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INTRODUCTION TO GERIATRIC MEDICINE

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INTRODUCTION TO GERIATRIC MEDICINE * * * * * * * * * * * * * DEMOGRAPHICS 1900 Life expectancy 47 years in US 4% over the age of 65 Mid 1990 s Life ... – PowerPoint PPT presentation

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Title: INTRODUCTION TO GERIATRIC MEDICINE


1
INTRODUCTION TO GERIATRIC MEDICINE
2
DEMOGRAPHICS
  • 1900 Life expectancy 47 years in US
  • 4 over the age of 65
  • Mid 1990s Life expectancy 65 years in US
  • 12.6 over the age of 65
  • By 2020 - over the age of 65
  • By 2040 - over the age of 65

3
DEMOGRAPHICS
  • 1900 Life expectancy 47 years in US
  • 4 over the age of 65
  • Mid 1990s Life expectancy 65 years in US
  • 12.6 over the age of 65
  • By 2020 17 over the age of 65
  • By 2040 22 over the age of 65
  • 1/3 women live to 85 15 men live to 85
  • Causes of death heart, cancer, stroke, lung

4
DEMOGRAPHICS
  • More than 70 of people now live to 65 (3 times
    that of 1900)
  • Life expectancy at age 65 is now gt17 years
  • Population of US increased 3 fold in the 20th
    century 11 fold for those over 65
  • 1900 19 of those who died over age 65
  • 2000 75 of those who die over age 65
  • Death rates changed from childhood and middle age

5
CENTENARIANS
  • 1900 rare
  • 2000 60,000
  • 2050- gt1,000,000

6
CENTENARIANS
7
DEMOGRAPHICS
  • 85 over age 65 have one chronic illness
  • 60 over age 65 have 2 or more chronic illnesses
  • 17 age 65-74 functional limitations
  • 29 age 75-84 functional limitations

8
FLORIDA DEMOGRAPHICS
  • 1995 19 over age 65
  • 2025 26 over age 65
  • Four surrounding counties with mean age over 55
    years
  • Tampa Bay area has over half the skilled nursing
    units in the state and the two largest hospice
    organizations in US

9
THE MYTHS OF AGING
  • Sick, demented, frail, weak, disabled, powerless,
    sexless, passive, alone, unhappy
  • Holding back society
  • Scientific reality or not?

10
MYTH 1 TO BE OLD IS TO BE SICK
  • Are the new seniors very sick/old or healthier?
  • Past Infectious illnesses
  • Mid century Arthritis, HTN, heart disease
  • Now Decrease prevalence arthritis, HTN, stroke,
    lung disease
  • Compression of morbidity less institutionalized
  • 1994 39 over 65 health very good or excellent
    with 29 fair or poor

11
MYTH 2 YOU CANT TEACH AN OLD DOG NEW TRICKS
  • Fear of developing
  • Alzheimers disease
  • Even those with short
  • term memory problems
  • have been shown to
  • improve recall
  • Deficits can be overcome
  • with proper training (lists, etc.)

12
MYTH 3 THE HORSE IS OUT OF THE BARN
  • Risky behaviors no point in changing
  • Not too late for no smoking, exercise and diet

13
MYTH 4 THE SECRET TO SUCCESSFUL AGING IS TO
CHOOSE YOUR PARENTS WISELY
  • Is the role of genetics overstated?
  • Increased longevity of offspring of those who
    died at much
  • earlier ages

14
MYTH 5 THE LIGHTS MAY BE ON BUT THE VOLTAGE IS
LOW
  • Inadequate physical/mental/sexual abilities
  • Sexual activity decreases in old age

15
MYTH 6 THE ELDERLY DONT PULL THEIR OWN WEIGHT
  • One third of elderly continue to work
  • One third of elderly volunteer
  • Others provide informal caregiving
  • Many more are willing and able to work

16
SUCCESSFUL AGING
  • Low probability of disease and
  • disease related disability
  • High cognitive and
  • functional capacity
  • Active engagement with LIFE
  • Rowe and Kahn, Gerontologist, 1997

17
HEALTH
  • WHO More than absence of disease
  • WHO Presence of physical, mental and social well
    being perceived in the context of each
    individuals experiences, beliefs, and
    expectations.
  • Can 2 individuals with same objective measures of
    health status have different perceptions of
    health related quality of life?

18
GERIATRIC RX
  • Functionally oriented biopsychosocial model
    fostering comprehensive, multidimensional
    approach to health assessment
  • Context of patients beliefs and values
  • Must elicit values of patients to determine
    benefits and burdens of interventions

19
ELEMENTS OF ASSESSMENTS
  • Biomedical acute/chronic diseases, physical
    function, ADLs, IADLs
  • Psychological Intellect. function, personality,
    mood, sensorium, psych history/symptoms
  • Social Family structure/involvement, friends,
    co-workers, neighbors, church, community, work
    history, financial resources, health insurance,
    living arrangements, life-style
  • Values Personal, cultural, ethnic, religious,
    spiritual

20
PRINCIPLES OF GERIATRIC ASSESSMENT
  • Goal Promote wellness, independence
  • Focus Function, performance
  • Scope Physical, cognitive, psychol, social
  • Approach Multidisciplinary
  • Efficiency Perform rapid screens to identify
    target areas
  • Success Maintaining/improving quality of life

21
STEPS TO ESTABLISH GOALS OF HEALTH CARE FOR
ELDERLY
  1. Use biopsychosocial-values model to develop
    functionally oriented comprehensive health
    assessment
  2. Develop all feasible options for care with
    benefits/burdens/risks and projected outcomes.
  3. Acknowledge uncertainty where present
  4. Relieve suffering
  5. Communicate effectively to patients and
    significant others become patient advocate

22
PHYSICIAN ROLE
  • The physician who enters the patients universe
    and understands the patients perceptions,
    assumptions, values and beliefs is a tremendous
    advantage.
  • Peabody, 1927 Care of the Patient, JAMA
  • It is therapeutic for the patient to feel that
    the physician cares enough about the individual
    to understand his life, particularly the meaning
    and purpose of his present existence.
  • Frankl 1959 (Mans Search for Meaning)
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