General principles of diagnosis and treatment of internal diseases in elderly patients. 

Preventive medicinePreventive medicine refers to measures taken to prevent illness or injury, rather refers to measures taken to prevent illness or injury, rather

than curing them.than curing them.

Primary preventionPrimary prevention avoids the development of a avoids the development of a disease. disease. SSecondary preventionecondary prevention activities are aimed at early activities are aimed at early disease detection, thereby increasing opportunities for disease detection, thereby increasing opportunities for interventions to prevent progression of the disease and interventions to prevent progression of the disease and emergence of symptoms.emergence of symptoms.Tertiary preventionTertiary prevention reduces the negative impact of an reduces the negative impact of an already established disease by restoring function and already established disease by restoring function and reducing disease-related complications. reducing disease-related complications.

Preventive MedicinePreventive Medicine

focuses on disease prevention and health promotion focuses on disease prevention and health promotion through identifying and reducing risk factors for through identifying and reducing risk factors for

development or transmission of diseasedevelopment or transmission of disease..

PreventionPreventionPrimary – prevent initial development of Primary – prevent initial development of disease disease Secondary – detect early existing disease Secondary – detect early existing disease Tertiary – reduce complications of existing Tertiary – reduce complications of existing disease disease

The most wide-spread diseasesThe most wide-spread diseases

Atherosclerosis Atherosclerosis

Leading causes of preventable deaths in the Leading causes of preventable deaths in the United States in the year 2000United States in the year 2000

Smoking: : 435,000 deaths or 18.1% of the total deaths435,000 deaths or 18.1% of the total deaths Overweight and and Obesity: 365,000 deaths or 15.2% of the : 365,000 deaths or 15.2% of the

total deathstotal deaths Alcohol consumption: 85,000 deaths or 3.5% of the total : 85,000 deaths or 3.5% of the total

deaths deaths Infections: 75,000 deaths or 3.1% of the total deaths: 75,000 deaths or 3.1% of the total deaths Toxic agents: 55,000 deaths or 2.3% of the total deaths: 55,000 deaths or 2.3% of the total deaths Motor vehicle collisions: 43,000 deaths or 1.8% of the total : 43,000 deaths or 1.8% of the total

deathsdeaths Incidents involving firearms: 29,000 deaths or 1.2% of the : 29,000 deaths or 1.2% of the

totaltotal Sexually transmitted infections: 20,000 deaths or 0.8% of the : 20,000 deaths or 0.8% of the

totaltotal Illicit use of drugs: 17,000 deaths or 0.7% of the total deaths.: 17,000 deaths or 0.7% of the total deaths.

Age Management MedicineAge Management Medicine

is in a unique position to embrace and support is in a unique position to embrace and support appropriate Preventive Medicine practices and appropriate Preventive Medicine practices and protocols which promote and maintain health and protocols which promote and maintain health and well-being and prevent disease, disability and well-being and prevent disease, disability and premature death. It is focused on lifestyle issues, premature death. It is focused on lifestyle issues, physiological and biomedical conditions and physiological and biomedical conditions and diseases of aging.diseases of aging.

Theories of Health and DiseaseTheories of Health and Disease::1.1. Humoral TheoryHumoral Theory2.2. Demonic TheoryDemonic Theory3.3. Religious TheoryReligious Theory4.4. Magnetic TheoryMagnetic Theory5.5. Miasmatic TheoryMiasmatic Theory6.6. Germ TheoryGerm Theory7.7. Christian Science TheoryChristian Science Theory8.8. Psychosomatic TheoryPsychosomatic Theory9.9. Stress TheoryStress Theory10.10. Ecologic Theory Ecologic Theory

Life spanLife span

refers to a theoretical limit on how long an refers to a theoretical limit on how long an organism might live under ideal organism might live under ideal circumstances. For humans, generally circumstances. For humans, generally assumed to be 115 to 120 years. This assumed to be 115 to 120 years. This figure has not changed for centuries. figure has not changed for centuries.

Compression of morbidityCompression of morbidity

suggests the ideal aging process would suggests the ideal aging process would keep disease and disability at a minimum keep disease and disability at a minimum until toward the end of life, after which one until toward the end of life, after which one would die quickly.would die quickly.

Theories of AgingTheories of Aging::Three general categories of internal or external Three general categories of internal or external

changes that contribute to the aging changes that contribute to the aging process:process:Secular changes – the result of natural wear and Secular changes – the result of natural wear and teartearSenescent changes – due to aging of tissues & Senescent changes – due to aging of tissues & organs, especially those with low mitotic rateorgans, especially those with low mitotic ratePathological changes – resulting from disease Pathological changes – resulting from disease processesprocesses

Theories of AgingTheories of Aging::Heavy Labor TheoryHeavy Labor Theory Overcrowded Conditions TheoryOvercrowded Conditions Theory Wear and Tear TheoryWear and Tear Theory Separation TheorySeparation Theory Hypoxia TheoryHypoxia Theory Enriched Environment TheoryEnriched Environment Theory Functional TheoryFunctional Theory Enzyme TheoryEnzyme Theory Nutritional TheoryNutritional Theory Free Radical TheoryFree Radical Theory Activity TheoryActivity Theory Fixed Life Span TheoryFixed Life Span Theory Metabolic TheoryMetabolic Theory Stress TheoryStress Theory Autoimmune TheoryAutoimmune Theory Mutation / Radiation TheoryMutation / Radiation Theory

Factors that Influence LongevityFactors that Influence Longevity::HeredityHeredity GenderGender Race and ethnicityRace and ethnicity SmokingSmoking DiseaseDisease Body weight and heightBody weight and height Physical activityPhysical activity Alcohol useAlcohol use Marital statusMarital status Psychological factorsPsychological factors Social classSocial class Cultural factorsCultural factors Physical environmentPhysical environment

Circulatory ConditionsCirculatory Conditions

– Coronary Heart Disease – Stroke Stroke

RespiratoryRespiratory Diseases Diseases

CancerCancer

Neurological and cognitive Neurological and cognitive conditionsconditions

– Dementia – Alzheimer’s Disease Alzheimer’s Disease – Dementia with Lewy Bodies Dementia with Lewy Bodies – Parkinson’s Disease Parkinson’s Disease

Sight and Hearing DegradationSight and Hearing Degradation

– Long-sightedness Long-sightedness – Glaucoma Glaucoma – Deafness Deafness

Muscular Skeletal DegradationMuscular Skeletal Degradation

– Osteoporosis Osteoporosis – Osteoarthritis Osteoarthritis – Rheumatoid arthritis

Major Geriatric ConcernsMajor Geriatric Concerns

Weakness and falls, fracturesWeakness and falls, fracturesDeliriumDelirium Urinary incontinenceUrinary incontinence Sleep disturbancesSleep disturbances Serious depressionSerious depression ComorbiditiesComorbidities

Geriatrics as the Model forChronic Disease

Chronic disease is the major issue inhealth care

Current organization of health care isInappropriate

Geriatrics = Chronic Care + Gerontology

Core of Geriatrics

Age-specific syndromes

Atypical disease presentation

Management– Multiple, simultaneous, interactiveproblems Medical coordination

Chronic Disease Epidemiology

Preventing a chronic disease will increase the absolute number of people with chronic diseases (Boult, 1996)

Competitive risk

Prevalence of chronic disease increases with age

Age-related and aging-associated diseases

Goals of Chronic Disease Care

1. Manage the disease as well as possible toreduce the extent and frequency ofexacerbations.

2. Minimize the transition from impairment todisability, and from disability to handicap.

3. Encourage patient to play an active role inmanaging his/her disease but avoidallowing the disease to become thedominant force in the person’s life.

More Goals

4. Provide care in a culturally sensitivemanner.

5. Integrate medical care with otheraspects of life without medicalizing those aspects

Components of Chronic Disease Care

Patient experience of Care

Care delivery teams

Organizations withinwhich delivery teamsand patients interact

Regulatory and payment environment

Models of Chronic Disease Care

Primary care with specialty referrals

Primary care from specialists

Organ systems care by specialists

Primary care by GNPs