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Physiology PharmacologyNursingHomes

FamousSeniors

Longevity& Survival

Physiology PharmacologyNursingHomes

FamousSeniors

Longevity& Survival

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The effect of agingon renal function

Physiology - $200

Decreased

• Renal function decreases with aging.• Glomerular filtration rate decreases about 1%

per year after age 30.• Urine concentrating ability also decreases

Physiology - $200The effect of aging on renal function

The effect of agingon resting heart rate

Physiology - $400

Decreased

• Normal aging results in:– decreased resting heart rate

– decreased maximum predicted heart rate with exercise

– decreased VO2 Max and maximum CO with exercise

• Cardiac output remains normal at rest largely related to increased stroke volume

Physiology - $400The effect of aging on resting heart rate

This physiologic effect is the result of eating a large

meal and is associated with drowsiness and unsteady

balance.

Physiology - $600

a6a

Post-prandial Hypotension

• Post-prandial hypotension (orthostatic hypotension) often follows a large meal, presumably as a result of shift in blood flow from the periphery to the mesenteric bed and can be an important cause of falls

Physiology - $600This physiologic effect is the result of eating alarge meal and is associated with drowsinessand unsteady balance

The effect of aging on gastric acid secretion

Physiology - $800

None

• Until recently it was widely thought that gastric secretion diminished as a result of normal aging processes. Recent studies, excluding those with atrophic gastritis, smoking and H.pilori have shown no change in acid secretion with aging.

Physiology - $800The effect of aging on gastric acid secretion

The effect of aging on collagen

Physiology - $1000

a10a

Increased Crosslinking

• Aging results in abnormal collagen and elastin metabolism. The result is increased collagen crosslinking which may explain decreased tensile strength, fragility, tissue strains and tears.

• Elastin also undergoes increased cross linking and results in decreased elastic recoil in skin and other tissues.

Physiology - $1000The effect of aging on collagen

Term for multiple drug use in elderly people associated

with increased risk for adverse drug reactions

Pharmacology - $200

Polypharmacy

• The risk of adverse drug events in elderly people rises with number of medications. ADR’s occur in 4% of those taking 5 drugs; 10% in those taking 6-10 drugs; 28% in those taking 11-15 drugs and 54% in those taking 16 or more drugs.

Pharmacology - $200The term for multiple drug use in elderly people associated with increased risk of adverse drug reactions

This single drug can be effective for both incontinence and

hypertension in elderly men

Pharmacology - $400

doxazocin (Cardura), prazocin (Minipress),

terazocin (Hytrin)

• Alpha adrenergic blockers are known to decrease the effect of BPH and bladder outlet obstruction as well as decrease blood pressure.

Pharmacology - $400This single drug can be effective for bothincontinence and hypertension in elderly men

Drug commonly used to treat congestive heart failure in

therapeutic doses can cause anorexia, delirium and

depression

Pharmacology - $600

Digoxin

• Digoxin even with normal therapeutic drug levels can cause anorexia, delirium and depression in elderly people.

Pharmacology - $600Drug commonly used to treat congestive heart failure in therapeutic doses can cause anorexia, delirium and depression

The effect of aging on adipose tissue

Pharmacology - $800

b8a

Increased

• Aging is associated with an increase in fat/lean body weight ration. Muscle mass tends to decrease and fat tends to increase. This effect can have a significant effect on drug distribution and elimination.

Pharmacology - $800The effect of aging on adipose tissue

The MS Contin doseequivalent to

MS elixir 30mg q6h

Pharmacology - $1000

MS Contin 60mg q12h

• The conversion from MS elixir toMS Contin is 1:1

• The 24 hr dose of MS elixir is 120mg• The equivalent dose of MS Contin is 120mg

or 60mg q12h

Pharmacology - $1000The MS Contin doseequivalent toMS elixir 30mg q6h

The majority of elderly people live in

nursing homes

Nursing Homes - $200

True or False

False

• Less than 5% of all elderly people live in nursing homes.• About 20% of those over age 85 reside in nursing homes• The lifetime chance of spending some time in a nursing home

is abut 20%

Nursing Homes - $200The majority of elderly peoplelive in nursing homes

Term for this skin lesion that has become an important indicator of

quality of care

Nursing Homes - $400

Pressure Sore(Bed Sore, Decubitus Ulcer or Pressure Ulcer)

• Pressure sores are caused by unrelieved pressure or shear

• They are considered predictable and preventable• Nursing homes can be liable for their

development

Nursing Homes - $400Term for this skin lesion that has becomean important indicator of quality of care

The source of reimbursement for care of

most nursing home residents

Nursing Homes - $600

Medicaid (Medical)

Nursing Homes - $600The source of reimbursement for care for most nursing home residents

• Only about 5% of care in nursing homes is reimbursed by Medicare.

• About 50% of nursing home residents are paid by Medicaid (Medical)

• About 45% are paid out of pocket

The number of nursing home residents that have

dementia

Nursing Homes - $800

50%

Nursing Homes - $800The number of nursing home residentsthat have dementia

• Dementia and psychological problems are common in the nursing home

• It has been estimated that 50% of all nursing home residents have some dementia

The national standardized assessment of patients

required within 2 weeks of admission to any nursing

home

Nursing Homes - $1000

Minimum Data Set (MDS)

• The Minimum Data Set is a national standardized assessment of each nursing home resident within 2 weeks of admission, at regular intervals or on any significant change in overall condition

• Usually completed by staff nurses or other nurses hired by each facility

Nursing Homes - $1000Nursing Homes - $1000The national standardized assessment of patientsrequired within 2 weeks of admission to any nursing home

d2

Common geriatric problem that prevented this elderly comedian from playing the London Palladium on his 100th birthday

Famous Seniors - $200

Fractured Hip

• Comedian/actor, George Burns, preformed professionally up until a few months prior to his 100th birthday when he suffered a fall and fractured hip resulting in his inability to fulfill a contract signed years earlier to play the London Palladium on his 100th birthday

Famous Seniors - $200

Common geriatric problem suffered by this famous athlete

Famous Seniors - $400

Parkinson’s Disease

• Mohammad Ali suffered severe disability for many years from Parkinson’s disease

• Pugilism or Pugilistic Parkinsonism is a condition mimicking Parkinson’s disease associated with boxing or a history of repeated head trauma

Famous Seniors - $400Common geriatric problemsuffered by this famous athlete

Daily Double

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Famous SeniorsThe Daily Double

This famous senior invented bifocal glasses at the age of

78

Benjamin Franklin

• Inventor, statesman, ambassador, framer of the constitution was the inventor of bifocal glasses when he we 78 years of age.

Famous SeniorsThe Daily DoubleThis famous senior invented bifocal glassesat the age of 78

This famous grandmother gave up making quilts in her 70’s when afflicted by arthritis and took up painting miniatures.

Famous Seniors - $800

Grandma Moses

Famous Seniors - $800This famous grandmother gave up making quiltsin her 70’s when afflicted by arthritisand took up painting miniatures.

• Born Anna Mary Robertson on September 7, 1860, she lived 101 years and 3 months until December 13, 1961.

• A remarkable lady, a mother of ten who started painting in earnest in her late 70's and continued until the summer of 1961

• Also known for folk wisdom: Life is what we make it; always has been, always will be.

Famous Seniors - $1000

Despite (some say because) of this affliction, Claude Monet, painted this and other masterpieces after age of 60

• Claude Monet (1840-1926) suffered for over 30 years from severe cataracts for which he refused surgical extraction.

• At age 84 visitors found him robust, vibrant and still painting.

Cataracts

Famous Seniors - $1000Despite (some say because) of this affliction,Claude Monet, painted this and other masterpieces after age of 60

Percent of U.S. population over age 65

Longevity and Survival - $200

13%

• In 1998, 12.7% of the population was over age 65.• Those over age 85 are the fastest growing segment.• By 2030, elderly will account for about 20% of the

population, equal to the number below 5 years.

Longevity and Survival - $200Percent of U.S. population over age 65

Life expectancy at birth

Longevity and Survival - $400

76.5 years

• The life expectancy for a child born 1997 was 76.5 years

• For males 71 years; for females 78 years• The gender differential in life expectancy is

largely related to cumulative differences in disease specific mortality

Longevity and Survival - $400Life expectancy at birth

The oldest age to which any human has ever lived

Longevity and Survival - $600

122 years

• The oldest fully authenticated age to which any human has ever lived is 122 years and 164 days, by Jeanne Louise Calment. She was born in France on February 21, 1875, and died at a nursing home in Arles, southern France on August 4, 1997.

Longevity and Survival - $600Oldest age to which any human has ever lived

Name for landmark observation that human

diploid cells cease to grow after a limited number of

doublings

Longevity and Survival - $800

Hayflick Phenomenon(Clonal Senescence)

• Leonard Hayflick made the important discovery relevant to aging and cancer, that normal human cells are not immortal and will cease to divide after a finite number of doublings

• Cells from older donor survived fewer doublings that cells from younger donors.

Longevity and Survival - $800Name for landmark observationthat human diploid cells cease togrow after a limited number of doublings

Longevity and Survival - $1000

The only intervention proven to increase maximum life potential in mammalian species

Longevity and Survival - $1000The only intervention proven to increase maximum life potentialin mammalian species

Caloric Restriction

• Mice, rats and primates have been shown to live 40% longer if they are restricted to a diet that contains adequate levels of all micronutrients and only 60% of the calories they would normally eat.

Final Jeopardy Category:

“Geriatric Organizations”

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Final Jeopardy

The Nation’s largest organization of older

people

Final JeopardyThe nations largest organization of older people

AARPThe American Association

of Retired Persons

• Founded in 1958, the organization boasts more than 30 million members over age 50

• One year dues are $10 (including spouse)• Activities include: information and education;

community service; and legislative, judicial, and consumer advocacy

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Brought to you by

The UCLA School of Medicine

Division of Geriatrics