INTRODUCTION TO GERIATRIC MEDICINE. DEMOGRAPHICS 1900 – Life expectancy 47 years in US 1900 –...
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Transcript of INTRODUCTION TO GERIATRIC MEDICINE. DEMOGRAPHICS 1900 – Life expectancy 47 years in US 1900 –...
INTRODUCTION TO GERIATRIC MEDICINE
DEMOGRAPHICS
1900 – Life expectancy 47 years in US1900 – Life expectancy 47 years in US
4% over the age of 654% over the age of 65 Mid 1990’s – Life expectancy 65 years in USMid 1990’s – Life expectancy 65 years in US
12.6% over the age of 6512.6% over the age of 65 By 2020 - % over the age of 65By 2020 - % over the age of 65 By 2040 - % over the age of 65By 2040 - % over the age of 65
DEMOGRAPHICS
1900 – Life expectancy 47 years in US1900 – Life expectancy 47 years in US4% over the age of 654% over the age of 65
Mid 1990’s – Life expectancy 65 years in USMid 1990’s – Life expectancy 65 years in US12.6% over the age of 6512.6% over the age of 65
By 2020 – 17% over the age of 65By 2020 – 17% over the age of 65 By 2040 – 22% over the age of 65By 2040 – 22% over the age of 65 1/3 women live to 85; 15% men live to 851/3 women live to 85; 15% men live to 85 Causes of death: heart, cancer, stroke, lungCauses of death: heart, cancer, stroke, lung
DEMOGRAPHICS
More than 70% of people now live to 65 (3 More than 70% of people now live to 65 (3 times that of 1900)times that of 1900)
Life expectancy at age 65 is now >17 yearsLife expectancy at age 65 is now >17 years Population of US increased 3 fold in the Population of US increased 3 fold in the
2020thth century; 11 fold for those over 65 century; 11 fold for those over 65 1900 – 19% of those who died over age 651900 – 19% of those who died over age 65 2000 – 75% of those who die over age 652000 – 75% of those who die over age 65 Death rates changed from childhood and Death rates changed from childhood and
middle agemiddle age
CENTENARIANS
1900 – rare1900 – rare 2000 – 60,0002000 – 60,000 2050- >1,000,0002050- >1,000,000
CENTENARIANS
DEMOGRAPHICS
85% over age 65 have one chronic illness85% over age 65 have one chronic illness 60% over age 65 have 2 or more chronic 60% over age 65 have 2 or more chronic
illnessesillnesses 17% age 65-74 functional limitations17% age 65-74 functional limitations 29% age 75-84 functional limitations29% age 75-84 functional limitations
FLORIDA DEMOGRAPHICS
1995 – 19% over age 651995 – 19% over age 65 2025 – 26% over age 652025 – 26% over age 65 Four surrounding Four surrounding
counties with mean age counties with mean age over 55 yearsover 55 years
Tampa Bay area has over Tampa Bay area has over half the skilled nursing half the skilled nursing units in the state and the units in the state and the two largest hospice two largest hospice organizations in USorganizations in US
THE MYTHS OF AGING
Sick, demented, frail, weak, disabled, Sick, demented, frail, weak, disabled, powerless, sexless, passive, alone, unhappypowerless, sexless, passive, alone, unhappy
Holding back societyHolding back society Scientific reality or not? Scientific reality or not?
MYTH # 1TO BE OLD IS TO BE SICK
Are the new seniors very sick/old or healthier?Are the new seniors very sick/old or healthier?Past: Infectious illnessesPast: Infectious illnessesMid century: Arthritis, HTN, heart diseaseMid century: Arthritis, HTN, heart diseaseNow: Decrease prevalence arthritis, HTN, Now: Decrease prevalence arthritis, HTN,
stroke, lung diseasestroke, lung diseaseCompression of morbidity; less institutionalizedCompression of morbidity; less institutionalized1994: 39% over 65 health very good or 1994: 39% over 65 health very good or
excellent with 29% fair or poorexcellent with 29% fair or poor
MYTH #2YOU CAN’T TEACH AN OLD DOG NEW TRICKS Fear of developing Fear of developing
Alzheimer’s diseaseAlzheimer’s disease Even those with short Even those with short
term memory problems term memory problems have been shown to have been shown to improve recallimprove recall
Deficits can be overcome Deficits can be overcome with proper training (lists, etc.)with proper training (lists, etc.)
MYTH #3 THE HORSE IS OUT OF THE BARN
Risky behaviors – no point in changingRisky behaviors – no point in changing Not too late for no smoking, exercise and Not too late for no smoking, exercise and
dietdiet
MYTH #4THE SECRET TO SUCCESSFUL AGING IS TO CHOOSE YOUR PARENTS WISELY
Is the role of genetics overstated?Is the role of genetics overstated? Increased longevity of offspring of those Increased longevity of offspring of those
who died at much who died at much
earlier agesearlier ages
MYTH #5THE LIGHTS MAY BE ON BUT THE VOLTAGE IS LOW
Inadequate physical/mental/sexual abilitiesInadequate physical/mental/sexual abilities Sexual activity decreases in old ageSexual activity decreases in old age
MYTH #6THE ELDERLY DON’T PULL THEIR OWN WEIGHT One third of elderly continue to workOne third of elderly continue to work One third of elderly volunteerOne third of elderly volunteer Others provide informal caregivingOthers provide informal caregiving Many more are willing and able to workMany more are willing and able to work
SUCCESSFUL AGING*
Low probability of disease and Low probability of disease and disease related disabilitydisease related disability
High cognitive and High cognitive and functional capacityfunctional capacity
Active engagement with LIFEActive engagement with LIFE
*Rowe and Kahn, Gerontologist, 1997*Rowe and Kahn, Gerontologist, 1997
HEALTH
WHO: More than absence of diseaseWHO: More than absence of disease WHO: Presence of physical, mental and WHO: Presence of physical, mental and
social well being; perceived in the context social well being; perceived in the context of each individual’s experiences, beliefs, of each individual’s experiences, beliefs, and expectations. and expectations.
Can 2 individuals with same objective Can 2 individuals with same objective measures of health status have different measures of health status have different perceptions of health related quality of life?perceptions of health related quality of life?
GERIATRIC RX
Functionally oriented biopsychosocial model Functionally oriented biopsychosocial model fostering comprehensive, multidimensional fostering comprehensive, multidimensional approach to health assessmentapproach to health assessment
Context of patient’s beliefs and valuesContext of patient’s beliefs and values Must elicit values of patients to determine Must elicit values of patients to determine
benefits and burdens of interventionsbenefits and burdens of interventions
ELEMENTS OF ASSESSMENTS
Biomedical: acute/chronic diseases, physical Biomedical: acute/chronic diseases, physical function, ADLs, IADLsfunction, ADLs, IADLs
Psychological: Intellect. function, personality, mood, Psychological: Intellect. function, personality, mood, sensorium, psych history/symptomssensorium, psych history/symptoms
Social: Family structure/involvement, friends, co-Social: Family structure/involvement, friends, co-workers, neighbors, church, community, work workers, neighbors, church, community, work history, financial resources, health insurance, living history, financial resources, health insurance, living arrangements, life-stylearrangements, life-style
Values: Personal, cultural, ethnic, religious, spiritualValues: Personal, cultural, ethnic, religious, spiritual
PRINCIPLES OF GERIATRIC ASSESSMENT
GoalGoal Promote wellness, independencePromote wellness, independence
FocusFocus Function, performanceFunction, performance
ScopeScope Physical, cognitive, psychol, socialPhysical, cognitive, psychol, social
ApproachApproach MultidisciplinaryMultidisciplinary
EfficiencyEfficiency Perform rapid screens to identify Perform rapid screens to identify target areastarget areas
SuccessSuccess Maintaining/improving quality of Maintaining/improving quality of lifelife
STEPS TO ESTABLISH GOALS OF HEALTH CARE FOR ELDERLY1.1. Use biopsychosocial-values model to develop Use biopsychosocial-values model to develop
functionally oriented comprehensive health functionally oriented comprehensive health assessmentassessment
2.2. Develop all feasible options for care with Develop all feasible options for care with benefits/burdens/risks and projected outcomes.benefits/burdens/risks and projected outcomes.
3.3. Acknowledge uncertainty where presentAcknowledge uncertainty where present4.4. Relieve sufferingRelieve suffering5.5. Communicate effectively to patients and Communicate effectively to patients and
significant others; become patient advocatesignificant others; become patient advocate
PHYSICIAN ROLE
““The physician who enters the patient’s The physician who enters the patient’s universe and understands the universe and understands the patient’s perceptions, assumptions, patient’s perceptions, assumptions, values and beliefs is a tremendous values and beliefs is a tremendous advantage.”advantage.”
Peabody, 1927 Care of the Patient, Peabody, 1927 Care of the Patient, JAMAJAMA
““It is therapeutic for the patient to feel It is therapeutic for the patient to feel that the physician cares enough that the physician cares enough about the individual to understand about the individual to understand his life, particularly the meaning and his life, particularly the meaning and purpose of his present existence.”purpose of his present existence.”
Frankl 1959 (Man’s Search for Frankl 1959 (Man’s Search for Meaning) Meaning)