TCP Week 9 (Epidemiology of Geriatrics)

young old age

60-69

middle old age

70-79

old old age

80+

centenarian age

100+

super centenarian age

110+

Global average life expectancy

73.5

countries w the highest population of elderly (>65)

- Monaco 36%

- Japan 29%

- Portugal and Bulgaria 24%

- Italy 23%

- Finland &Greece 22%

US life expectancies (males and females)

average - 79

females - 81.4

males - 76.5

in the U.S., the fastest-growing elderly subgroup is generally ?

"oldest-old" population, those age 85 and older

also have the highest need for healthcare, long-term care, and support services.

often considered the most important growth cohort because it accounts for a disproportionate share of frailty, dementia, disability, hospitalization, and long-term care utilization.

The _______ population grew dramatically between 2010 and 2020, increasing 38.6%, the fastest decade-long growth since the 1880s.

The 65+ population grew dramatically between 2010 and 2020, increasing 38.6%, the fastest decade-long growth since the 1880s.

what other (smaller) group is growing rapidly?

An even smaller subgroup, centenarians (100+), is growing very rapidly. The U.S. Census Bureau reported that the number of centenarians increased by about 50% between 2010 and 2020.

DEMOGRAPHIC TRANISTION

•Based on historical population trends of two demographic characteristics - birth rate and death rate

•This suggests that a country's total population growth rate cycles through stages as that country develops economically.

how does the increase number of people over 85 affect the US

- Increased demand for health care and long-term care services (nursing homes)

- Increase in number of people requiring memory care due to rise in dementia

- Slow growth in the working age people that pay taxes to support public programs

positive developments in the population

- Education Levels increasing

- The gender gap in life expectancy is narrowing

- Poverty rate for Americans 65 and older has decreased

challenges of demographic transition

- Wide economic disparities across different population subgroups

- More older adults are divorced which means more older adults live alone

- Social Security and Medicare expenditures have and will continue to increase

What is a dependency support ratio?

The dependency ratio relates the number of children (0-14 years old) and older persons (65 years or over) to the working-age population (15-64)

Why is the dependency ratio important?

The dependency ratio is important because it shows the ratio of economically inactive compared to economically active.

The total dependency ratio tells us the proportion of the population not in the work-force who are 'dependent' on those of working-age.

challenges of long term care pic

factors affecting longevity

-gender

-genetics

-childhood illness

-marital status

-social-economic status

-education

-ethnicity

-health literacy

-lifestyle

-medical technologies

comorbidity and disability in the elderly

1. Hypertension (53.3%)

2. Osteoarthritis (49%)*

3. Cardiovascular disease (21.1%)*

4. Cancer (21.1%)

5. Lung dysfunction (20.6%)

6. Diabetes (18%)

7. Stroke (9.3%)

8. Dementia**

9. Osteoporosis**

10. Hearing impairment **

11. Vision impairment **

What are the top 2 conditions that lead to physical disability?

OA and CVD are the top two conditions that lead to physical disability!

How do comorbidities and disabilities impact us as health care providers

the style of medicine will have to change from a one-time intervention that corrects a single issue to an ongoing management of multiple disease processes and integrates biopsychosocial factors.

mortality risk factors in community include

-increased age

-male gender

-altered mental status

-impaired functional status

-diagnosis

-ADL impairments

-social isolation

MEMORY IMPAIRMENT

global prevalence of dementia? epi?

• The global prevalence of dementia is somewhere between 5-7% in people 60 and over

•By the age of 85, between 25-50% of people display symptoms of dementia.

•About 40% of people 65 and older have age associated memory impairment. In the US, that is approximately 16 million people

•An estimated 5.5 million Americans are currently living with Alzheimer's Disease

•Projections of the prevalence of dementia suggest that nearly 14 million people could have Alzheimer's disease in the US by 2060

Caregivers

Adult children taking care of two generations

"Sandwich generation"

Aging parents also taking care of their grandchildren, may be still working or newly retired.

Demographic variables affecting psychsocial health

• Death of a partner, an adult child, siblings, friends

• Living arrangements

• Socioeconomic status

• Level of disability

• Functional status

assessment and care of the elderly as a PA: psychosocial considerations

environment/social constraint assessments

-Transportation

-Religious involvement/ Spiritual needs

-Insurance coverage/cost of prescriptions

-Discrimination

-Social isolation

-Difficulty with communication

-Household composition

-Education

-Occupation

-income (adequacy of)

-Social support

assessment and care of the elderly as a PA: psychosocial considerations

health behavior assessment questions

-Alcohol and drug use

-Diet

-Exercise

-Sleep

-Smoking

-Quality of healthcare utilization

assessment and care of the elderly as a PA: psychosocial considerations

psychological influences assessment

-Perceived stress

-Affect/emotionality

-Personality (hostility, optimism, self-esteem, mastery, control)

-Major life events

-Deaths of loved ones

-Loss of independence/self-sufficiency

Elderly: History

•Quiet, well-lit room

•Face your patient at eye level

•Acknowledge who else is in the room

•Ask about basic and instrumental ADL's

•Be Patient

•Confirm understanding of information

•Target modifiable geriatric syndromes

geriatric syndromes include?

Examples of geriatric syndromes include delirium, falls, frailty, dizziness, syncope and urinary incontinence

PE for elderly

•Postural BP

•Assess for memory impairment (mini-Cog or MMSE)

•Depression Screening ( 2 questions, then PHQ-9 if positive)

•Oral Exam (properly fitting dentures, teeth, gums)

•Foot Exam

•Visual acuity

•Auditory Assessment and Ear Exam (excessive cerumen)

•Weight Loss/Muscle Atrophy

functional assessment of elderly

- gait assessment

- fall risk assessment (timed get up and go)

- MSK: strength and ROM

-Coordination (touch nose, each finger to thumb)

- ability to follow multiple step commands

- offer assistance

Timed get-up and go

In the timed up and go (TUG) test, subjects are asked to rise from a standard armchair, walk to a marker 10 feet away, turn, walk back, and sit down again. The test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time.

Safety considerations for elderly

-driving

-elderly abuse

-advance directives

tips to turning in the car keys

1. Have a close family member prepare a list of observations about their driving ability.

2. Discuss alternative transportation options

3. Approach the subject respectfully and acknowledge how difficult this is for them

4. Be understanding and give them time to accept the changes

Possible abuse in the elderly population

-physical

-emotional

-neglect

-abandonment

-financial

-sexual

Physician Assistants are MANDATORY reporters (mostly)

* if in outpt (private practice) - mandatory reporter is less clear

physical abuse in the elderly

happens when someone causes bodily harm by hitting, pushing, or slapping.

this may also include restraining an older adult against his/her will, such as locking them in a room or tying them to furniture.

emotional abuse in elderly

sometimes called psychological abuse, can include a caregiver saying hurtful words, yelling, threatening, or repeatedly ignoring the older adult.

keeping that person from seeing close friends and relatives is another form of emotional abuse.

neglect of elderly population

occurs when the caregiver does not try to respond to the older adult's needs.

this may include physical, emotional, and social needs, or withholding food, medications, or access to health care.

abandonment of elderly

is leaving an older adult who needs help alone without planning for his or her care.

sexual abuse of elderly

involves a caregiver forcing an older adult to watch or be part of sexual acts.

financial abuse of elderly

happens when money or belongings are stolen from an older adult. It can include forging checks, taking someone else's retirement or Social Security benefits, using a person's credit cards and bank accounts without their permission. It also includes changing names on a will, bank account, life insurance policy, or title to a house without permission.

Advance directives of elderly

Durable Power of Attorney

Health Care Proxy

Living Will

Code Orders: Full Code, DNR, DNI

- DNR = DO NOT RESUSITATE / DNI = DO NOT INTUBATE

Five Wishes