Transcript HOW CAN WE MAKE THE GOLDEN YEARS MORE GOLDEN?

Kirk Panneton, M.D., FACP
George Giokas, M.D.
Medical Director, Senior Services
CDPHP
Director, Palliative Care
The Community Hospice
September 8, 2012
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Discuss the aging process…can it be altered?
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Define the Metabolic Syndrome
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Review the effects of polypharmacy
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Propose tips on being more successful with
Geriatric care
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Cell proliferation
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Chromosomal changes
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Key trigger
◦ usually occurs in late teens/early twenties
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Certain genes seem to lead to longevity
◦ certain populations that live longer
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Sir 2 gene
◦ one of a family of genes (sirtuins)
◦ present in all complex forms of life
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If eliminated, life span decreases by 30 – 40 %
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If stimulated, certain proteins get activated
which help protect cellular mechanisms
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Metabolic rate (Olshansky)
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Oxidation of free radicals (Sinclair)
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Chromosomal mutations (Kunkel)
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Caloric restriction (CR) appears to be at the
center of all of these studies; plant and
animal models all show healthier longevity
when under the stress of CR.
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Characteristics:
◦ Central obesity
◦ Insulin resistance
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Risk factors:
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Aging
Genetics
Hormonal changes
Decreased exercise
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BP > 130/85
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FBS > 100
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Waist
measurement
◦ Men > 40
◦ Women > 35
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HDL
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Triglycerides >
150
◦ Men < 40
◦ Women < 50
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Weight loss ( 7 – 10% )
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Exercise ( 5 – 7 days/week )
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Nutritional counseling
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Low dose ASA
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No smoking
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Less calories
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More activity
◦ Physical
◦ Mental
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Meet psychosocial needs
◦ Community resources
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Less dependence on medications
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> 5 Medications
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ADR’s – adverse drug reactions
◦ Responsible for up to 1/3 of all hospital admissions in
the elderly
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Functional decline
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Lethargy
Decreased appetite/weight loss
Change in bowel function
Gait/mobility
depression
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•20% of elders in the
community
•take more than
•10 meds per day!!
Thanks to Faddy Morgan and Ryan Watson
Albany College of Pharmacy and Health
Sciences
Pharm. D. Candidate 2011
79 y.o. with COPD, DM,
HBP, DJD, osteoporosis
• If the relevant practice guidelines
followed…
• 12 meds ($406 a month)
•CM Boyd, et al Clinical Practice Guidelines and Quality of Care for
Older
•Patients With Multiple Comorbid Diseases. JAMA. 2005;294:716-724.
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88 y.o. female….living independently in a flat above
her daughter’s family. No meds. PMH significant for
memory loss and some weight loss.
Falls and sustains an acute vetebral
fracture….brought to the emergency room
W/U: mid back pain…ambulates with assistance…no
other significant findings except osteopenia on xrays
Tx: Lortab 5mg. every 4 hrs.
Fosamax 10mg tabs one a day
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Limit medications
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Easy dosing
Use generics ( be aware of costs! )
Beware of certain drug classes ( Beer’s list )
Review for side effects
Brown bag analysis
D/C meds after therapeutic effect realized
Encourage exercise
◦ Physical
◦ Mental
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Encourage work and/or volunteer activity
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Encourage social interaction
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Remember caregiver support
◦ Respite
◦ Knowledge of community resources
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Advance directives
For frail elders, review goals in care and goals in
life
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