Transcript The older person as a patient

THE OLDER PERSON AS A
PATIENT
Dr. Enrique Vega
Regional Advisor in Aging and Health
PAHO/WHO
[email protected]
The Problem of Mr. Z:
 Mr. Z is 83 years old and functionally ok. He is the
caregiver of his 62 year old wife who has been diagnosed
with dementia. He is a retired business man who is
socially active, economically stable and with a good heath
insurance program.
 In the last three months Mr. Z has lost some strength and
fell down two times, and he has arthritis in has right
knee. He has taken 6 medications and he is not
depressed.
 Last week he fell and now he has been admitted to the
hospital with two rib fractures and a trauma in his right
knee.
JAMA. December 2009. Vol 302 No 24
The Problem of Mrs. Z:
 Mrs. Z is 62 years old and was diagnosed with Alzheimer
Disease in the last five years. She can not be alone for
more than 8 hours due to her limitation in daily living
activities, although she is in good economic condition
and has a good heath insurance program. She has
received support from social services.
 She has LDL elevated and high systolic blood pressure
and auricular fibrillation. She doesn’t sleep well and
takes 8 medications.
 Her husband suffered a fall last week and was admitted
to the hospital and her two children live in another city.
JAMA, December 2009. 302 No 24
If Mrs. and Mr. Z were Mrs. And Mr.
Thompson:
 … with the same heath picture
 Mr. Thompson would be an informal worker
, without any economic pension and living
with his wife with dementia and his single
daughter and his adolescent grandson.
 Without health coverage and only access to
a basic primary health care in the health
center.
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Or maybe Mrs. And Mr. Parodi:
 … with the same heath picture
 If Mr Parodi were a retired teacher, he
would have an adequate pension and would
be living with his wife with dementia, a
nurse, his single daughter and his
adolescent grandson.
 With health insurance coverage and access
to the programs or service available.
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Aging in Latin America and the Caribbean:
Aging Population Growth IS NOW
Population in
Millions
EPIDEMILOGIC TRANSITION
400
350
300
Cardiop. Isquémica
Cancer
Tuberculosis
Disentería
Neumonía
1360-69.
20
0
200
-20
150
Cambio (%)
Muertes/100.000
250
40
-40
100
-60
50
Cardiop. Isquémica
ACVA
Mortalidad no CV
-80
0
1900
1920
1950
1950
1960
1975
Braunwald E, N Engl J Med 1997; 337: 1360-9
1995
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Pe
THE NEW PATIENT
Classic Patient
Contemporary
Patient
• Unique, acute disease
• Without functional repercussion
• Without aftermath
• Chronic and usually multiple diseases
• Frequent exacerbations
• Functional repercussions
• Functional and social aftermath
Several Patient Types
Heterogeneous
Different needs
Care- Caregiver
Unit
NEW PROBLEMS
DISABILITY
FRAILTY
COMORBIDITY
NEW WAYS?
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I DON’T UNDERSTAND WHAT YOUR
PROBLEM IS. TALK MORE CLEARLY
PROPORTIONAL MORTALITY
AND USE OF SERVICES
MORTALITY BY CANCER
ONCOLOGY CONSULTATION
22.7
33.3
66.7
77.3
> 60
< 60
> 60
< 60
J Am Geriatr Soc 56:1796 –1801, 2008.
EDITORIAL Leading on Behalf of an Aging Society L Fried, JAGS 20
EDITORIAL Leading on Behalf of an Aging Society L Fried, JAGS 2008
MUST BE TEAMWORK BASED
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NEVER GIVE UP