annual wellness visit. Because of these
results this study may be used as a stepping stone for further research related to AWVs. In future
studies more senior citizen centers should be included along with a larger population sample.
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Although these study results were statistically insignificant, it can be concluded that an
educational presentation may increase what senior citizens find to be important in an annual
wellness visit.
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Appendix 1
Jaime Piccola, FNP-C
Clarion and Edinboro Universities
(Date)
Dear (name of manager of senior citizen centers),
Your senior citizen center is being invited to participate in a research study that aims to
investigate if seniors can learn what is included in an annual wellness visit (AWV) through an educational
presentation, thus increasing participation to achieve optimal health.
The research study should take approximately 2 hours. During this time, a pre- survey will be
given to the senior citizen residents at the center. Following the pre- survey, the researcher will be
presenting a 15-20 minute power point presentation to the senior citizens on AWVs. After the power
point presentation, the study participants will be given a post survey to complete. Privacy and anonymity
will be maintained by only requiring the sex of the participants and their age. Information will be kept
confidential to the researcher and the statistician who will be helping sort out the data results.
The results of the study will be mailed to all participating senior centers once all of the data is
collected and analyzed.
I have read the above information regarding this research study on investigating if seniors can
learn what should be included in an annual wellness visit (AWV) through an educational presentation and
consent to participate in this study.
______________________________________________(Printed Name)
______________________________________________(Signature)
______________________________________________(Date)
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Appendix 2
UNIVERSITY AFFILIATION: Clarion University of PA IRB Administrative Office, Carlson125,
Clarion University, Clarion, PA 16214, 814-393-2343
STUDY TITLE: Assessing Knowledge in Senior Citizens. Can Education Improve their
Knowledge on Annual Wellness Visits?
PRINCIPAL INVESTIGATOR: J a im e Pi cc ol a , 123 Syc a m ore Dr., Pi tt sburgh, PA
15237, 412 -414 -9228, J .L.Pi c c ol a@c la ri on.e du
DESCRIPTION: I understand that I have been asked to participate in this research project which
is a study th at aims to investigate if seniors can learn what is included in an annual wellness
visit (AWV) through an educational presentation, thus increasing participation to achieve
optimal health.
The research study should take approximately 2 hours. During this time, a pre- survey will be
given to me at the center. Following the pre- survey, the researcher will be presenting a 15-20
minute power point presentation on AWVs. After the power point presentation, I will be given
a post survey to complete.
RISK AND BENEFITS: There are no risks associated in my participation in this study. I may
benefit from this study by increasing my knowledge on what an annual wellness visit is for senior
citizens.
COST AND PAYMENTS: There is no cost to participate in this study. No payment will be
offered to me for my participation.
CONFIDENTIALITY: I understand that any information about me obtained from this research
will be kept strictly confidential. Privacy and anonymity will be maintained by only requiring
the sex of the participants and their age. Information will be kept in locked files and only (the
principal investigator and statistician) will have access to it. It has been explained to me that
my identity will not be revealed in any description or publication of this research. Therefore, I
consent to publication for scientific purposes.
DISCLOSURE: I understand that any information about me obtained from this research may be
disclosed. It has been explained to me that my identity may be revealed in any description or
publication of this research. Therefore, I consent to publication for scientific purposes.
RIGHT TO REFUSE OR END PARTICIPATION: I understand that I may refuse to participate
in this study or withdraw any time. I also understand that I may be withdrawn from the study
any time by the investigator(s).
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Signature of Subject:
_____________________________________
Signature of Investigator:
IRB Research Approval #
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Appendix 3
Attention Seniors over 65
Free seminar
Are you interested in learning more about your health and what an Annual Wellness Visit is?
Come to the center on (date of study and time insertion here). A certified nurse practitioner
(CRNP) will be here presenting information on what an Annual Wellness Visit is and why they
are important.
Light refreshments and
snacks will be provided.
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Appendix 4
Please read the following questions in response to your Annual Wellness Visit that you receive from your
health care provider. Answer the questions to the best of your ability. Thank you.
____Male or Female_______
Age________
Senior Citizen Center name_____________
1. It is important that my primary care provider have a list of all my health care providers.
Very important
Less important
Not important
2. It is important that my provider is aware of my family medical history (mother, father, brother, sister).
Very important
Less important
Not important
3. It is important that I have a depression screening.
Very important
Less important
Not important
4. It is important to complete a functional assessment (this can include home safety, your fall risk, and
activities of daily living like dressing, bathing, grocery shopping, etc.) with my provider.
Very important
Less important
Not important
5. It is important that my provider obtain my height, weight, and body mass index (BMI).
Very important
Less important
Not important
6. It is important that my provider completes a cognition (memory) assessment test with me.
Very important
Less important
Not important
7. It is important that my provider discusses referral options (for example, the Area for Aging) with me.
Very important
Less important
Not important
8. It is important that my provider discusses recommended vaccines with me.
Very important
Less important
Not important
9. It is important that my provider discusses recommended screenings for me including mammograms,
DEXA scans, a colonoscopy or occult stool testing, and an eye exam.
Very important
Less important
Not important
10. Is it important that my provider discusses advanced directives with me.
Very important
Less important
Not important
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http://www.cdc.gov/visionhealth/pdf/vision_brief.pdf
Centers for Disease Control and Prevention, Administration on Aging, Agency for Healthcare
Research and Quality, and Centers for Medicare and Medicaid Services. Enhancing Use
of Clinical Preventive Services Among Older Adults. Washington, DC: AARP, 2011.
Retrieved from
http://www.cdc.gov/aging/pdf/Clinical_Preventive_Services_Closing_the_Gap_Report.p
df
Centers for Disease Control and Prevention. (August 19, 2016). Shingles Surveillance. Retrieved
26
from http://www.cdc.gov/shingles/surveillance.html
Fiegl, C. (May, 2, 2011). Medicare’s Missed Checkups: Few Seniors Get Wellness Exam.
American Medical News. Retrieved from
http://www.amednews.com/article/20110502/government/305029954/4/
Golinowska, M., Groot, W., Baji, P., & Pavlova, M. (September 5, 2016). Health
Promotion Targeting Older People. BMC Health Services Research, 16(Suppl 5).
pp. 367-369. DOI:10.1186/s12913-016-1514-3
Gourlay, M, Fine, J., Preisser, J., May, R., Li, C., Lui, L., Ransohoff, D., Cauley, J. & Ensrud, K.
January 19, 2012. Bone-Density Testing Interval and Transition to Osteoporosis in Older
Women. New England Journal of Medicine. (366). pp. 225-233.
DOI: 10.1056/NEJMoa1107142
Helwick, C. June 1, 2011. Screening Colonoscopy May Benefit Elderly Patients. Retrieved from
http://www.medscape.com/viewarticle/743816#vp_1
Infectious Diseases Society of America. September 10, 2015. Where flu vaccination rates are
higher in adults under 65, lower flu risk for seniors: Study suggests association between
immunizations of younger adults against flu and flu related illnesses in the
elderly. ScienceDaily. Retrieved from
www.sciencedaily.com/releases/2015/09/150910084557.htm
Malmgren, J., Parikh, J., Atwood, M., & Kaplan, H. December 2014. Improved Prognosis of
Women Aged 75 and Older With Mammography Detected Breast Cancer.
http://dx.doi.org/10.1148/radiol.14140209
Mayo Clinic Staff. (September 16, 2015). Postherpetic Neuralgia. Definition. Retrieved
from http://www.mayoclinic.org/diseases-conditions/postherpetic-
27
neuralgia/basics/definition/con-20023743
MLN Matters. (March 2, 2016). Annual Wellness Visit (AWV), Including Personalized
Prevention Plan Services (PPPS). Retrieved from
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/MM7079.pdfNational Center for Health Statistics, July 6,
2016. Pneumonia. Retrieved from
http://www.cdc.gov/nchs/fastats/pneumonia.htm
Nursing Theories, (2012, January 31). Health Belief Model. Retrieved from
http://currentnursing.com/nursing_theory/health_belief_model.html
Span, Paula. January 18, 2012. Older Women and Bone Tests. Retrieved from
http://newoldage.blogs.nytimes.com/2012/01/18/older-women-and-bone-tests/?_r=0
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of
Medical Education, 2, 53‒55.
Jaime Piccola
Assessing Knowledge in Senior Citizens. Can Education Improve What is Important to Senior
Citizens in Regard to the Annual Wellness Visit
2
Chapter 1
The thought of our health becomes increasingly important as we become elderly.
Remaining independent and enjoying life becomes a priority for seniors. Taking that into
consideration, preventative health should remain important to them. Preventative healthcare is
vital in maintaining one’s health. The Annual Wellness Visit (AWV) is a great example of
preventative care for senior citizens.
The AWV is for adults 65 and over who are Medicare eligible. This annual service
provides Medicare patients with a chance to create a prevention plan to stay healthy. It also
gives them an opportunity to talk to their health care provider and ask questions about their
health. The purpose of this study is to assess the knowledge of what senior citizens know about
an AWV by completing a pre- and post-test using my AWV survey. Can seniors learn what is
included in an AWV through an educational presentation, thus leading to an increase in
participation and possible improving of overall health?
Background
The AWV was mandated to be reimbursed for Medicare patients over 65 years of age
when the Affordable Care Act was implemented on January 1, 2011 (“MLN Matters”, 2016).
The Annual Wellness Visit includes:
establishment of an individual’s medical/family history, a list of current providers
who are involved in the individual’s medical care, measurement of height, weight,
BMI, BP, detection of any cognitive impairment the individual may have, review
of the individual’s potential risks for depression or other mood disorders by using
the appropriate screening instrument, review of the individual’s functional ability
and level of safety based on direct observation or screening questionnaire,
3
establishment of a written screening schedule based on recommendations of the
United States Preventive Services Task Force (USPSTF) and the Advisory
Committee on Immunization Practices (ACIP), as well as the individual’s health
status, screening history, and age-appropriate preventive services covered by
Medicare, establishment of a list of risk factors and conditions for which primary,
secondary, or tertiary interventions are recommended, and furnishing of
personalized health advice to the individual and a referral, as appropriate, to
health education or preventive counseling services or programs aimed at reducing
identified risk factors and improving self-management, or community-based
lifestyle interventions to reduce health risks and promote self-management and
wellness, including weight loss, physical activity, smoking cessation, fall
prevention, and nutrition (“MLN Matters”, 2016, pp. 2-4).
The exam is very comprehensive and covers many different aspects of an individual’s health.
An AWV may or may not include a physical exam as its focus is on having a conversation to
address health prevention and screening.
Despite the benefits available in the AWV, many elderly patients do not take advantage
of this service. Although 2 million seniors qualify for Medicare every year, there are around
100,000 annual wellness exams that are billed (Fiegl, 2011). One reason is Medicare patients
may not know that preventive care is covered (Beran & Craft, 2015). Other reasons include
patients’ lack of understanding and perception of wellness visits being valuable (Beran & Craft,
2015). Most people think that the only reason to seek out a healthcare providers’ help is when
an acute problem arises.
4
In 2011, a report was published called Enhancing Use of Clinical Preventative Services
Among Older Adults, Closing the Gap. The purpose of this report was to bring attention to the
preventative services available for older Americans over 65. The report described the challenges
older adults’ experience that can contribute to them not getting an AWV. Besides their lack of
education in not knowing what services are covered, other reasons include transportation
difficulties, language barriers, culture sensitivity, and disability (Centers for Disease Control and
Prevention, Administration on Aging, Agency for Healthcare Research and Quality, and Centers
for Medicare and Medicaid Services, 2011). Older adults count on their healthcare provider’s
expertise and recommendations. Unfortunately, because of a lack of time or forgetfulness,
healthcare providers may not tell their older patients which preventative services they should
receive (Centers for Disease Control and Prevention, Administration on Aging, Agency for
Healthcare Research and Quality, and Centers for Medicare and Medicaid Services, 2011).
These gaps in care can be reduced through education by increasing the knowledge about the
AWV.
5
Chapter 2
Older adults are lacking the knowledge on health promotion and prevention. An example
of this is the underutilization of an AWV. This study involved health promotion and education
for the elderly. Health promotion is important for people of all ages, including the elderly.
There are many things that the elderly can choose to do to promote their health.
Evidence has shown that exercising, quitting smoking and limiting alcohol
consumption, participating in learning activities and integrating in the community
can help to inhibit the development of many diseases and prevent the loss of
functional capacity, thus improving quality of life and lengthening life expectancy
(Golinowska, Groot, Baji, & Pavlova, 2016, p. 367).
With advancing technologies in medicine and research, people are living longer. For the elderly,
there are three health promotion components that increase in importance with advancing age, and
these include functional capacity, self-care, and stimulation of their social activity (Golinowska,
Groot, Baji, & Pavlova, 2016). These three components play a large role in the elderly
remaining at home and being independent.
The conceptual framework that best fits this study is the Health Belief Model. “This
model was created to promote healthy behaviors in individuals by encouraging individuals to
utilize preventative care services” (Callaghan, Bieda, & Centopanti, 2013, para. 2). There are
four main components to consider in regard to people’s perceptions of their health. They are
“the severity of a potential illness, the person’s susceptibility to that illness, the benefits of taking
a preventative action, and the barriers to taking that action” (Nursing Theories, 2012, para. 4).
These components are described in detail below.
6
Perceived Susceptibility: refers to a person’s perception that a health problem is
personally relevant or that a diagnosis of illness is accurate. Perceived
severity: even when one recognizes personal susceptibility, action will not occur
unless the individual perceives the severity to be high enough to have serious
organic or social complications. Perceived benefits: refers to the patient’s belief
that a given treatment will cure the illness or help to prevent it. Perceived Costs:
refers to the complexity, duration, and accessibility of the treatment. Modifying
factors: include personality variables, patient satisfaction, and socio-demographic
factors (Nursing Theories, 2012, para. 9-12 and 14).
The components are all related to people’s perceptions. Luckily, people’s perceptions can be
changed through education.
Patient perception is important to understand when trying to promote health screenings to
older adults. Familiarizing with the patient perceptions’ will help to establish what methods one
can use to provide education. For example, does verbal communication work better than written
communication? Understanding their perceptions will help with providing education on why
they need to get recommended screenings and vaccines.
Health promotion of screening exams such as mammograms, colonoscopies, FIT (fecal
immunochemical test) testing, eye exams, vaccines and DEXA scans are all topics discussed in
an AWV. These screening measures provide value to the older adult. They are all preventative
care measures. The lack of knowledge on the importance of these screening exams is one of the
reasons why elderly people do not partake in them.
For the older adult over 65, it is recommended that they receive an influenza, Herpes
Zoster, pneumococcal, and Tdap vaccines. The influenza (flu) shot is recommended annually.
7
“In recent years, between 80 and 90 percent of flu-related deaths and more than half of flurelated hospitalizations have occurred in people age 65 and older, according to the Centers for
Disease Control and Prevention…”(Infectious Diseases Society of America, 2015, para. 4). The
pneumococcal vaccine is recommended once for older adults over 65 years. It is only
recommended that patients get it a second time if they have received the vaccine before the age
of 65 and five years have passed. The Shingles (Herpes Zoster) vaccine is recommended one
time for adults over 60. “Almost 1 out of 3 people in the United States will develop shingles
during their lifetime. About 1 out of 5 people with shingles will get post herpetic neuralgia or
PHN” (Centers for Disease Control and Prevention, 2016, para. 2). It affects the nerve endings
and can cause a burning pain (Mayo Clinic Staff, 2015). The risk of shingles increases with age.
“Approximately 1 to 4% of people who get shingles are hospitalized for complications. Each
year, about 96 shingles-related deaths occur in the United States. Almost all the deaths occur in
elderly people or those with a weakened or suppressed immune system” (Centers for Disease
Control and Prevention, 2016, para. 4 and 5). A shingles vaccine can reduce the complications.
A Tdap (tetanus, diphtheria, and pertussis) vaccine is recommended every 10 years. With a
decrease in the number of children getting vaccinated against whooping cough (pertussis), it is
important for older adults to protect themselves. They are at greater risk because of their
weakened immune systems.
The mammogram is also a valuable screening tool that is beneficial to elderly women. In
the United States, 21% of women over the age of 75 have breast cancer (Malmgren, Parikh,
Atwood, & Kaplan, 2014). Early detection can help to decrease that number. A 2014 study
conducted by Malmgren, Parikh, Atwood, & Kaplan showed that mammograms are still
effective in detecting breast cancer in women over the age of 75. “Mammography detection of
8
breast cancer in women aged 75 years and older is associated with a reduction in advanced-stage
cancer, which has few acceptable systemic treatment options in the elderly” (Malmgren, Parikh,
Atwood, & Kaplan, 2014, para. 27).
The DEXA scan or bone density test is a simple and cost effective test that can help older
adults escape some of the injuries related to falling. A DEXA scan or bone density test is
another important screening tool as it can be helpful in diagnosing osteoporosis. Unfortunately,
it may not always be used. “A 2008 study using a 5 percent sample of all Medicare beneficiaries
revealed that from 1999 to 2005 only 30 percent of women turning 65 (and 4 percent of men)
had bone density tests (Span, 2012, para. 7)”. Another study conducted by Gourlay et. al, (2012)
suggest that a DEXA scan be completed during intervals and prior to treatment of osteoporosis
and a fracture of a hip or vertebrae.
Colonoscopies are an invasive procedure that requires people to undergo anesthesia. The
test involves a flexible scope with a camera attached to take a good look at the colon. According
to the American Cancer Society, “colorectal cancer is expected to cause about 49,190 deaths in
2016” (American Cancer Society, 2016, para. 3). “However, the average age of CRC (colorectal
cancer) diagnosis is 71 years, and 43% of CRC cases are diagnosed at age 75 years and older”
(Helwick, 2011, para. 5). Benefits versus risks need to be weighed when considering this test.
FIT stands for fecal immunochemical testing. It is a test that is used to detect blood in
the stool that visually cannot been seen. The FIT is a good test if patients are refusing a
colonoscopy. They are easy for adults to complete in the comfort of their own home.
The last screening exam to consider beneficial for older adults is the eye exam. Adults
over the age of 65 are at risk for macular degeneration and glaucoma. People who are diabetic
are also at risk for developing diabetic retinopathy. “The prevalence of blindness and vision
9
impairment increases rapidly with age among all racial and ethnic groups, particularly among
people older than 75 years” (CDC, 2011, para. 2). Visual impairment can significantly affect the
older adult’s quality of life. “Research has shown that recommended eye care that addresses eye
diseases and refractive error may remediate 50% of vision problems” (CDC, 2011, para. 7).
Yearly eye exams can lead to early detection of vision problems which in turn can lead to early
intervention and improved outcomes. Education on vision loss can give people the opportunity to
try and prevent it.
10
Chapter 3
Methodology
The aim of this quantitative study was to investigate if an educational presentation would be
effective in increasing the knowledge of what senior citizens consider to be important in an
AWV. Participants were recruited with the use of a flyer that described the topic of the study and
informed them that refreshments would be served (Appendix 3). A 10-question survey, which
includes a likert scale, was used to gather the data (Appendix 4). The study participants
completed the questionnaire prior to attending the educational presentation. They then attended
the presentation and completed the survey once again. Data from both surveys was collected and
analyzed. Prior to completing the survey, each participant was screened for any cognitive
impairment using the 6CIT. This test only takes 4 minutes to complete, has a high sensitivity,
and results that are easy to interpret.
Research Design
A non-randomized cross-sectional study with purposeful sampling was used to ensure all
participants were Medicare patients. The survey was administered twice, once before the
powerpoint presentation and verbal discussion on AWVs and then once after the presentation.
The pre- and post- surveys were differentiated by assigning colors, red for the pretest and green
for the post-test, and corresponding numbers.
Setting
The setting for this survey study included two senior citizen centers, the Etna Senior
Citizen, and the Lawrenceville Senior Center, both of which are located in the area of Pittsburgh,
11
PA. Both centers are located in communities where senior citizens have the ability to come from
their homes and participate in various activities, as well as, have lunch. They were chosen based
on their response by email and phone calls to participate in the study.
Sample
The study sample was comprised of senior citizens over the age of 65, regardless of sex,
gender, religious affiliation, or cultural background, and who were found to be eligible to
participate in the study. The minimum sample size was determined to be 34 participants who
met the study criteria. This number was determined using the sample size calculator from Altherapy statistics (ALCTB, 2017). To determine eligibility for participation in the study, all
potential participants took the 6CIT, a test that is comprised of 6 questions and screens for
cognitive impairment. This was administered by the principal investigator, a DNP student and a
FNP with a MSN. The principal investigator read the questions to each potential participant
individually and recorded their answers, which were given verbally. The principal investigator
then scored each test based on the guidelines of the 6CIT. Senior citizens with a score higher
than 8 were excluded from the study.
There were 17 participants in the study, three of whom were male and 14 of whom were
female. Five participants were between the ages of 70 and 74 years, four were between the ages
of 85 and 89 years, three were between the ages of 65 and 69 years, and two were between the
ages of 80 and 84 years. There was one participant between the ages of 75 and 79 years and one
who was 90 years of age or older. The racial composition, socioeconomic status, or cultural
differences were not identified in this study. Please see the table below.
12
Table 1
Description of the Sample
Characteristic
Gender
Male
Female
n
%
3
14
17.6
82.4
13
4
76.5
23.5
3
5
1
2
4
1
17.6
29.4
5.9
11.8
23.5
5.9
Site
Lawrenceville
Etna
Age
65-69
70-74
75-79
80-84
85-89
90 or older
Ethical Considerations
Institutional review board approval was obtained from Clarion University prior to the
start of the study. Because the senior citizen centers do not have an institutional review board, a
letter (appendix 1) was provided to the managers of the senior citizen centers outlining the
details of the study and asking permission for the study to occur in in their respective center.
Once permission was granted, study participants were recruited using flyers (appendix 3)
provided to the centers. The information on the flyer included the day the study would occur and
the fact that light refreshments and snacks would be available for all participants. Informed
consent (Appendix 2) from the potential participants was obtained by the principal investigator.
Participation was voluntary with no risks, benefits or compensation to and for the participants.
Privacy and anonymity was maintained by having participants only use their gender and age as
identifiable markers on the surveys.
13
Instrumentation
The survey was specifically created by the principal investigator for the study. All of the
questions on the survey are specific to an AWV and are required by Centers for Medicare and
Medicaid Services (CMS) to be included on an AWV. Prior to the conduction of this research
study, the survey was piloted to test for sensitivity, specificity, and validity. The sample size for
the pilot study was 4 participants, which is about 4% of the actual study sample size. The 4
participants were senior citizens from the Lawrenceville senior center who did not want to
participate in the study, but agreed to complete the survey.
The survey (Appendix 4), which is comprised of ten questions, includes the gender and
age of participants as well as the name of the senior citizen center. The survey responses were
based on a three-point Likert scale which includes the responses of very important, less
important, and not important.
Reliability of Pretest and Posttest Items
Cronbach’s alpha coefficient was used to calculate the reliability of the pretest and
posttest questionnaire items. The reliability of the items at each administration of the
questionnaire was .71 (See Table 3). The reliability of the scales is considered to be adequate
(Tavakol & Dennick, 2011).
Table 2
Reliability of Items at Pretest and Posttest
Administration
Number of items in scale
Cronbach’s alpha coefficient
Pretest
10
.709
Posttest
10
.711
14
Data Collection
After approval from the IRB at Clarion University was obtained and permission from the
senior citizen centers was given to the principal investigator, the study was conducted and the
data was collected. The principal investigator collected all pre- and post- test surveys from the
participants on the same day as the educational presentation was given. To assure that the data
reflected the correct information for each participant, each pretest was identified by having a red
dot on it, along with an assigned number and each post-test was identified by having a green dot
on it, along with the number that corresponds to the respective pretest. After all data was
collected from the two senior citizen centers, the principal investigator reviewed the results to
ensure all surveys were completed correctly. The data was then given to the statistician for
analysis of the results. Once the results of the study were analyzed and recorded they were
provided to the managers of the two participating senior citizen centers.
Statistical Analysis
Descriptive statistics were used to analyze the data. A paired samples t-test was utilized
to determine any differences in the pre- and post-survey answers. Central tendency measures
were used to look at the average age of participants and their gender. A post hoc analysis using
G*Power was also used to look at the sample size and the effect of their results .
15
Chapter 4
Results
This study was conducted to determine if an educational presentation was effective in
increasing the knowledge of an AWV for senior citizens. The 10-item questionnaire was
administered to a total of seventeen participants, 3 males and 14 females between the ages of 65
and 98 years with the average of 78 years, before and after the they attended the presentation.
At pretest, six of the 10 items were considered very important to 88% or more of the participants.
At posttest, eight items were considered very important to 88% or more of the participants (See
Table 3 below). Two items, depression and functional assessments, were considered less
important to the participants at both pretest and posttest (See Table 4 below).
Table 3
Pretest and Posttest Responses to Questionnaire Items
Level of importance
Pretest
Item
Very*
Posttest
Less
Not
Very
Less
Not
Has a list of my providers
100
0
0
100
0
0
Aware of family medical history
100
0
0
100
0
0
Complete a depression screening
47
41
12
59
35
6
Complete a functional assessment
65
39
6
77
23
0
Know height, weight, BMI
94
6
0
100
0
0
Complete cognition assessment
82
12
6
88
6
6
Discuss referral options
82
18
0
94
6
0
100
0
0
94
6
0
88
12
0
94
6
0
Discuss recommended vaccines
Discuss recommended screenings
16
Discuss advanced directives
94
6
0
88
12
0
* Percentage of respondents
Table 4
Difference in Level of Importance at Pretest and Posttest
Test
n
M
SD
Pretest
17
1.17
.20
Posttest
17
1.12
.17
t
1.35
p
.20
Data Analysis
The participants responded to the 10 pretest and posttest items using a 3-point Likert
scale that ranged from 1 (very important) to 2 (less important) to 3 (not important). A mean
score, level of importance, was calculated for the participants based on their Likert responses to
the 10 items. The level of importance score could range between 1 (very important) to 3 (not
important). A paired-samples t test was conducted to determine if the participants’ responses
were significantly different from pretest to posttest (See Table 4). The mean at pretest was 1.17
(SD = .20), indicating many of the participants rated the items as very important. The mean at
posttest (M = 1.12, SD = .17) was even closer to 1 (very important), indicating that even more of
the participants rated the items as very important. However, there was not a statistically
significant difference (t = 1.35, p =.20) in the participants’ level of agreement from before the
educational presentation and after the educational presentation.
17
Chapter 5
Summary and Conclusions
The purpose of this study was to investigate if an educational presentation would be
effective in improving what is important to senior citizens in regard to the annual wellness visit
through the completion of a pre and post-test. The sample size consisted of 17 seniors over the
age of 65. The setting was comprised of two senior citizen centers, both near Pittsburgh, PA.
Seventeen participants viewed an educational presentation about the annual wellness visit
provided by Medicare. The participants responded to a questionnaire asking them to indicate the
level of importance they placed on components of the AWV. After the educational presentation,
the same participants were asked to respond again to the questionnaire. An analysis of their
responses found that the seniors considered six of the components of the AWV very important at
pretest, but after the educational presentation they indicated eight of the components were very
important. Before the presentation, the participants had considered the following components
important; has a list of my providers, aware of family medical history, know height, weight,
BMI, discuss recommended vaccines and screenings, and discuss advance directives. After the
presentation, the participants considered the following components important; has a list of my
providers, aware of family medical history, know height, weight, BMI, complete cognition
assessment, discuss referral options, discuss recommended vaccines and screenings, and discuss
advance directives. Although there was positive change in knowledge after the educational
presentation, the statistical analysis of the change was not significant.
Several reasons may have provided a lack of statistical significance. First, the
participants indicated many of the items on the AWV were very important before the
educational presentation. Therefore, the analysis could not find a statistically significant change
in knowledge after the presentation because the participants’ knowledge was already high at
18
pretest. Another possible reason for lack of significance could be low sample size. A post hoc
analysis using G*Power found the power of analysis with 17 participants was low at .25.
The results revealed a positive change in knowledge after the educational presentation.
However the statistical analysis of the change was not significant. Prior to the educational
presentation, 88% of seniors viewed six out of the ten items on the survey as very important.
These six items included the following: that their healthcare provider: 1) has a list of all their
other providers, 2) is aware of their family medical history, 3) knows their height, weight, and
BMI, 4) can provide recommendations for vaccines, 5) can provide recommendations for
screenings, and 6) could have a discussion on advance directives.
The educational presentation included a discussion on all ten of the survey items. After
the educational presentation was completed, 88% of seniors viewed eight out of ten items on the
survey as very important. The two additional items seniors felt important are a completed
cognition assessment and discussion of referral options.
Recommendations For Further Research
For the future, education on AWVs should continue despite the age of the
population. Health care providers need to utilize any opportunity that arises to provide education
on the benefits of preventive health care. AWVs are one method of addressing the preventative
health care needs in the elderly.
Despite the small sample size, results did indicate a positive change in what is viewed as
important by senior citizens as to what is important in an annual wellness visit. Because of these
results this study may be used as a stepping stone for further research related to AWVs. In future
studies more senior citizen centers should be included along with a larger population sample.
19
Although these study results were statistically insignificant, it can be concluded that an
educational presentation may increase what senior citizens find to be important in an annual
wellness visit.
20
Appendix 1
Jaime Piccola, FNP-C
Clarion and Edinboro Universities
(Date)
Dear (name of manager of senior citizen centers),
Your senior citizen center is being invited to participate in a research study that aims to
investigate if seniors can learn what is included in an annual wellness visit (AWV) through an educational
presentation, thus increasing participation to achieve optimal health.
The research study should take approximately 2 hours. During this time, a pre- survey will be
given to the senior citizen residents at the center. Following the pre- survey, the researcher will be
presenting a 15-20 minute power point presentation to the senior citizens on AWVs. After the power
point presentation, the study participants will be given a post survey to complete. Privacy and anonymity
will be maintained by only requiring the sex of the participants and their age. Information will be kept
confidential to the researcher and the statistician who will be helping sort out the data results.
The results of the study will be mailed to all participating senior centers once all of the data is
collected and analyzed.
I have read the above information regarding this research study on investigating if seniors can
learn what should be included in an annual wellness visit (AWV) through an educational presentation and
consent to participate in this study.
______________________________________________(Printed Name)
______________________________________________(Signature)
______________________________________________(Date)
21
Appendix 2
UNIVERSITY AFFILIATION: Clarion University of PA IRB Administrative Office, Carlson125,
Clarion University, Clarion, PA 16214, 814-393-2343
STUDY TITLE: Assessing Knowledge in Senior Citizens. Can Education Improve their
Knowledge on Annual Wellness Visits?
PRINCIPAL INVESTIGATOR: J a im e Pi cc ol a , 123 Syc a m ore Dr., Pi tt sburgh, PA
15237, 412 -414 -9228, J .L.Pi c c ol a@c la ri on.e du
DESCRIPTION: I understand that I have been asked to participate in this research project which
is a study th at aims to investigate if seniors can learn what is included in an annual wellness
visit (AWV) through an educational presentation, thus increasing participation to achieve
optimal health.
The research study should take approximately 2 hours. During this time, a pre- survey will be
given to me at the center. Following the pre- survey, the researcher will be presenting a 15-20
minute power point presentation on AWVs. After the power point presentation, I will be given
a post survey to complete.
RISK AND BENEFITS: There are no risks associated in my participation in this study. I may
benefit from this study by increasing my knowledge on what an annual wellness visit is for senior
citizens.
COST AND PAYMENTS: There is no cost to participate in this study. No payment will be
offered to me for my participation.
CONFIDENTIALITY: I understand that any information about me obtained from this research
will be kept strictly confidential. Privacy and anonymity will be maintained by only requiring
the sex of the participants and their age. Information will be kept in locked files and only (the
principal investigator and statistician) will have access to it. It has been explained to me that
my identity will not be revealed in any description or publication of this research. Therefore, I
consent to publication for scientific purposes.
DISCLOSURE: I understand that any information about me obtained from this research may be
disclosed. It has been explained to me that my identity may be revealed in any description or
publication of this research. Therefore, I consent to publication for scientific purposes.
RIGHT TO REFUSE OR END PARTICIPATION: I understand that I may refuse to participate
in this study or withdraw any time. I also understand that I may be withdrawn from the study
any time by the investigator(s).
22
Signature of Subject:
_____________________________________
Signature of Investigator:
IRB Research Approval #
23
Appendix 3
Attention Seniors over 65
Free seminar
Are you interested in learning more about your health and what an Annual Wellness Visit is?
Come to the center on (date of study and time insertion here). A certified nurse practitioner
(CRNP) will be here presenting information on what an Annual Wellness Visit is and why they
are important.
Light refreshments and
snacks will be provided.
24
Appendix 4
Please read the following questions in response to your Annual Wellness Visit that you receive from your
health care provider. Answer the questions to the best of your ability. Thank you.
____Male or Female_______
Age________
Senior Citizen Center name_____________
1. It is important that my primary care provider have a list of all my health care providers.
Very important
Less important
Not important
2. It is important that my provider is aware of my family medical history (mother, father, brother, sister).
Very important
Less important
Not important
3. It is important that I have a depression screening.
Very important
Less important
Not important
4. It is important to complete a functional assessment (this can include home safety, your fall risk, and
activities of daily living like dressing, bathing, grocery shopping, etc.) with my provider.
Very important
Less important
Not important
5. It is important that my provider obtain my height, weight, and body mass index (BMI).
Very important
Less important
Not important
6. It is important that my provider completes a cognition (memory) assessment test with me.
Very important
Less important
Not important
7. It is important that my provider discusses referral options (for example, the Area for Aging) with me.
Very important
Less important
Not important
8. It is important that my provider discusses recommended vaccines with me.
Very important
Less important
Not important
9. It is important that my provider discusses recommended screenings for me including mammograms,
DEXA scans, a colonoscopy or occult stool testing, and an eye exam.
Very important
Less important
Not important
10. Is it important that my provider discusses advanced directives with me.
Very important
Less important
Not important
25
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