Treatment of Common Conditions Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine

Common Conditions and Aging  Hypertension  Diabetes  High cholesterol  Arthritis  Osteoporosis  Dementia  Falls  Parkinson’s  Heart failure  Stroke  Cancer  Influenza & pneumonia  Depression  Anxiety  Sleep disorders  GERD

Arthritis  Multiple pain problems – low back, hip, knee, ankles, hands  Treatments Tylenol equal to Celebrex and NSAID in studies Lower rate of GI bleeding and kidney damage Glucosamine (Rotta-brand - Dona) Possibly ginger  Exercise provides greatest benefits in function  Arthroscopy not beneficial

Osteoporosis  USPSTF recommends screening  Fracture risk should be calculated (FRAX)  Exercise is the mainstay of treatment  Calcium, (and maybe vitamin D) - initial treatment  Medical treatments likely help high risk or very low bone density patients  If treatment is taken, 5 years is likely enough

Mild Cognitive Impairment  Memory loss that is measurable but does not affect function  Drugs for dementia do not prevent dementia or improve memory in MCI  Exercise, Mediterranean diet, possibly mental games

Dementia  Many types – Alzheimer’s, vascular, Lewy body, frontotemporal  Prevention – exercise, alcohol, Med diet  Get a detailed diagnosis – rule out other things  Medications usually not helpful (common side effects)  Small benefits from a huge number of complimentary medicines

Falls  6 th leading cause of death over age 65  Medications often the cause – all drugs that act on the central nervous system, heart drugs  Exercise is mainstay of prevention and treatment  Emphasize strength and balance  Tai Chi most effective intervention

Heart Failure  #1 cause of death in people over age 65  Self-management skills significantly decrease hospital admissions  Know your “ejection fraction”  Exercise is the most common forgotten treatment (cardiac rehabilitation)

Stroke  #3 cause of death in people over age 65  Acute thrombolysis? (“clot busting”) Red score on NNT – all positive studies were drug-company funded, all negative studies were not High risk of hemorrhage 3 hour window  Aspirin also not recommended for prevention

Cancer  All cancers are different  Second opinion recommended  Discuss the actual experience of treatment  Always include palliative care – symptom control

Influenza & Pneumonia  Annual flu shot, one-time pneumovax shot  Personal benefit – lower risk of serious infection and death  Community benefit – reduce spread  Prior worries of swine flu (Guillean-Barre) have not been seen in many years

Depression  Get an accurate diagnosis (PHQ-9 or Geriatric Depression Scale)  3 equally effective treatments: Exercise Cognitive-behavioral therapy Medications  Combination of them more effective than one  9 months of treatment after resolution, then attempt taper off medications

Anxiety  Sometimes depression can present as anxiety  Best treatment is exercise, mindfulness meditation or other means of stress reduction, massage, and cognitive-behavioral therapy  Medications as a last resort All increase risk of falls and confusion SSRI rather than a benzodiazepine

Sleep Disorders  Most common problem is lack of sleep  Sleep apnea – daytime drowsiness, snoring, snorting, waking up with headache, high blood pressure  Weight loss, exercise, “sleep hygiene”  A sleep study can confirm it  CPAP effective if basic interventions fail

GERD  Proton pump inhibitors (omeprazole) are effective but should not be used indefinitely No difference between types – buy the cheapest  H2 blockers (ranitidine) can do as good sometimes and has less risk over time  Once a course has been completed (2-3 weeks) taper off and use as needed  Lifestyle modifications help

GERD - Lifestyle  Avoid aggravating foods – acidic, alcohol, caffeine, chocolate, onions, garlic  Avoid large meals  Medications – calcium channel blockers, nitrates, sedatives  Stop smoking  Don’t lie down after eating, raise bed  Lose weight