Kathy Sykes

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• Kathy Sykes
• Senior Advisor, US EPA Aging Initiative
• October 31, 2007
• Improving Patient Safety Through Informed
  Medication Prescribing and Disposal Practices

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Why Should Aging and the Environment Be a
Research Priority?

• The Demographic Imperative
• By 2030, the 65 population will double to 70
  million
• The population 85 is the frailest and most
  rapidly increasing cohort
• 4 million today 19 million by 2050
• These increases are projected to be long-lasting
  features of American demographics

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Why Focus on Older Adults?

• Demographics
• Decrease in organ function reserves
• Impaired chemical clearance and detoxification
• Vulnerable to medication-environment adverse
  interactions (example - heat/psychotropic drugs)
• Legacy of past occupational and environmental
  cumulative exposures to persistent agents.

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Interactions with Environmental Agents Concern
about Polypharmacy

• The body uses the same biological processes to
  clear medications as it does environmental
  toxicants.

• Older persons take multiple medications.
• Could be at increased risk of adverse reactions
  due to unknown interactions between medications
  and concurrent environmental exposures.

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Indicator 30 - Prescription Drugs
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Indicator 27 - Air Quality
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Indicator 27 - Air Quality
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The public health concern
WHO estimates 4 of all deaths and 5 of health
loss to disability is caused by diarrhea. It is
most commonly caused by gastrointestinal
infections which kill around 2.2 million people
globally. Contaminated water is an important
cause of diarrhea.
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Burden of Gastrointestinal Illness in the United
States

• CDC estimates 211 million episodes of acute
  gastrointestinal (GI) illness occur each year in
  the US resulting in over 900,000 hospitalizations
  and 6,000 deaths.
• Many of these cases may be of infectious origin
  due to food or waterborne transmissionteasing
  apart this difference is a key reason for doing
  trials.
• Source Mead 1999

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Older adults at increased risk for GI illness

• Decline in immunity, changes in GI functions,
  and dehydration associated with aging lead to an
  increased susceptibility of enteric infections
• Older adults may be at increased risk for
  infectious GI illness, severe diarrhea, or dying
  from diarrheal illness (Peterson 2003, Mounts
  1999, Gerba 1996, Lew 1991)
• Older adults are recognized by the USEPA as a
  sensitive subpopulation for waterborne diseases
  (USEPA 2000)

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Burden of Waterborne Disease

• Studies by Payment found that 1/3 of GI illness
  cases are related to drinking water, suggesting
  that up to 70 million cases of GI illness may be
  caused by waterborne pathogens.
• Source Payment 1991 1997

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Gastroenteritis Costs

• In the US, infectious gastroenteritis costs are
  estimated to exceed 20 billion annually.
• Source Peterson 2003

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Bacterial and Viral Enteric Diseases as
Contributing Causes of Death by Age, 1989 - 1996
Viral 89-90
91-92 93-94
95-96
Bacteria 89-90
91-92 93-94
95-96
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GI Hospitalizations

• Older adults are at the highest risk of dying
  during an gastroenteritis-related
  hospitalization, even when compared to infants
• 65-74 14.4 deaths/1000 discharges
• 75 24.9 deaths/ 1000 discharges)
• Source Mounts 1999

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GI Hospitalizations 65 Population

• Persons over 65 years of age account for over
  75 of hospitalizations due to gastroenteritis
• Source Mounts 1999

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Deaths Due to Enteric Disease

• Highest rates of death related to enteric
  disease 75 years
• Deaths related to bacterial enteric disease in
  older adults are increasing at a greater rate
  than in any other age category
• Source Peterson 2003

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Major GI Pathogens

• Morbidity
• Parasites- Cryptosporidium, Cyclospora, Giardia,
  Microsporidia
• Morbidity and Mortality
• Bacteria- Salmonella, Pseudomonas, Clostridium
  difficile, Campylobacter, Mycobacterium avium
  complex, E.Coli
• Viruses- Norwalk and Norwalk-like viruses,
  enteroviruses, rotavirus, adenovirus

Cryptosporidium spores
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Intervention Identify Educate People at
Risk

• Susceptible populations include those with
• Advanced age
• Immune suppression due to disease
• Immune suppression due to taking
• pharmaceuticals

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Building Healthy Communities for Active Aging

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Building Healthy Communities for Active Aging

• Can improve air water quality in the community
  and improve the health of older adults and all
  citizens through intentional community design and
  systematic programming for active aging.
• Change Behavior at the Community Level

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Aging Initiative Fact Sheets and Posters

• Age Healthier, Breathe Easier Fact sheet and
  poster
• Effective Control of Household Pests
• Its Too Darn Hot--Planning for Excessive Heat
  Events
• Environmental Hazards Weigh Heavy on the Heart
• Water Works
• Diabetes and Environmental Hazards
• Spanish, Portuguese, Chinese, Korean,
  Vietnamese, Russian, Japanese, Italian, French
  and Arabic and Haitian Creole
• Low Vision Large font
• Purple Series for persons with limited reading
  ability

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Aging Initiative List Serve

• Join EPAs Aging Initiative monthly list serve
• www.epa.gov/aging