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					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, co-
    workers, 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.   Use biopsychosocial-values model to develop
     functionally oriented comprehensive health
     assessment
2.   Develop all feasible options for care with
     benefits/burdens/risks and projected outcomes.
3.   Acknowledge uncertainty where present
4.   Relieve suffering
5.   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)