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I Optometric Practice for a Geriatric Population Base
A) Understanding older patients
a. Implications of demographic trends
b. Aging and the life cycle continuum
c. Myths and realities about older persons
d. Some characteristics of older persons
B) Factors influencing the examination and management of the elderly patient
a. Multiple health challenges
b. Communication problems
c. Poly-pharmacy and compliance issues
d. Interaction of psychological, social and physical factors
e. Clinical evaluations –methods and techniques
f. Role of the multidisciplinary team
g. Institutionalization
C) Ocular aging
a. Normal aging – related changes in vision
b. Media changes and effects
c. Retinal aging and function
d. CNS effects
D) Visual – perceptual changes and functional ramifications
E) Clinical assessment and management guidelines
a. Goals of geriatric patient care: quality of life
b. Taking an appropriate case history
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c. Pharmacology and the elderly
d. Communication strategies
e. Assessing visual acuity, far and near point
f. Considering binocularity
g. Refraction techniques: objective and subjective
h. Assessment of near vision
i. Assessing ocular health
j.
Prescription design considerations
II “American Diet”—Abundance with micronutrient deficiencies
A) High in refined sugars, saturated, trans fats and calories
B) Salt, calcium and iron predominate over antioxidants and B vitamins
C) Health authority efforts to encourage more fresh fruits and vegetables have
failed and there is an epidemic of obesity (62 % of persons have a BMI>25)
D) Multivitamins mentioned by doctors less than 1 % of the time
E) Mass use of multivitamins would reduce health care costs
F) 2 to 20 % of population has a low intake of B12, vitamin C, E or zinc
G) The lowest quartile for fruit and vegetable intake has double the risk of cancer
III Organizations Make a U-turn concerning vitamins
A) The FDA now encourages the flow of high-quality, science-based information
regarding the health benefits of foods and food supplements (FDA bulletin,
Dec 18,2002)
B) The AMA recommends multivitamins for every American and a double dose
for elders (J Am Med Assn 287:3116-26,2002)
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C) 1st Amendment of the Constitution allows health claims on product labels
D) The only way to keep health care costs from bankrupting the US is to lower
the incidence of disease
E) Only 1/3rd of Americans are regular users of vitamins
IV General nutritional considerations for older Americans
A) Many pharmaceuticals induce micronutrient deficiencies
B) The average 65 y/o takes 4 medications
C) Elders often eat less calories and absorb less nutrients with each decade thus
they have increased nutritional needs (Geriatric Nutrition, Raven Press 1998)
D) With increased lifespan there is the danger of iron overload
E) Dehydration risk from loss of hypothalamic feedback
F) The dosage of vitamins and minerals in common vitamins such as Centrum ®
is too low to realize a therapeutic benefit with respect to eye disease
G) Vitamins and minerals protect DNA and reduce cancer risk
H) Antioxidant supplements remarkably well tolerated and free from toxicity
I) Elders consuming a multivitamin providing 18 nutrients experienced only 18
sick days versus 32 sick days for adults who did not take vitamins (Lancet
340:1124-7,1992)
J) Essential fatty acids i.e. omega fatty acids are essential for all aspects of
health.
V Specific recommendations for elderly
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A) The best diet may not provide enough vitamin B12 to eliminate the risk of
short-term memory loss and nerve problems.
B) Increased folic acid (vitamin B6 and B12), which induces high oxidant
homocysteine levels, prevents Alzheimer’s disease, heart and blood vessel
disease and colon cancer.
C) 10 year users of 250 mg - 300 mg of vitamin C have 45-83% reduction in risk
for cataract (Br Med J 305:335-9, 1992 and other references)
D) Indoor living and isolation without sunlight promotes vitamin D deficiency
associated with osteoporosis and cancer and the highest rates of colon, breast
and prostate cancer correlate with cloud cover.
E) Antioxidants such as vitamin C, vitamin E and glutathione protect brain cells
from premature aging.
F) B vitamins in general improve memory.
G) 500 mg vitamin C reduces blood pressure (Am J Therapy 9:289-93,2002)
H) The world death rate rises in winter when vitamin D levels are low.
I) Vitamin COQ10 and Parkinson’s disease
VI Vitamin – minerals sometimes more trouble than benefit
A) Due to imbalance, too low or too high a dose
B) Nonetheless rarely cause serious medical issues
C) Too low in vitamin C - failure to prevent cataract
D) Too high in riboflavin (vitamin B2) – induce cataracts and retinitis
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E) Overloading the diet with Beta carotene is dangerous for smokers and reduces
availability of other protective plant pigments such as lutein / zeaxanthin
F) Excessive zinc impairs absorption and availability of copper
G) Excessive Calcium (without magnesium) leads to recurrent migraines, eyelid
twitches, and fatigue, kidney stones and heart spasms.
VII Nutrients for the eyes
A) Lutein / zeaxanthin – i.e. spinach
B) Magnesium- spinach
C) Vitamin C – citrus fruit and spinach
D) Vitamin E
E) Glutathione
F) Selenium
G) Zinc
H) Bioflavonoids
I) Omega 3 fatty acids
VIII Summary – purported benefits of a potent balanced
multivitamin for the elderly
A) Reduced sick days, colds and flu
B) Reduces # of individual supplements and saves $
C) Improves mental functioning
D) Minimizes nutritional shortages
E) Improves ability to handle physical, emotional and mental stress
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F) Long term users reduce risk of eye disease i.e. AREDS, vitamin C
G) Minimizes damage from homocysteine
H) Protects DNA against cancer
I) Reduces risk of chronic disease and slows aging
J) “Cheap” vitamins will cost you a fortune
IX REFERENCES
A) Bill Sardi, The New Truth about vitamins and minerals, ISBN 0-9705640-8-2
B) Vitacost. com
C) Luteininfo.com
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