1. Challenging Patient The Older Patient with Multiple Co-Morbidities

2. Objectives for the Day  Role of FM in caring for an aging population  Aging  Chronic disease and aging  Prescribing for older adults  Role of FM in caring for an aging population  Aging  Chronic disease and aging  Prescribing for older adults

3. 3 million 35 million 70 million 4.2 million 21 million

4. Increases in the Oldest Old U.S. Population Aged 85+ (millions) Source of data: U.S. Census Bureau, “We the American Elderly,” September 1993.

5. Percentage of Americans Age 65 Expected to Survive Age 90 Source of data: US Census Bureau

6. Prevalence of Chronic Conditions NHIS, 2000, 2007

7. Percentage of Medicare Beneficiaries with  2 Chronic Conditions Medicare Beneficiary Survey, 2000

10. Health Affairs, 2004

13. Case 1  Mr. 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 exam what is your initial assessment? Your plan?  Mr. 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 exam what is your initial assessment? Your plan?

14. Case 1 - More data  Meds: HCTZ 25, Simvastatin 20 mg  VS: BP 144/84, P 72, Wt 85 kg, Ht 170 cm  Lab: BUN 18, Cr 0.8, TC 200, LDL 130, HDL 44  Meds: HCTZ 25, Simvastatin 20 mg  VS: BP 144/84, P 72, Wt 85 kg, Ht 170 cm  Lab: BUN 18, Cr 0.8, TC 200, LDL 130, HDL 44