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Geriatric Medicine Principles Falls Robert Kirby, MD, FACP Clinical Professor of Medicine

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Title: Geriatric Medicine Principles Falls Robert Kirby, MD, FACP Clinical Professor of Medicine


1
Geriatric MedicinePrinciplesFallsRobert
Kirby, MD, FACPClinical Professor of Medicine
2
Geriatric Medicine
3
Geriatric MedicinePrinciples/ Falls
  • Learning Objectives
  • 1. List two characteristics of the geriatric
  • population.
  • 2. Describe two instruments to assess function.
  • 3. Define geriatric syndrome. Name three.
  • 4. List four risk factors for falls.
  • 5. Outline three interventions to reduce fall
    risk.

4
Biology of Aging
  • Genetic
  • Oxidative Stress
  • Mitochondrial Dysfunction
  • Hormonal Changes
  • Telomere Shortening (Hayflick Limit)
  • Defective Host Defenses
  • Accumulation of Senescent Cells



  • Harrison on Line

5
Demographics
  • USA 2020 gt65 yo 16
  • Dependency Ratio-Europe
  • 2050 22 to gt50

Harrison on Line Merck Manual Geriatrics
6
Demographics
  • Over Age 65
  • 40 of Hospital Resources
  • 24 of Office Visits
  • 25 of Prescription Drug Costs
  • 25 of Medicare expenditure in last year of life-
    Half of this in last 60 days
  • Residents of Nursing Homes
  • Age 65 1
  • Age 85 17

Merck Manual of Geriatrics
7
Chronic Disease Burden

Condition Age 65 Age 75

Arthritis 50 54
Hypertension Heart 36 32 39 39
Hearing Cataracts 28 16 36 24
Diabetes Vision 10 8 11 11
Merck Manual Geriatrics
8
Life Expectancy




Walter LC, Covinsky KE, JAMA 2001
9
Function Activities of Daily Living
  • Basic Intermediate
  • Dressing Shopping
  • Eating Housework
  • Ambulating Accounting
  • Toileting Food Preparation
  • Hygiene Transportation

10
Function with Aging
11
Principles in a Flash
  1. Aging is not a disease.
  2. Geriatric conditions are chronic, multiple,
    multifactorial
  3. Reversible conditions are underdiagnosed and
    undertreated
  4. Function and quality of life are critical
    outcomes
  5. Social support and patient preferences are
    critical aspects
  6. Geriatrics is multidisciplinary
  7. Cognitive and affective disorders prevalent and
    undiagnosed at early stages
  8. Iatrogenic disease common and often preventable
  9. Care is provided in multiple settings
  10. Ethical and end of life issues guide practice

www.cha.emory.edu/reynoldsprogram
12
Clinical Approach
  • Not what disease caused the problem
  • But what combination of physiologic change,
    impairments and diseases are contributing
  • And which ones can be modified

Modawal
13
Geriatric Syndromes
  • Dementia and Delerium
  • Falls
  • Polypharmacy
  • Pressure Ulcers
  • Urinary Incontinence

14
Mary Anderson
  • This 85 year old widow presents after a fall in
    the bedroom of the home where she has raised her
    family and lives independently.
  • She does not know why she fell, was able to
    ambulate after the fall and presents six hours
    later with a bruise on her left cheek and an
    abrasion on the left forearm.
  • Daughter reports occasional confusion and some
    limitation of activities due to weakness. She
    reports a fall four months ago.
  • PMH
  • DJD hips and knees with chronic pain
  • Hypertension
  • Macular degeneration
  • Diabetes 2
  • Urinary urgency and rare incontinence

15
  • Medications Hydrochlorothiazide, Fentanyl
    patch, KCL,Tylenol, MVI
  • Examination
  • BP supine 160/88 standing 3 minutes 168/92
  • Vision 20/50
  • Chest
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