Kirk Panneton, M.D., FACP George Giokas, M.D. Medical Director, Senior Services Director, Palliative Care CDPHP The Community Hospice September 8,

 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

 Cell proliferation  Chromosomal changes  Key trigger ◦ usually occurs in late teens/early twenties 3

 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 1010

Thanks to Faddy Morgan and Ryan Watson Albany College of Pharmacy and Health Sciences Pharm. D. Candidate % 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: If the relevant practice guidelines followed… 12 meds ($406 a month)

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 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 1414

 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 1515

 Encourage work and/or volunteer activity  Encourage social interaction  Remember caregiver support ◦ Respite ◦ Knowledge of community resources  Advance directives  For frail elders, review goals in care and goals in life 1616