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Aging Demographics and Psychiatric Diagnoses in the Elderly

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Title: Aging Demographics and Psychiatric Diagnoses in the Elderly Author: test Last modified by: doron Created Date: 2/20/2006 9:18:30 PM Document presentation format – PowerPoint PPT presentation

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Title: Aging Demographics and Psychiatric Diagnoses in the Elderly


1
????? ?????? ???? ????? ????? ?????
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??' ????? ??????? ???? ????? ????? ??????
?????? ????????? ??? ????? ?????? ?????? ????
??????, ???? ???.
2
It is an art of no little importance to
administer medicines properly
but, it is an art of much greater and more
difficult acquisition to know when to suspend or
altogether to omit them."
Philippe Pinel, 1745-1826 ( 18th. Century !!! )
3
?????? ?????? ????? ?????? ????? ??? ?????????
  • ??? ?? ?????????, ??? ?????? ?????? ????? ?????
    ???. ???, ???? ? 20 ????? ???? ?????
    ?????? "??????" ?????? ?????? ??? ???? ???? ?????
    ??? ???? (MAGIC BULLETS).
  • ???? ???? ?? ???? ? 20, ?????? ????? ????????
    ?????? ???? ?? ???? ???? ??? ??? ????? - ????
    ???? ????? ??? ?? ?????. ?????? ?????
    ??????? ?????? (???????? ??????) ????? ??????? ??
    ????? ?????? ?????? ?????? ?????? ???? ??? ??,
    ?????, ??? ???? ??, ?????, ????? ??? ??? ????? ??
    ??? ????? ???? ?? ????? ?????.
  • ???, ?? ?????? ?????? ????? - ?????? ?????? ??
    ?? ????? ?? ????? ??????? ?????????, ??????
    ????? ??? ?????? ?????? ???????? ?????, ??
    ?????? ?? ???????? ?"??????" ??"??????"? ?? ????
    ????? ??????, ??? ?? ??????? ???????, ??? ????
    ???? ????? ???? ???? ?????? ?

4
?????? ?????? ????? ?????? ????? ??? ?????????
  • ????? ?????? ?? ???? ??? ??????? ??? ???? ?????
    ?????? ?????? (EVIDENCE BASED MEDICINE) ?? ????
    ?????. ???, ????? ???? ???
    ??????? ??????? ????? (????? ?? ???) ?? ???? ??
    ????? "??????" ?/?? "????? ???? ?????" (????"?).
  • ???? ?????, ??? ??????? ??????? ?? ????,
    ??????? ????? ????? (GUIDELINES) ???????? ????
    ?????? ???? ???? ????, ??????? (EXTRAPOLATION)
    ???? ???? ????"? ???????? ??? ???? ???????.
  • ???? ?????? ?? ???? ????? ????? ?????? ??????????
    ?? ???? ????? ???? ???? ????"? ??????? ??????
    ?????????. ?? ?????? ?????? ?????, ?????
    ?????? ???? (COMMON SENSE) ?????? ??????
    ????????????? - ??? ????? ????? ??????? ??????
    ??????? ??????.

5
?????? ?????? ????? ?????? ????? ??? ?????????
  • ???? ??????? ?????? (CURATIVE) ????? ????
    ??????. ??? ????????, ??????? ???????? ??????
    ????? ????????? ????? ?????, ?????? ???????,
    ????? ?????? ??? ??? ??? ?? ??????? ????? ???? /
    ???- ????? ??? ????? ?????? ???? ???? ????? ????
    ???? ?????? (?? ?? ?????? ???? ??? ????? ?????
    ????? ????).
  • ???? ??????? ?????? ????? - ????? ??? ??? ????.
    ????? ????? "????? ????" ?????? ???
    ?????? ????? ????? ??? ????? ?? ??? ?????? ?????
    ????? ???? ??????? ???? ?????? ??????? ??? ?????
    ?????? ( POLYPHARMACY) .

6
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????????
  • ???????? ?????? - ???? ?????? ??? ?????
    ??, ????? ???? (?????),
  • ?????
    ?????, ????? ??? ?? ??????? .
  • ? ? ? ? ? ? ? ? ? ? - (
    ??? 2 ) ??? ????? ???
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    ?????? gtgt ???????
  • ????? ?????? (?????, ????????, ????? ?????)
    gtgt??????? ??????
  • ?? ????? ??????? / ????? ??????? ???? ???
    ????? ?????

? ? ? ? ? ?
????? ?? ????? ????????
7
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(????????) ???????? ????? ???? ????? ACE /
ARI ????? ????? ???? ??????? ?????????? ?????
?????? / ?????? -------------------------- ????? ?
??????? / ????? H2 ??????? / ???????????? ?????
???
  • ???????? ?????? ??????? ????????? -
  • ??? ????? ???
  • ? ? ? ? ? ? ? ? ? ?
  • ? ? ? ?
  • ?????? (??????) ????????
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8
(No Transcript)
9


? ? ? ? ? ? ?
? ?
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? ? ? ?
????? ????, "????? ????"
? ? ? ? ?
?? ????????
?????? ?
??? ? ?? ?? ??? ?
??? ???? ?????
gt???? --- ????gtgt ?????? gtgt ?????? gtgtgt ????
??????????? ????? - BACKWORD EXTRAPOLATION
??????????? ????? ?? ???? ??? ??????
????????gt ??????gt ??????gtgt...??????
10
???? ????? ????? ?????????? ??????????? ?????
?????? ??????? ??????????
?????? ?????? ?? ????? ???? ?????? ?? ?????
?????? / ??????. ???? ?? ?????? ?????? ????? ??
????? ???????? ????? ??? ??? ??? ????? ???? ??
????. ???? ??? ????.
11
???? ????? ????? ?????????? ??????????? ?????
?????? ??????? ??????????
?????? ?????? ?? ????? ???? ?????? ?? ?????
?????? / ??????. ??????? ?????? ??????? ????????
????? ???? ?????? ????? ???????? ?????? ?????
????? ???????, ????? ?????, ?????? ????? ?"? ???
??????? ?????? ????? ???? (?????? ???????).
12
???? ????? ????? ?????????? ?? ???? ????? ???? ??
?????? ??????-????? ?? ?????? ???? ???????
????????????
?????? ?????? ?? ?????? ????? ???? ?????? ??
????? ?????? / ??????. ?????? ??? ???? ???? ???
????? ????? ????? ???? ????? ?????? ?? ????, ???
??? ????? ????? (?? ???????? ????? ????? ???
???????) ?? ?? ??????, ???? ?? ??????....
13
THE WAR AGAINST POLYPHARMACY A New, Cost
Effective, Geriatric - Palliative Approach for
Improving Drug Therapy in Disabled Elderly People
DORON GARFINKEL, SARAH ZUR-GIL, JOSHUA BEN-ISRAEL
ISRAEL MEDICAL ASSOCIATION JOURNAL (IMAJ) 9 430
- 4 (June 2007)
14
???? ????? ????? ????????? ?????? ???????? ?
  • ????? ?????? ????? ?? ????? ?????? ?????

No. Pts.
Reccurence of of . DRUG
Stopped Symptoms/Signs
Success . NITRATES 22
0 100
H2 BLOCKERS 35
2 94 ANTI
HTn 51
9 82

DIURETICS (fusid) 27 (25)
4 (4) 85
PENTOXIFYLLINE 15
0 100 SLOW K
20 0
100 SLOW FE
19 1
95 SEDAT TRANQUIL 16
2 88
ANTIDEPRESSANTS 19 5
74 ANTIPSYCHOTICS
13 4
69
15
Annual Rate of Deaths and Referrals to Acute
Care Facilities
P - Value Control Group Study Group
71 119 Total No.
0.001 32 (45) 25 (21) Deaths
16
Annual Rate of Deaths and Referrals to Acute
Care Facilities
P - Value Control Group Study Group
71 119 Total No.
0.001 32 (45) 25 (21) Deaths
0.002 21 (30) 14 (11.8) Referrals to Acute Care Facilities
17
Conclusions Our results indicate that,
At least in Nursing Departments, the Sum
Total of Negative Impacts of MEDICATIONS,
OUTWEIGHS the Sum Total of the Potential
Beneficial Effects of all specific drugs.
18
?? ???? ?????? ?????? ?????? ? ???? ????? ?????
??????????
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??????? ?? ????? ???? ?????? 2 - 7 ?????? ???
??????? ????? ??? ????? ?????? ?????. ?????
?????? ????? ????? ????? ??? 6 ?????? ????
????? ?????? ?? 84 ?? ?????? 7 ?????? - ?????
??????? ?????? ??????? ????? ?????? ????????
MMSE ? - 14/30 ? 23/30. ????? ??????? ?? 73
???? ????? 6 ??????, ???? ????? ???? ???? ?????
?????? ???????? MMSE ? - 14/30 ? 30/30.
19
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???? ??? ???? ???....
??????? ????? ?? ??????
????? ?? ???? ?????, ?????? ???? ????? ??????
???????.
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