1. Aging, Health and Mental Health Prepared for distribution by the CSWE Gero-Ed Center

2. HEALTH Older Adult Mortality Health Conditions Medication Problems

3. Leading Causes of Death Among Older Adults  Heart Disease  Cancer  CAD-Stroke  Pneumonia/Influenza  Chronic Obstructive Lung Disease* *National Center for Health Statistics 1991

4. Patient Reported Conditions Arthritis Hypertension Hearing Impairment Heart Disease Chronic Sinusitis

5. Reported Conditions (Cont’d) Cataracts Orthopedic Conditions Osteoarthritis Osteoporosis Diabetes Visual Impairment Tinnitus

6. Medication Problems  ”Critical health care issue…nations other drug problem” *  *Inspector General:DHHS  Elder Over-medication is epidemic**  ** Harvard Health Newsletter

7. System Factors Contributing to Problem MD: Inadequate Geriatric Training Wrong Drug and Dosage Inadequate Drug Tests Inadequate Labeling Polymedicine

8. Additional Factors Polypharmacy Pharmacokinetics Absorption Distribution Excretion Elder Abuse and Misuse

9. Extent of Problem 12% of Population 25% of Prescriptions Persons Over age 60+, 40% of Adverse Drug Reaction 1/6 of age 70 hospital admissions due to medications

10. Extent of Problem (Cont’d.) Over age 60, 15 times more likely medication admission 1986: 613 million prescriptions at retail pharmacies (15.5 Rxs per person & 40% of Rxs (outside of institutions)

11. Most Frequently Used Prescriptions Heart & heart related diseases 40% of all Rxs: Over-treatment for hypertension=increase in depression Analgesics for pain Implicated as possible cause for depression, psychosis, delirium and hallucinations: pseudo dementia Tranquilizers, sleeping pills, anti-psychotic drugs and anti-depressants Most likely to victimize older persons

12. Need for Knowledge and Concern Physicians Drug Manufacturer Pharmacists Patients Families Direct Practitioners

13. Practitioner Roles  Education  Counseling  Monitoring Effects of Medications

14. Symptoms of Adverse Reactions Confusion Forgetfulness Tremor Constipation or Diarrhea Loss of Appetite

15. Adverse Reactions (Cont’d) Depression Impaired Mental Abilities Urinary Retention Dizziness Falling Weakness Lethargy

16. Barriers to Detection MD sole responsibility Socialization of elders, family, workers Trust/reliance supreme in physician/patient relationship

17. Mental Health Common Psychiatric Disorders Cognitive Disorders

18. Common Psychiatric Disorders Depression Anxiety Somatoform Disorders Alcoholism and Drug Abuse Paranoia Psychosis

19. Cognitive Disorders Delirium Dementia Possible Reversible Causes of Cognitive Impairment

20. Features of Delirium  Disorders of consciousness  Disorders of perception  Disturbances of thinking  Disturbances of affect  Abnormalities of movement  Autonomic dysfunction* *Wells, C.E., 1976

21. Components of Comprehensive Assessment  Social  Economic  Physical Health  Activities of Daily Living  Mental Health  Environment