| Course | NUR 616 Primary Care of Adults and Gerontological Patients |
|---|---|
| Module | Module 1 |
| Paper type | Discussion post on primary prevention evidence in older adults |
| Length | About 450 words, 3 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 616 Module 1
Module One Discussion
Why I Would Tell Her Not to Start
A patient I will call Mrs. L. is 64, retired from teaching and treated for hypertension. No heart attack, stroke or stent appears anywhere in her history. Her estimated 10-year risk of a cardiovascular event is about 9%. Her sister takes an 81 mg aspirin every morning and told her she should too. Ten years ago many clinicians would have agreed. Today I would advise her not to start, and the reason is a trial that enrolled people very much like her.
ASPREE enrolled 19,114 older adults living in the community, most aged 70 and up (65 and up for Black and Hispanic Americans), and assigned them at random to aspirin 100 mg daily or placebo. None had known cardiovascular disease. After a median of 4.7 years, the rate of cardiovascular disease was 10.7 events per 1,000 person-years with aspirin and 11.3 with placebo, a difference that was not statistically significant. Major hemorrhage, however, occurred at 8.6 per 1,000 person-years with aspirin compared with 6.2 with placebo, a hazard ratio of 1.38 (McNeil et al., 2018). In other words, the benefit did not appear and the harm did.
The US Preventive Services Task Force drew on ASPREE and other trials in its 2022 statement. Its advice is a D grade, meaning do not start, for anyone 60 or older who has no cardiovascular disease, and a C grade for people in their forties and fifties whose 10-year risk reaches 10%, where the small net benefit makes it a personal choice (US Preventive Services Task Force, 2022). The 2019 ACC/AHA prevention guideline had already advised against routine aspirin for primary prevention after 70 and in anyone at higher bleeding risk (Arnett et al., 2019). Mrs. L. is over 60 and below the 10% threshold, so both parts of the statement point the same way.
Two cautions keep this from becoming a blanket rule. The recommendation applies to primary prevention only; a patient who has had a heart attack, stroke or stent should continue aspirin unless told otherwise. And for people already taking aspirin for primary prevention, stopping is a shared decision, since the evidence on discontinuing is thinner than the evidence on starting.
With Mrs. L., I would explain that aspirin's small protective effect is outweighed at her age by the risk of bleeding in the stomach and brain, and that controlling her blood pressure, staying active and reviewing her cholesterol will do more for her heart. I would also suggest she mention the new advice to her sister's clinician.
Question for classmates: how do you handle a patient who has taken aspirin for years for primary prevention and is now over 70?
References
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Munoz, D., Smith, S. C., Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596-e646. https://doi.org/10.1161/CIR.0000000000000678
McNeil, J. J., Wolfe, R., Woods, R. L., Tonkin, A. M., Donnan, G. A., Nelson, M. R., Reid, C. M., Lockery, J. E., Kirpach, B., Storey, E., Shah, R. C., Williamson, J. D., Margolis, K. L., Ernst, M. E., Abhayaratna, W. P., Stocks, N., Fitzgerald, S. M., Orchard, S. G., Trevaks, R. E., . . . Murray, A. M. (2018). Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. New England Journal of Medicine, 379(16), 1509-1518. https://doi.org/10.1056/NEJMoa1805819
US Preventive Services Task Force. (2022). Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA, 327(16), 1577-1584. https://doi.org/10.1001/jama.2022.4983
What the NUR 616 Module 1 instructions ask for
The first NUR 616 discussion usually asks you to examine a prevention or management question in adults or older adults, such as screening, aspirin, statins or blood pressure targets, and to explain how evidence applies across ages. Some prompts ask you to compare recommendations from two organizations. Initial posts tend to fall somewhere near 300 to 500 words, cite a couple of current sources in APA 7 and invite replies later in the week. Start from a specific patient with an age and risk level, report the key trial with its numbers and then show how the recommendation applies to that patient, because the course rewards applying evidence to a person rather than restating a guideline.
How this NUR 616 Module 1 discussion example is built
The post centers on a composite 64-year-old retired teacher with hypertension and a 10-year cardiovascular risk of about 9% who asks about daily aspirin. It reports the ASPREE trial: 19,114 older adults without cardiovascular disease, no significant reduction in cardiovascular events at 10.7 versus 11.3 per 1,000 person-years, and more major bleeding at 8.6 versus 6.2, a hazard ratio of 1.38. It then applies the 2022 USPSTF statement against starting aspirin at 60 or older, adds the limits of that advice for secondary prevention and for current users and shows how the conversation with the patient would go before asking classmates a question about long-term users over 70.
Where the NUR 616 Module 1 rubric puts the points
Discussion rubrics in NUR 616 generally reward accurate use of current evidence, application to a patient in the adult or geriatric population, critical appraisal, APA 7 citation and substantive peer engagement. Posts that report effect sizes from the key trial and explain whether its population matches the patient tend to score higher than posts that summarize a guideline. Identifying the limits of a recommendation, such as the difference between starting and stopping a drug, shows graduate reasoning. Replies earn credit when they add a new patient scenario, a contrasting guideline or a practical communication strategy. Posting on time across the week usually counts as well, as does a professional tone.
NUR 616 Module 1 help: the mistakes that cost points
Early posts in this course lose points by citing older guidance that has been replaced, by applying a primary prevention recommendation to a patient with known cardiovascular disease or by stating a conclusion without the trial numbers behind it. Name the patient's age and risk, report the trial population and results, apply the current recommendation and state its limits. Close by asking peers how they would handle a related case in their own clinics. If your prompt asks about statins, blood pressure targets or cancer screening after 75, send it with the rubric for a first post built around the evidence for that question and the age group it concerns.
Get NUR 616 Module 1 written to your instructions
Send the discussion prompt and the prevention or treatment question it raises. A first post that applies the key trial and current recommendation to a specific older patient, with numbers and limits stated, will be ready in 24 to 48 hours, and your first one is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 616 Module 1 questions, answered
Where can I find a free NUR 616 Module 1 Discussion sample?
A complete first post appears on this page: daily aspirin for primary prevention in a 64-year-old woman, using the ASPREE trial and the 2022 USPSTF statement, with APA 7 citations.
Should adults over 60 start aspirin for primary prevention?
The 2022 USPSTF statement recommends against starting low-dose aspirin for primary prevention in adults 60 and older, because bleeding risk outweighs the small benefit.
What did the ASPREE trial find?
In 19,114 older adults without cardiovascular disease, aspirin 100 mg daily did not significantly reduce cardiovascular events but increased major hemorrhage, with a hazard ratio of 1.38.
Does the aspirin recommendation apply after a heart attack or stroke?
No. It concerns primary prevention only. People with established cardiovascular disease usually continue aspirin for secondary prevention unless their clinician advises otherwise.
Should older adults already taking aspirin stop it?
It is a shared decision. Evidence on stopping is more limited than evidence on starting, so clinicians weigh bleeding risk, cardiovascular risk and the patient's preferences.