Transcript INTRODUCTION TO GERIATRIC MEDICINE

INTRODUCTION TO
GERIATRIC
MEDICINE
DEMOGRAPHICS
1900 – Life expectancy 47 years in US
4% over the age of 65
 Mid 1990’s – 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

DEMOGRAPHICS
1900 – Life expectancy 47 years in US
4% over the age of 65
 Mid 1990’s – 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

DEMOGRAPHICS
More than 70% of people now live to 65 (3
times that of 1900)
 Life expectancy at age 65 is now >17 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

CENTENARIANS
1900 – rare
 2000 – 60,000
 2050- >1,000,000

CENTENARIANS
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

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
THE MYTHS OF AGING
Sick, demented, frail, weak, disabled,
powerless, sexless, passive, alone, unhappy
 Holding back society
 Scientific reality or not?

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
MYTH #2
YOU CAN’T TEACH AN OLD
DOG NEW TRICKS
Fear of developing
Alzheimer’s disease
 Even those with short
term memory problems
have been shown to
improve recall
 Deficits can be overcome
with proper training (lists, etc.)

MYTH #3
THE HORSE IS OUT OF THE
BARN
Risky behaviors – no point in changing
 Not too late for no smoking, exercise and diet

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

MYTH #5
THE LIGHTS MAY BE ON BUT
THE VOLTAGE IS LOW
Inadequate physical/mental/sexual abilities
 Sexual activity decreases in old age

MYTH #6
THE ELDERLY DON’T 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

SUCCESSFUL AGING*
Low probability of disease and
disease related disability
 High cognitive and
functional capacity
 Active engagement with LIFE

*Rowe and Kahn, Gerontologist, 1997
HEALTH
WHO: More than absence of disease
 WHO: Presence of physical, mental and
social well being; perceived in the context
of each individual’s experiences, beliefs,
and expectations.
 Can 2 individuals with same objective
measures of health status have different
perceptions of health related quality of life?

GERIATRIC RX
Functionally oriented biopsychosocial model
fostering comprehensive, multidimensional
approach to health assessment
 Context of patient’s beliefs and values
 Must elicit values of patients to determine
benefits and burdens of interventions

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, coworkers, neighbors, church, community, work
history, financial resources, health insurance, living
arrangements, life-style
Values: Personal, cultural, ethnic, religious, spiritual
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
STEPS TO ESTABLISH
GOALS OF HEALTH CARE
FOR ELDERLY
1.
2.
3.
4.
5.
Use biopsychosocial-values model to develop
functionally oriented comprehensive health
assessment
Develop all feasible options for care with
benefits/burdens/risks and projected outcomes.
Acknowledge uncertainty where present
Relieve suffering
Communicate effectively to patients and
significant others; become patient advocate
PHYSICIAN ROLE
“The physician who enters the patient’s
universe and understands the
patient’s 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 (Man’s Search for
Meaning)