a senior moment l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
A Senior Moment PowerPoint Presentation
Download Presentation
A Senior Moment

Loading in 2 Seconds...

play fullscreen
1 / 98

A Senior Moment - PowerPoint PPT Presentation


  • 475 Views
  • Uploaded on

A Senior Moment Time Passes By And one man in his time plays many parts, His acts being seven ages. At first the infant, Mewling and puking in the nurse’s arms. And then the whining school-boy, with his satchel, And shining morning face, creeping like snail

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'A Senior Moment' - sandra_john


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
a senior moment

A Senior Moment

Time Passes By

slide2
And one man in his time plays many parts,

His acts being seven ages. At first the infant,

Mewling and puking in the nurse’s arms.

And then the whining school-boy, with his satchel,

And shining morning face, creeping like snail

Unwillingly to school. And then the lover,

Sighing like furnace, with a woeful ballad

Made to his mistress’ eyebrow. Then a soldier,

Full of strange oaths, and bearded like the bard,

Jealous in honor, sudden and quick in quarrel,

Seeking the bubble reputation

Even in the cannon’s mouth.

And then the justice,

In fair round belly with good capon lin’d,

With eyes severe, and beard of formal cut,

Full of wise saws and modern instances;

And so he plays his part. The sixth age shifts

Into the lean and slipper’d pantaloon,

With spectacles on nose and pouch on side,

His youthful hose well sav’d, a world too wide

For his shrunk shank; and his big manly voice,

Turning again toward childish treble, pipes

And whistles in his sound. Last scene of all,

That ends this strange eventful history,

Is second childishness and mere oblivion,

Sans teeth, sans eyes, sans taste, sans everything

the aging of america
The Aging of America

Every eight seconds another baby boomer turns 50, and by mid-century there will be more Americans over 55 than under 18 for the first time in history.

the aging of america4
Prevalence

> 65

2030: 20%

>80/y/o in US

2000

9,300,000

2030

19,500,000

Average life expectancy

2004: 76-80

2050: 86-90

The Aging of America
seniors with functional limitations
2000

2,300,000

2050

7,200,000

Costs of nursing home care and home health

1990

$66,000,000,000

2001

$232,000,000,000

Seniors with functional limitations
major cause of physical decline
Major cause of physical decline
  • 70% of functional decline related to behavior
  • Lack of health promotion and disease prevention activities
geriatric assessment
Geriatric Assessment

Specialty model

  • Comprehensive
  • Multidisciplinary
  • Time-intensive
  • Already identified as at risk
geriatric assessment10
Geriatric Assessment
  • Primary care model
    • Caring for functional and healthy elderly
    • Comprehensive health screening
    • Continuity
    • Gather data over time
primary care focus
Primary Care Focus
  • Maximizing function
  • Critical question
    • “How does this problem/symptom impact your daily life?”
usptf focus in geriatrics
USPTF Focus in Geriatrics
  • Geriatric areas of special concern (over 65)
    • Sensory perception: vision, hearing
    • Accident prevention
    • Immunizations
    • Sexuality
slide13
[

Any Advice for these seniors?

injury prevention
Injury Prevention
  • Universal issues
    • Bike helmets
    • Safety belts
    • Smoke detectors
    • Hot water heater at 120 degrees F
senior specific falls
Annual incidence

65-80: 25% rate of accidental falls

>80: 50%

10% of the falls fracture

Annual cost >$20,200,000,000

2020: $32,000,000,000

Senior Specific: Falls
risks for falls intrinsic
Posture control

Gait

Visual perception

Altered sensory input

Strength and coordination

Osteoporosis

Hypotension

Risks for falls: Intrinsic
extrinsic risks
Medication

Poor lighting

Slippery floors

Loose footing: carpets, slippery floors

Lack of supportive railing for stairs, bathrooms

Obtrusive furniture

Extrinsic risks
screening
Screening
  • Review of intrinsic and extrinsic risks
  • Focused exam
    • One leg balance: stand on one leg for 5 seconds without assistance
    • Get Up and Go: Get up from chair, walk 10 feet, return and sit plus timing > 16 seconds
      • Sensitive for fall risk
      • Positive test: more complete evaluation
counseling
Counseling
  • Smoke detectors
  • Guns and ammunition
  • Lighting of halls and stairwells
  • Remove hazards and barriers
    • Loose rugs
    • Cords
    • Toys
  • Driving safety
intervention
Intervention

Address risk factors

trumped
Trumped
  • Mrs. C.T. Rack is sad because she has to stop her Wednesday evening bridge club. She can no longer drive due to the halo like glaring of the street lights. She is also having more difficulty reading her mystery novels?
sensory perception vision
Sensory Perception: Vision
  • Visual impairment worse than 20/40
    • 65-74: 4%
    • 80-84: 16%
    • Best correction worse than 20/40
      • 4.5%
impact of visual loss
Impact of visual loss
  • Risk factor for falls
  • Reduced quality of life
  • Severe bilateral visual loss
    • Association with all-cause mortality and cardiovascular related mortality in women
common vision problems
Common Vision Problems
  • Presbyopia
  • Glaucoma
  • Macular degeneration
  • Diabetic retinopathy
  • Cataracts
glaucoma risks
Glaucoma Risks
  • Age
    • Caucasian > 65
    • Black patients > 40
  • Diabetics
  • Patients with myopia
  • Ocular hypertension
  • Family history of glaucoma
blindness by race
Blindness by race
  • Glaucoma, posterior capsular opacification, diabetic retinopathy
    • More common cause of blindness in blacks
  • Macular degeneration
    • More common cause of blindness in whites
screening27
Screening
  • Family history of visual problems
  • Ask about role of visual impairment in ADLs.
    • Because of your eyesight, do you have trouble driving a car, watching television, reading or doing your daily tasks?
  • Snellen eye chart
referral to eye specialist
Referral to eye specialist
  • 20/40 or worse (with lenses)
  • Patients who report that vision interferes with ADLs
  • High risks individuals for glaucoma
  • Comorbidities that increase risk
eh what did you say
Eh! What did you say
  • 3rd most prevalent condition in elderly
  • 14-46% prevalence
  • 32% of impaired have hearing aid
impact
Impact
  • Social isolation
  • Depression
  • Cognitive well-being
causes of hearing loss
Causes of Hearing Loss
  • Presbycusis most common cause
    • Reduced ability to interpret speech
  • Cerumen impaction
  • Chronic otitis media
screening32
Ask

Pure tone audiometry

Whisper test

Otoscope: canal obstruction, TM inspection

Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S

Screening
intervention33
Intervention
  • Removal of ear wax
  • Hearing aids
  • Avoid ototoxic drugs
  • Periodic screening
  • Remove Ear Wax
amplification
Amplification
  • Barriers to hearing aid
    • Psychological
    • Functional
    • Financial
    • The peace of quiet

Gas Powered Hearing Aid

communication
Stand 2–3 ft away

Have the person's attention

Have the person seated in front of a wall, which will help reflect sound

Use lower-pitched voice

Speak slowly and distinctly; don't shout

Rephrase rather than repeat

Pause at the end of phrases or ideas

Communication
a matter of taste
A Matter of Taste
  • Olefactory impairment
    • ¼ of adults between 53 and 97
    • 2/3 between 80 and 97
    • Interferes with taste and enjoyment of food
      • Loss of appetite and weight loss
nutrition jack sprat
Nutrition: Jack Sprat
  • Failure to thrive
  • Involuntary weight loss
  • Abnormal BMI (<22, >27)
  • Hypoalbuminemia (< 3.58 (<160)
  • Vitamin or mineral deficiency
  • Hypocholesterolemia
nutrition ms sprat
Nutrition: Ms. Sprat
  • Unhealthy diet
    • Coronary heart disease
    • Stroke
    • Type II Diabetes
    • Cancer
    • Obesity
screening usptf
Screening: USPTF
  • Evidence
    • Fair evidence for brief, low- to medium-intensity behavioral counseling produce small to medium changes
    • Good evidence for medium- to high-intensity counseling for medium to large changes in adults at increased risk for diet related chronic disease
screening40
Screening
  • How
    • Malnutrition risk
      • Have you lost 10 pounds in the past six months without trying?
    • Oral health
    • Nutritional Health Screen
      • DETERMINE
nutrition
Nutrition
  • Disease
  • Eating poorly
  • Tooth loss, mouth pain
  • Economic hardship
  • Reduced social contact
  • Multiple medicines
  • Involuntary weight loss or gain
  • Need for assistance in self-care
  • Elderly (age >80)
intervention42
Intervention
  • Oral hygiene:
    • Flossing and brushing
    • Regular dental visits
  • Nutrition
    • Dietary counseling
    • Address barriers
physical inactivity
Physical Inactivity

60% of elderly Americans are physically inactive

benefits of physical activity
Reduced cardiovascular mortality and morbidity

Maintain ability to live independently

Improved bone health

Reduce risk of falling

Reduce risk of fracture

Reduced BP

Reduced risk of chronic disease

Reduced cancer risk

Benefits of Physical Activity
benefits
Benefits
  • Improve stamina
  • Reduce the symptoms of arthritis
  • Reduction of depression and anxiety
screening47
Screening
  • Inquire about physical activity
  • Height, weight
  • BMI
intervention48
Recommend at least 30 minutes of activity most days of the week

Identify community resources

Evaluate for safety of exercise intensity

Community Advocacy

Strength training

Intervention
a shot in the dark
A Shot in the Dark
  • Mr. Gardener is a 65 year old gentlemen with a passion for his roses. He is in your clinic today for a health maintenance visit. It is October. He has no chronic health problems. He hasn’t had a shot in over a decade.
  • What, if any immunizations would you provide today?
immunizations for the elderly
Immunizations for the Elderly
  • Influenza
    • Yearly starting at age 50
  • Pneumococcus: PPV23
    • Age 65 or older
    • Low risk: once
    • High risk or received prior to age 65
      • Repeat after 5 year interval
what else
What else
  • Td: every 10 years
    • Elderly may be at increased risk of developing both diseases
    • Rapid, age-related decline in protection against tetanus
  • Remainder similar to other adults
    • Shots 2004 available for PDA
      • www.immunizationed.org
sex after 60 my nature
Sex after 60: “My Nature”
  • Change in frequency and intensity may occur
  • Should continue to have an enjoy sexual relationship
  • Problems not a part of normal aging process
impact53
Impact
  • Emotional consequences
    • Depression
    • Social isolation
  • Few patients volunteer the information
    • Embarrassment
    • “Normal” concept
barriers
Chronic disease

Genital issues

Erectile dysfunction

Dyspareunia

Medication ADRs

Alcohol

Fear of precipitating an MI

Fatigue

Depression

Loss of life partner

Barriers
screening55
Screening
  • Ask about sexuality
  • Patient may be reluctant to bring it up
  • Open and direct questions
intervention56
Intervention
  • Open and honest discussion
  • STD prevention
    • Including Hepatitis B immunization
  • Evaluation of sexual dysfunction
  • Case specific management
  • Reassurance
leaky plumbing
Leaky Plumbing
  • 11-34% elderly men
  • 17-55% elderly women
  • Underreported
  • Not a normal part of aging
frequently reversible
Frequently reversible
  • DRIP
    • Delirium
    • Restricted mobility
    • Infection, Inflammation, Impaction
    • Polyuria, Pharmaceuticals
risk factors
Age-related: BPH, Atrophic Urethritis

CHF, COPD, Chronic cough

Constipation

Dementia, depression, stroke, Parkinson’s

Impaired ADLs

Detrusor overactivity, uninhibited contractions

Increased post-void residual or decreased bladder capacity

Environmental obstacles

Obesity

Risk Factors
screening60
Screening
  • Do you ever lose urine when you don’t want to?
  • Have you lost urine on at least six separate days?
  • Yes to both= Positive
    • Further evaluation indicated
diapers
DIAPERS
  • Delirium
  • Infection
  • Atrophy
  • Pharmacology, Psychological
  • Endocrine
  • Restricted mobility
  • Stool impaction
mental status
Mental Status
  • Cognitive
    • Dementia
      • Gradual onset of impaired memory
      • Deficits in two or more areas of cognition
        • Anomia
        • Agnosia
        • Apraxia
        • Executive function
  • Depression
dementia
Dementia
  • Not part of original USPSTF
  • Prevalent with multilayered impact
  • Realistic planning
  • Anticipate problems in understanding and adhering to therapy
cognitive decline
Alzheimer’s Disease

50% over age 80

4,000, 000 Americans

$80-100,000,000,000 per year

Progressive disorders: 15-30%

Reversible causes: 2-5%

Drug toxicity

Metabolic changes

B12 Deficiency

Thyroid disease

SDH

Normal pressure hydrocephalus

Cognitive decline
dementia risks for ad
Definite

Advanced age

Family history

Down syndrome

APOE-E4

Possible

Other genes

Head trauma

Lower educational level

Depression

Dementia: Risks For AD
screening66
Screening
  • Mini-Mental Status Exam
    • Sensitivity: 71-92%
    • Specificity: 56-96%
    • PPV: 15-72% (10% Prevalence)
    • NPV: 95-99%
  • Clock Drawing Test (CDT)
  • Structured family report: IQCDE
considerations
Considerations
  • Improving cognition
  • Decreasing institutionalization
  • Decreasing behavioral problems
  • Limiting injury
  • LOWER CAREGIVER STRESS
caregivers
Caregivers
  • Assess impact of care giving

when impairment is detected

  • Caregiver “burnout”
  • Elder abuse and neglect
depression
Depression
  • Rapid onset relative to dementia
  • Possible cognitive impairment
  • Time limited duration
slide70
Time passes

Life happens

Distance separates

Children grow up

Love waxes and wanes

Hearts break

Careers end

Jobs come and go

Parents die

risk factors71
Risk Factors
  • Intrinsic risk same as younger ages
  • Extrinsic
    • Co-morbidities
    • Decrease function and independence
    • Isolation
    • Higher concentration of major life changes
  • Higher incidence of alcohol use
    • 1 in 10 primary care older adults
screening72
Screening
  • Yale Depression Scale
    • Do you often feel sad or depressed?
  • Geriatric Depression Scale
alcoholism
Alcoholism
  • The U.S. Preventive Services Task Force (USPSTF) recommends screening and behavioral counseling interventions to reduce alcohol misuse (by adults, including pregnant women, in primary care settings.
tools
Tools
  • CAGE
    • Abuse and dependence
    • Does not address misuse
  • Quantity and frequency
    • Average number of days per week
    • Number drinks per day
    • Maximum number of drinks on any day in past month
intervention alcohol misuse
Intervention: alcohol misuse
  • Assess consumption
  • Advise reduction
  • Agree on individual goals
  • Assist in getting support
  • Arrange follow-up
polypharmacy
Polypharmacy
  • Multiple medication
  • Adverse drug reactions
  • Drug interactions
  • Cost
screening78
Screening
  • Identify all medications
  • Prescription
  • Over the counter
  • Vitamins and supplements
  • Herbs
intervention79
Intervention
  • Maintain up to date medication profile
  • Identify and discuss potential problems
  • Advise
social issues
Social Issues
  • Social issues impact functional ability
  • Independence and self-sufficiency important
screening81
Activities of daily living (ADLs)

Instrumental ADLs

Review social support network and availability of care

Query about recent changes

Living arrangements

Finances

Activities

Caregivers

Level of stress

Burnout potential

Screening
activities of daily living
Activities of Daily Living
  • Toilet
  • Feeding
  • Dressing
  • Grooming
  • Ambulation
  • Bathing
instrumental adls
Instrumental ADLs
  • Phone
  • Shopping
  • Food preparation
  • Housekeeping
  • Laundry
  • Transportation
  • Handle medication
  • Finances
advanced directives
Advanced Directives
  • End of Life care
  • Factors
    • Age
    • Nature of any illness
    • Ability of medicine to sustain life
    • Emotions and preferences of patient and his/her family
  • Best done before condition deteriorates
intervention85
Intervention
  • Identify resources
  • Advanced directives
    • Living will
  • Health Care Power of attorney
  • CPR training of caregivers
advanced care directives
Advanced Care Directives
  • Family physician in best position to know when to raise the issue and help clarify
  • Should take place with patients who are suffering with chronic disease before terminally ill or death imminent
advanced care directives87
Advanced Care Directives
  • Discuss situations during a normal visit
  • Hypothetical scenarios
  • Note and document preferences and values
  • Encourage completion of an advanced directive and HCPOA
  • Update PRN
advanced care directives88
Advanced Care Directives
  • Discussions actually increase patient satisfaction with physician
  • Cannot serve as legal witness, nor can an employee of the facility
geriatric checklist
Injury prevention

Sensorium

Nutrition

Immunizations

Sexuality

Continence

Mental status

Mental health

Social issues

Geriatric Checklist
references
References
  • Healthy Aging for Older Adults. http://www.cdc.gov/aging/
  • Morbidity and Mortality Weekly Report: Special Series on Public Health and Aging: http://www.cdc.gov/aging/publications.htm#mmwr
  • Chronic Disease Notes and Reports: Preventing the Diseases of Aging. http://www.cdc.gov/nccdphp/cdfall99.pdf
  • Staying Healthy at 50 Plus. http://www.ahrq.gov/ppip/50plus/50plus.pdf
references96
References
  • Aging and Health Issues: The Family Physician’s Role. http://www.aafp.org/PreBuilt/videocme/aging2004.pdf
  • Adult Immunization Schedule: http://www.immunizationed.org/downloads/2004Adult.pdf
  • Sexuality in Later Life. http://www.niapublications.org/engagepages/sexuality.asp
references97
References
  • Geriatrics at Your Fingertips
    • http://www.geriatricsatyourfingertips.org
  • The Geriatric Patient: A Systematic Approach to Maintaining Health
    • http://www.aafp.org/afp/20000215/1089.html
  • Boustani M, Peterson B, Hanson L, Harris R, Lohr K. Screening for Dementia in Primary Care: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Int Med 2003;138;927-37
references98
References
  • Alcohol Screening tools
    • http://www.niaaa.nih.gov/publications/arh21-4/348.pdf