Transcript geriatric pharmacology

Let’s Play
Physiology Pharmacology
Nursing
Homes
Famous
Seniors
Longevity
& Survival
Physiology
Pharmacology
Nursing
Homes
Famous
Seniors
Longevity
& Survival
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Physiology - $200
The effect of aging
on renal function
Physiology - $200
The effect of aging on renal function
Decreased
• Renal function decreases with aging.
• Glomerular filtration rate decreases about 1%
per year after age 30.
• Urine concentrating ability also decreases
Physiology - $400
The effect of aging
on resting heart rate
Physiology - $400
The effect of aging on resting heart rate
Decreased
• Normal aging results in:
– decreased resting heart rate
– decreased maximum predicted heart rate with exercise
– decreased VO2 Max and maximum CO with exercise
• Cardiac output remains normal at rest largely related to
increased stroke volume
Physiology - $600
This physiologic effect is
the result of eating a large
meal and is associated with
drowsiness and unsteady
balance.
Physiology - $600
This physiologic effect is the result of eating a
large meal and is associated with drowsiness
and unsteady balance
Post-prandial Hypotension
• Post-prandial hypotension (orthostatic
hypotension) often follows a large meal,
presumably as a result of shift in blood flow
from the periphery to the mesenteric bed and
can be an important cause of falls
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Physiology - $800
The effect of aging on
gastric acid secretion
Physiology - $800
The effect of aging on gastric acid secretion
None
• Until recently it was widely thought that
gastric secretion diminished as a result of
normal aging processes. Recent studies,
excluding those with atrophic gastritis,
smoking and H.pilori have shown no change
in acid secretion with aging.
Physiology - $1000
The effect of aging on
collagen
Physiology - $1000
The effect of aging on collagen
Increased Crosslinking
• Aging results in abnormal collagen and elastin
metabolism. The result is increased collagen
crosslinking which may explain decreased tensile
strength, fragility, tissue strains and tears.
• Elastin also undergoes increased cross linking and
results in decreased elastic recoil in skin and other
tissues.
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Pharmacology - $200
Term for multiple drug use
in elderly people associated
with increased risk for
adverse drug reactions
Pharmacology - $200
The term for multiple drug use in elderly
people associated with increased risk of
adverse drug reactions
Polypharmacy
• The risk of adverse drug events in elderly
people rises with number of medications.
ADR’s occur in 4% of those taking 5 drugs;
10% in those taking 6-10 drugs; 28% in those
taking 11-15 drugs and 54% in those taking
16 or more drugs.
Pharmacology - $400
This single drug can be
effective for both
incontinence and
hypertension in elderly men
Pharmacology - $400
This single drug can be effective for both
incontinence and hypertension in elderly men
doxazocin (Cardura), prazocin (Minipress),
terazocin (Hytrin)
• Alpha adrenergic blockers are known to
decrease the effect of BPH and bladder
outlet obstruction as well as decrease
blood pressure.
Pharmacology - $600
Drug commonly used to
treat congestive heart failure
in therapeutic doses can
cause anorexia, delirium and
depression
Pharmacology - $600
Drug commonly used to treat congestive heart failure
in therapeutic doses can cause anorexia, delirium and depression
Digoxin
• Digoxin even with normal therapeutic
drug levels can cause anorexia, delirium
and depression in elderly people.
Pharmacology - $800
The effect of aging on
adipose tissue
Pharmacology - $800
The effect of aging on adipose tissue
Increased
• Aging is associated with an increase in
fat/lean body weight ration. Muscle
mass tends to decrease and fat tends to
increase. This effect can have a
significant effect on drug distribution
and elimination.
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Pharmacology - $1000
The MS Contin dose
equivalent to
MS elixir 30mg q6h
Pharmacology - $1000
The MS Contin dose
equivalent to
MS elixir 30mg q6h
MS Contin 60mg q12h
• The conversion from MS elixir to
MS Contin is 1:1
• The 24 hr dose of MS elixir is 120mg
• The equivalent dose of MS Contin is 120mg
or 60mg q12h
Nursing Homes - $200
The majority of elderly
people live in
nursing homes
True or False
Nursing Homes - $200
The majority of elderly people
live in nursing homes
False
• Less than 5% of all elderly people live in nursing homes.
• About 20% of those over age 85 reside in nursing homes
• The lifetime chance of spending some time in a nursing home
is abut 20%
Nursing Homes - $400
Term for this skin lesion that has
become an important indicator of
quality of care
Nursing Homes - $400
Term for this skin lesion that has become
an important indicator of quality of care
Pressure Sore
(Bed Sore, Decubitus Ulcer or Pressure Ulcer)
• Pressure sores are caused by unrelieved
pressure or shear
• They are considered predictable and
preventable
• Nursing homes can be liable for their
development
Nursing Homes - $600
The source of
reimbursement for care of
most nursing home
residents
Nursing Homes - $600
The source of reimbursement for care for
most nursing home residents
Medicaid (Medical)
• Only about 5% of care in nursing homes is
reimbursed by Medicare.
• About 50% of nursing home residents are
paid by Medicaid (Medical)
• About 45% are paid out of pocket
Nursing Homes - $800
The number of nursing
home residents that have
dementia
Nursing Homes - $800
The number of nursing home residents
that have dementia
50%
• Dementia and psychological problems are
common in the nursing home
• It has been estimated that 50% of all
nursing home residents have some dementia
Nursing Homes - $1000
The national standardized
assessment of patients
required within 2 weeks of
admission to any nursing
home
Nursing Homes - $1000
The national standardized assessment of patients
required within 2 weeks of admission to any nursing home
Minimum Data Set (MDS)
• The Minimum Data Set is a national standardized
assessment of each nursing home resident within 2
weeks of admission, at regular intervals or on any
significant change in overall condition
• Usually completed by staff nurses or other nurses
hired by each facility
Famous Seniors - $200
Common geriatric
problem that
prevented this
elderly comedian
from playing the
London Palladium
on his 100th
birthday
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Famous Seniors - $200
Fractured Hip
• Comedian/actor, George Burns, preformed
professionally up until a few months prior to
his 100th birthday when he suffered a fall and
fractured hip resulting in his inability to fulfill a
contract signed years earlier to play the
London Palladium on his 100th birthday
Famous Seniors - $400
Common
geriatric problem
suffered by this
famous athlete
Famous Seniors - $400
Common geriatric problem
suffered by this famous athlete
Parkinson’s Disease
• Mohammad Ali suffered severe disability for
many years from Parkinson’s disease
• Pugilism or Pugilistic Parkinsonism is a
condition mimicking Parkinson’s disease
associated with boxing or a history of
repeated head trauma
Daily Double
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Famous Seniors
The Daily Double
This famous senior invented
bifocal glasses at the age of
78
Famous Seniors
The Daily Double
This famous senior invented bifocal glasses
at the age of 78
Benjamin Franklin
• Inventor, statesman, ambassador,
framer of the constitution was the
inventor of bifocal glasses when he we
78 years of age.
Famous Seniors - $800
This famous grandmother gave up making
quilts in her 70’s when afflicted by arthritis
and took up painting miniatures.
Famous Seniors - $800
This famous grandmother gave up making quilts
in her 70’s when afflicted by arthritis
and took up painting miniatures.
Grandma Moses
• Born Anna Mary Robertson on September 7, 1860, she lived
101 years and 3 months until December 13, 1961.
• A remarkable lady, a mother of ten who started painting in
earnest in her late 70's and continued until the summer of 1961
• Also known for folk wisdom: Life is what we make it; always
has been, always will be.
Famous Seniors - $1000
Despite (some say
because) of this
affliction, Claude
Monet, painted this
and other
masterpieces after
age of 60
Famous Seniors - $1000
Despite (some say because) of this affliction,
Claude Monet, painted this and
other masterpieces after age of 60
Cataracts
• Claude Monet (1840-1926)
suffered for over 30 years from
severe cataracts for which he
refused surgical extraction.
• At age 84 visitors found him
robust, vibrant and still painting.
Longevity and Survival - $200
Percent of U.S. population
over age 65
Longevity and Survival - $200
Percent of U.S. population over age 65
13%
• In 1998, 12.7% of the population was over age 65.
• Those over age 85 are the fastest growing
segment.
• By 2030, elderly will account for about 20% of the
population, equal to the number below 5 years.
Longevity and Survival - $400
Life expectancy at birth
Longevity and Survival - $400
Life expectancy at birth
76.5 years
• The life expectancy for a child born 1997 was
76.5 years
• For males 71 years; for females 78 years
• The gender differential in life expectancy is
largely related to cumulative differences in
disease specific mortality
Longevity and Survival - $600
The oldest age to which
any human has ever lived
Longevity and Survival - $600
Oldest age to which any human has ever lived
122 years
• The oldest fully authenticated age to which
any human has ever lived is 122 years and
164 days, by Jeanne Louise Calment. She
was born in France on February 21, 1875,
and died at a nursing home in Arles,
southern France on August 4, 1997.
Longevity and Survival - $800
Name for landmark
observation that human
diploid cells cease to grow
after a limited number of
doublings
Longevity and Survival - $800
Name for landmark observation
that human diploid cells cease to
grow after a limited number of doublings
Hayflick Phenomenon
(Clonal Senescence)
• Leonard Hayflick made the important
discovery relevant to aging and cancer, that
normal human cells are not immortal and will
cease to divide after a finite number of
doublings
• Cells from older donor survived fewer
doublings that cells from younger donors.
Longevity and Survival - $1000
The only intervention proven
to increase maximum life
potential in mammalian
species
Longevity and Survival - $1000
The only intervention proven
to increase maximum life potential
in mammalian species
Caloric Restriction
• Mice, rats and primates have been shown to live
40% longer if they are restricted to a diet that
contains adequate levels of all micronutrients and
only 60% of the calories they would normally eat.
Final Jeopardy Category:
“Geriatric Organizations”
Make a Wager
Final Jeopardy
The Nation’s largest
organization of older
people
Final Jeopardy
The nations largest
organization of older people
AARP
The American Association
of Retired Persons
• Founded in 1958, the organization boasts more
than 30 million members over age 50
• One year dues are $10 (including spouse)
• Activities include: information and education;
community service; and legislative, judicial, and
consumer advocacy
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Brought to you by
The UCLA School of Medicine
Division of Geriatrics