Kirk Panneton, M.D., FACP George Giokas, M.D. Medical Director, Senior Services Director, Palliative...
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Transcript of Kirk Panneton, M.D., FACP George Giokas, M.D. Medical Director, Senior Services Director, Palliative...
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
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)
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