Kirk Panneton, M.D., FACP George Giokas, M.D. Medical Director, Senior Services Director, Palliative Care CDPHP The Community Hospice September 8, 2012.

Kirk Panneton, M.D., FACP George Giokas, M.D.

Medical Director, Senior Services Director, Palliative Care CDPHP The Community Hospice

September 8, 2012

•1

Discuss the aging process…can it be altered?

Define the Metabolic Syndrome

Review the effects of polypharmacy

Propose tips on being more successful with Geriatric care

•2

Cell proliferation

Chromosomal changes

Key trigger◦ usually occurs in late teens/early twenties

•3

Certain genes seem to lead to longevity◦ certain populations that live longer

Sir 2 gene◦ one of a family of genes (sirtuins)◦ present in all complex forms of life

If eliminated, life span decreases by 30 – 40 %

If stimulated, certain proteins get activated which help protect cellular mechanisms

•4

Metabolic rate (Olshansky)

Oxidation of free radicals (Sinclair)

Chromosomal mutations (Kunkel)

Caloric restriction (CR) appears to be at the center of all of these studies; plant and animal models all show healthier longevity when under the stress of CR.

•5

Characteristics:◦ Central obesity◦ Insulin resistance

Risk factors:◦ Aging◦ Genetics◦ Hormonal changes◦ Decreased exercise

•6

BP > 130/85

FBS > 100

Waist measurement◦ Men > 40◦ Women > 35

HDL◦ Men < 40◦ Women < 50

Triglycerides > 150

•7

Weight loss ( 7 – 10% )

Exercise ( 5 – 7 days/week )

Nutritional counseling

Low dose ASA

No smoking

•8

Less calories

More activity◦ Physical ◦ Mental

Meet psychosocial needs◦ Community resources

Less dependence on medications

•9

> 5 Medications

ADR’s – adverse drug reactions◦ Responsible for up to 1/3 of all hospital admissions in

the elderly

Functional decline◦ Lethargy◦ Decreased appetite/weight loss◦ Change in bowel function◦ Gait/mobility◦ depression

•10

Thanks to Faddy Morgan and Ryan WatsonAlbany College of Pharmacy and Health

SciencesPharm. D. Candidate 2011

•20% of elders in the community

•take more than

•10 meds per day!!

79 y.o. with COPD, DM, HBP, DJD, osteoporosis

•CM Boyd, et al Clinical Practice Guidelines and Quality of Care for Older

•Patients With Multiple Comorbid Diseases. JAMA. 2005;294:716-724.

• If the relevant practice guidelines followed…

• 12 meds ($406 a month)

•13

88 y.o. female….living independently in a flat above her daughter’s family. No meds. PMH significant for memory loss and some weight loss.

Falls and sustains an acute vetebral fracture….brought to the emergency room

W/U: mid back pain…ambulates with assistance…no other significant findings except osteopenia on x-rays

Tx: Lortab 5mg. every 4 hrs. Fosamax 10mg tabs one a day

•14

Limit medications◦ Easy dosing◦ Use generics ( be aware of costs! )◦ Beware of certain drug classes ( Beer’s list )◦ Review for side effects◦ Brown bag analysis◦ D/C meds after therapeutic effect realized

Encourage exercise◦ Physical◦ Mental

•15

Encourage work and/or volunteer activity

Encourage social interaction

Remember caregiver support◦ Respite◦ Knowledge of community resources

Advance directives

For frail elders, review goals in care and goals in life

•16