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CKD – a disease of older people

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• Aging 204,274

• Nephrology 4435

• Nephrology and Aging 19

• Nephrology and Geriatrics 32

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• What are we going to do about it?

• What does it mean? How do I relate to it?

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• Social

• Psychology

• Biology

• Health

• Cultural

Geriatric medicineGerontological NursingOld Age PsychiatryGerodontologyGeronephrologists?…

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We are born copies….…but die as originals

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● Ageing = Complexity

● Growth AND Loss at all ages

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Association Between Positive Age Stereotypes and Recovery

From Disability in Older Persons

Becca R. Levy, PhD, Martin D. Slade, MPH, Terrence E. Murphy, PhD, and Thomas M. Gill,

MD

Division of Social and Behavioral Sciences, Yale School of Public Health (Dr Levy;

becca.levy@yale.edu) and Department of Internal Medicine, Yale School of Medicine (Mr Slade

and Drs Murphy and Gill), New Haven, Connecticut

To the Editor

Little research has been conducted on factors that account for why some older persons

recover from disability and others do not. We considered a new culture-based explanatory

factor: age stereotypes (defined as beliefs about old people as a category). 1 Positive age

stereotypes may promote recovery from disability through several pathways: limiting

cardiovascular response to stress,2 improving physical balance,3 enhancing self-efficacy,4

and increasing engagement in healthy behaviors. 1,4 We hypothesized that older persons with

positive age stereotypes would be more likely to recover from disability than those with

negative age stereotypes. Recovery was based on 4 essential activities of daily living

(ADLs; bathing, dressing, transferring, and walking) that are strongly associated with use of

health care services and longevity.5,6

Methods

The sample was drawn from the Precipitating Events Project, a study with high participation

(75.2%) and follow-up (95.4%) rates. Participants were recruited from a health plan in

greater New Haven, Connecticut, interviewed monthly for up to 129 months, and completed

home-based assessments every 18 months from March 1998 through December 2008. 5,6

Inclusion criteria were age of 70 years or older, English-speaking, community-living,

nondisabled (ie, independent in the 4 ADLs at baseline), responded to the baseline age-

stereotype measure, and experienced at least 1 month of ADL disability during follow-up

(117 participants remained nondisabled). The final sample consisted of 598 participants

(79.3% of the Precipitating Events Project cohort). The Yale University Human Subjects

Committee approved the study; all participants provided verbal informed consent.

©2012 American Medical Association. All rights reserved.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of

Interest and none were reported.

Author Contributions: Dr Levy had full access to all of the data in the study and takes responsibility for the integrity of the data and

the accuracy of the data analysis.

Study concept and design: Levy, Slade, Gill.

Acquisition of data: Levy, Gill.

Analysis and interpretation of data: Levy, Slade, Murphy, Gill.

Drafting of the manuscript: Levy, Slade.

Critical revision of the manuscript for important intellectual content: Levy, Slade, Murphy, Gill.

Statistical analysis: Levy, Slade, Murphy.

Obtained funding: Levy, Gill.

Study supervision: Levy, Gill.

NIH Public AccessAuthor ManuscriptJAMA. Author manuscript; available in PMC 2013 April 02.

Published in final edited form as:

JAMA. 2012 November 21; 308(19): 1972–1973. doi:10.1001/jama.2012.14541.

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Thanks to us oldies, the world economy is threatened, China’s prospects are stagnating and inequality is rising That’s nice, dear

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Economic Longevity Dividend

• $3.2 trillion/year to US economy 1970-2000

• Bonus of $1.3 million for each US citizen

• £40 billion a year to UK economy

21 22

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Damned

nuisance,

all those windows….

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The tragedy of old age is not the fact that each of us must grow old and die, but that the process of doing so has been made unnecessarily and at times excruciatingly painful, humiliating, debilitating, and isolating through insensitivity, ignorance, and poverty

Why Survive? Being Old in America

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25

.

Lancet 2011;377:1828-9.

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Grandparents Driving Grandchildren: An Evaluation ofChild Passenger Safetyand Injuries

WHAT’SKNOWNONTHISSUBJECT: Appropriate child-restraint

and seating practices reducechild-passenger injury risk, and

child-passenger safety education typically targets parent drivers.

Grandparents also drivewith their grandchildren, yet little is

known about their child-passenger safety practices or injuries

after crashes.

WHATTHISSTUDYADDS: In this study, grandparents

represented nearly10%of drivers in crashes involving child

occupants. Theadjusted risk of child injury for grandparent

drivers was 50%lower than that for parent drivers, despite less

optimal useof child restraint in grandparent-driver crashes.

abstractOBJECTIVES: To compare restraint-use practices and injuries among

children in crashes with grandparent versus parent drivers.

METHODS: This was a cross-sectional study of motor vehicle crashes

that occurred from January 15, 2003, to November 30, 2007, involving

children aged 15 years or younger, with cases identified via insur-

ance claims and data collected via follow-up telephone surveys. We

calculated the relative risk of significant child-passenger injury for

grandparent-driven versusparent-driven vehicles.Logistic regression

modeling estimated odds ratios (ORs) and 95%confidence intervals

(CIs), adjusting for several child occupant, driver, vehicle, and crash

characteristics.

RESULTS: Children driven by grandparents comprised 9.5% of the

sample but resulted in only 6.6%of the total injuries. Injuries were

reported for 1302 children, for an overall injury rate of 1.02 (95%CI:

0.90–1.17) per 100 child occupants. These represented 161 weighted

injuries (0.70%injuryrate) withgrandparent driversand2293injuries

(1.05%injury rate) with parent drivers. Although nearly all children

werereportedtohavebeenrestrained,childrenincrasheswithgrand-

parent drivers used optimal restraint slightly less often. Despite this,

children in grandparent-driven crashes were at one-half the risk of

injuries as those in parent-driven crashes (OR: 0.50 [95% CI: 0.33–

0.75]) after adjustment.

CONCLUSIONS: Grandchildren seem to be safer in crashes when

driven by grandparents than by their parents, but safety could be

enhanced if grandparents followed current child-restraint guidelines.

Additional elucidation of safegrandparent drivingpractices whencar-

rying their grandchildren may inform future child-occupant driving

education guidelines for all drivers. Pediatrics 2011;128:289–295

AUTHORS: FredM. Henretig, MD,a,bDennisR. Durbin, MD,

MSCE,a,b,c,d Michael J. Kallan, MS,c,dand FlauraK.

Winston, MD, PhDb,c,d,e,f

aDivision of Emergency Medicine, cCenter for Injury Research

and Prevention, and eDivision of General Pediatrics, Children’s

Hospital of Philadelphia, Philadelphia, Pennsylvania;bDepartment of Pediatrics and dCenter for Clinical Epidemiology

and Biostatistics, University of Pennsylvania School of Medicine,

Philadelphia, Pennsylvania; and fLeonard Davis Institute for

Health Economics, University of Pennsylvania, Philadelphia,

Pennsylvania

KEYWORDS

child passenger safety, family issues, motor vehicle accidents,

motor vehicle safety

ABBREVIATIONS

NHTSA—National HighwayTrafficSafety Administration

PCPS—Partners for Child Passenger Safety

OR—odds ratio

CI—confidence interval

All theauthors contributed substantially to this article, including

participation in theconception and design of thestudy, drafting

and revision of thearticle, and providing approval of thefinal

draft of themanuscript.

www.pediatrics.org/cgi/doi/10.1542/peds.2011-0046

doi:10.1542/peds.2011-0046

Accepted for publication Apr 4, 2011

Address correspondence to FredM. Henretig, MD, Division of

Emergency Medicine,Children’s Hospital of Philadelphia, 3400

Civic Center Blvd, Philadelphia, PA19104. E-mail: henretig@email.

chop.edu

PEDIATRICS(ISSNNumbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2011bytheAmerican Academy of Pediatrics

FINANCIALDISCLOSURE: Theauthors have indicated theyhaveno personal financial relationships relevant to this article todisclose.

ARTICLES

PEDIATRICSVolume128, Number 2, August 2011 289 at Trinity Health Sciences Centre on March 21, 2012pediatrics.aappublications.orgDownloaded from

DOI: 10.1542/peds.2011-0046; originally published online July 18, 2011; 2011;128;289Pediatrics

Fred M. Henretig, Dennis R. Durbin, Michael J. Kallan and Flaura K. Winstonand Injuries

Grandparents Driving Grandchildren: An Evaluation of Child Passenger Safety

http://pediatrics.aappublications.org/content/128/2/289.full.html

located on the World Wide Web at: The online version of this article, along with updated information and services, is

of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy published, and trademarked by the American Academy of Pediatrics, 141 Northwest Pointpublication, it has been published continuously since 1948. PEDIATRICS is owned, PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

at Trinity Health Sciences Centre on March 21, 2012pediatrics.aappublications.orgDownloaded from

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• Broaden debate

• Ageism in access to full spectrum of care

• Embracing the complexity of frailty

• Gerontological competence no longer discretionary

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Reduces death and disability by 25%

Comprehensive geriatric assessment for older adults

admitted to hospital (Review)

EllisG, Whitehead MA, O’Neill D, LanghorneP, Robinson D

Thisisareprint of aCochranereview, prepared and maintained byTheCochraneCollaboration and published in TheCochraneLibrary

2011, Issue7

http://www.thecochranelibrary.com

Comprehensive geriatric assessment for older adults admitted to hospital (Review)

Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ComprehensiveGeriatricAssessment

34

Medical• Co-morbidity and

disease severity• Neurobiological

basis Dx• Medication review• Nutritional status

• Frailty*• Problem list

Social• Informal

support• Social network

Function• PADL

• Gait/balance*• Activity/exercise

• DADL/IADL

Mental Health• Cognition*

• Mood*• Fears

• + Collateral Hx

Environment• Home

• ?Telehealth• Transport

• Local resources

Elements of CGA

BGS 2015

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Expertise

Diligence

Time

The desire to do it!

36

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• Fried

• Phenotype

– Weight loss

– Weakness

– Fatigue

– Slowness

– Low activity

• Rockwood*

• Cumulative deficit

*asserting copyright!

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..nobody is quite sure what they are for, but they add a touch of class

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Key Question

• Threshold for stepping back

• Trigger for CGA approach

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Successful or Optimal Ageing

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• Older people do not primarily define themselves in terms of an overall state of ‘frailty’

• Older people do, however, recognise the experience of living with frailty

!

Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society

June 2015

!

Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society

June 2015

!

Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society

June 2015

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• Older people unaware of CGA• Name CGA disliked• Feel that it is a good idea in principle, despite

reservations about the time, effort and what it would entail in practice!

!

Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society

June 2015

!

Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society

June 2015

!

Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society

June 2015

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Single Assessment ToolMeasures needsFacilitates communicationPrompts careCommunity, hospital and nursing homeElectronicInternational comparison

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…terms older Europeans deemed unacceptable: “elderly,” “aged,” and “old,” with a particularly forceful rejection of “elderly”.

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Carer Burden

or

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The film succeeds

brilliantly in the

evocation of the wider

themes of ageing:

wisdom, altruism,

negotiation, and that

combination of “tough

but frail” that

increasingly

characterises older

people in the 21st

centuryBMJ 2009;339:b4215

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