Challenging Patient

Download Challenging Patient

Post on 14-Jan-2016




0 download

Embed Size (px)


Challenging Patient. The Older Patient with Multiple Co-Morbidities. Objectives for the Day. Role of FM in caring for an aging population Aging Chronic disease and aging Prescribing for older adults. 70 million. 35 million. 21 million. 3 million. 4.2 million. - PowerPoint PPT Presentation


Challenging Patient

Challenging PatientThe Older Patient with Multiple Co-MorbiditiesObjectives for the DayRole of FM in caring for an aging populationAgingChronic disease and agingPrescribing for older adultsObjectives for this first session are 4-fold.First, we will discuss the role of FM in caring for an aging populationWe will then look at review some common changes with aging, and how those changes may affect your interactions with older patients and some of the more common physical exam findings in older patients that are due to agingWe will then look at the prototypical chronic disease diabetes and discuss management of this in the context of a diabetes check, and try to highlight some of the interactions that occur between aging and diabetesFinally, we will examine issues related to prescribing for older adults.2

3 million35 million70 million4.2 million21 million3This slide shows the growth of the older population from 1900 to the present and projects that growth to 2050.

Over the 20th century, the population of adults age 65 and over (shown here in orange) grew from 3 million to 35 million or 12% of the population. ++ ++

During the same time period, the oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 4.2 million in 2000. ++ ++

However, in 2011, the Baby Boomers (those born between 1946 and 1964) will start turning 65.

++ The number of older people will increase dramatically during the 2010-2030 period. The size of the older population in 2030 is projected to be twice as large as their counterparts in 2000, representing nearly 20 percent of the total U.S. population.

After 2030, the growth rate of the older population is projected to slow down and stabilize at around 20 percent of the total population when the last Baby Boomers enter the ranks of the older population. +++However, the oldest-old population is projected to continue to grow rapidly after 2030, when the Baby Boomers move into this age group. The U.S. Census Bureau projects that the population age 85 and over could grow from 4.2 million in 2000 to nearly 21 million by 2050. +++

From a global perspective, two-thirds of all seniors in the world who have ever lived are alive today. The United States is fairly young for a developed country, with just over 12 percent of its total population age 65 and over. The older population made up more than 15 percent of the population in most European countries and nearly 19 percent in both Italy and Japan in 2003.

Percentage of Americans Age 65 Expected to Survive Age 90Source of data: US Census Bureau5The likelihood that an American who is age 65 will survive to the age of 90 has quadrupled since 1940. By 2050, 2 out of 5 65 years old are likely to reach the age of 90. Prevalence of Chronic Conditions

NHIS, 2000, 20076In 2000, 1 in 8 americans was over 65, by 2030, that will be 1 out of 5. 2/3 between age 65 to 74, 2/3 live with spouse, vs 1/5 of those over 85. Growing number of foreign born elders - primarily Asia and Latin AmericaPercentage of Medicare Beneficiaries with 2 Chronic Conditions

Medicare Beneficiary Survey, 2000

9Per capital Medicare spendingInverse relationship between - spending and quality measures (% receiving b-blocker after MI; % undergoing cath)- spending and mortality

Positive assoc b/w spending and- number of visits to specialists- likelihood of hospitalization

Health Affairs, 200410These measures use samples of patientdischarge records for the treatment of six common medical conditions (acute myocardialinfarction, breast cancer, diabetes mellitus, heart failure, pneumonia, andstroke) and capture interventions and evaluations for which there is strong scientificevidence and professional consensus that the process of care either directly improvesoutcomes or is a necessary step in a chain of care that does so, such as theprescription ofwarfarin for atrial fibrillation or biennial eye examination for diabetics.7

Health Affairs, 2004Case 1Mr. D is a 70 y/o patient with h/o HTN and hyperlipidemia. Recent lab includes FBS of 140 and 176.He presents for follow-up of lab.

Your task: Outline your visit -what will you ask, look for on examwhat is your initial assessment? Your plan?Case 1 - More dataMeds: HCTZ 25, Simvastatin 20 mgVS: BP 144/84, P 72, Wt 85 kg, Ht 170 cmLab: BUN 18, Cr 0.8, TC 200, LDL 130, HDL 44