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Let’s Play Physiology Pharmacology Nursing Homes Famous Seniors Longevity & Survival Physiology Pharmacology Nursing Homes Famous Seniors Longevity & Survival $200 $200 $200 $200 $200 $400 $400 $400 $400 $400 $600 $600 $600 $600 $600 $800 $800 $800 $800 $800 $1000 $1000 $1000 $1000 $1000 Physiology - $200 The effect of aging on renal function Physiology - $200 The effect of aging on renal function Decreased • Renal function decreases with aging. • Glomerular filtration rate decreases about 1% per year after age 30. • Urine concentrating ability also decreases Physiology - $400 The effect of aging on resting heart rate Physiology - $400 The effect of aging on resting heart rate Decreased • Normal aging results in: – decreased resting heart rate – decreased maximum predicted heart rate with exercise – decreased VO2 Max and maximum CO with exercise • Cardiac output remains normal at rest largely related to increased stroke volume Physiology - $600 This physiologic effect is the result of eating a large meal and is associated with drowsiness and unsteady balance. Physiology - $600 This physiologic effect is the result of eating a large meal and is associated with drowsiness and unsteady balance Post-prandial Hypotension • Post-prandial hypotension (orthostatic hypotension) often follows a large meal, presumably as a result of shift in blood flow from the periphery to the mesenteric bed and can be an important cause of falls a6a Physiology - $800 The effect of aging on gastric acid secretion Physiology - $800 The effect of aging on gastric acid secretion None • Until recently it was widely thought that gastric secretion diminished as a result of normal aging processes. Recent studies, excluding those with atrophic gastritis, smoking and H.pilori have shown no change in acid secretion with aging. Physiology - $1000 The effect of aging on collagen Physiology - $1000 The effect of aging on collagen Increased Crosslinking • Aging results in abnormal collagen and elastin metabolism. The result is increased collagen crosslinking which may explain decreased tensile strength, fragility, tissue strains and tears. • Elastin also undergoes increased cross linking and results in decreased elastic recoil in skin and other tissues. a10a Pharmacology - $200 Term for multiple drug use in elderly people associated with increased risk for adverse drug reactions Pharmacology - $200 The term for multiple drug use in elderly people associated with increased risk of adverse drug reactions Polypharmacy • The risk of adverse drug events in elderly people rises with number of medications. ADR’s occur in 4% of those taking 5 drugs; 10% in those taking 6-10 drugs; 28% in those taking 11-15 drugs and 54% in those taking 16 or more drugs. Pharmacology - $400 This single drug can be effective for both incontinence and hypertension in elderly men Pharmacology - $400 This single drug can be effective for both incontinence and hypertension in elderly men doxazocin (Cardura), prazocin (Minipress), terazocin (Hytrin) • Alpha adrenergic blockers are known to decrease the effect of BPH and bladder outlet obstruction as well as decrease blood pressure. Pharmacology - $600 Drug commonly used to treat congestive heart failure in therapeutic doses can cause anorexia, delirium and depression Pharmacology - $600 Drug commonly used to treat congestive heart failure in therapeutic doses can cause anorexia, delirium and depression Digoxin • Digoxin even with normal therapeutic drug levels can cause anorexia, delirium and depression in elderly people. Pharmacology - $800 The effect of aging on adipose tissue Pharmacology - $800 The effect of aging on adipose tissue Increased • Aging is associated with an increase in fat/lean body weight ration. Muscle mass tends to decrease and fat tends to increase. This effect can have a significant effect on drug distribution and elimination. b8a Pharmacology - $1000 The MS Contin dose equivalent to MS elixir 30mg q6h Pharmacology - $1000 The MS Contin dose equivalent to MS elixir 30mg q6h MS Contin 60mg q12h • The conversion from MS elixir to MS Contin is 1:1 • The 24 hr dose of MS elixir is 120mg • The equivalent dose of MS Contin is 120mg or 60mg q12h Nursing Homes - $200 The majority of elderly people live in nursing homes True or False Nursing Homes - $200 The majority of elderly people live in nursing homes False • Less than 5% of all elderly people live in nursing homes. • About 20% of those over age 85 reside in nursing homes • The lifetime chance of spending some time in a nursing home is abut 20% Nursing Homes - $400 Term for this skin lesion that has become an important indicator of quality of care Nursing Homes - $400 Term for this skin lesion that has become an important indicator of quality of care Pressure Sore (Bed Sore, Decubitus Ulcer or Pressure Ulcer) • Pressure sores are caused by unrelieved pressure or shear • They are considered predictable and preventable • Nursing homes can be liable for their development Nursing Homes - $600 The source of reimbursement for care of most nursing home residents Nursing Homes - $600 The source of reimbursement for care for most nursing home residents Medicaid (Medical) • Only about 5% of care in nursing homes is reimbursed by Medicare. • About 50% of nursing home residents are paid by Medicaid (Medical) • About 45% are paid out of pocket Nursing Homes - $800 The number of nursing home residents that have dementia Nursing Homes - $800 The number of nursing home residents that have dementia 50% • Dementia and psychological problems are common in the nursing home • It has been estimated that 50% of all nursing home residents have some dementia Nursing Homes - $1000 The national standardized assessment of patients required within 2 weeks of admission to any nursing home Nursing Homes - $1000 The national standardized assessment of patients required within 2 weeks of admission to any nursing home Minimum Data Set (MDS) • The Minimum Data Set is a national standardized assessment of each nursing home resident within 2 weeks of admission, at regular intervals or on any significant change in overall condition • Usually completed by staff nurses or other nurses hired by each facility Famous Seniors - $200 Common geriatric problem that prevented this elderly comedian from playing the London Palladium on his 100th birthday d2 Famous Seniors - $200 Fractured Hip • Comedian/actor, George Burns, preformed professionally up until a few months prior to his 100th birthday when he suffered a fall and fractured hip resulting in his inability to fulfill a contract signed years earlier to play the London Palladium on his 100th birthday Famous Seniors - $400 Common geriatric problem suffered by this famous athlete Famous Seniors - $400 Common geriatric problem suffered by this famous athlete Parkinson’s Disease • Mohammad Ali suffered severe disability for many years from Parkinson’s disease • Pugilism or Pugilistic Parkinsonism is a condition mimicking Parkinson’s disease associated with boxing or a history of repeated head trauma Daily Double Make a Wager Famous Seniors The Daily Double This famous senior invented bifocal glasses at the age of 78 Famous Seniors The Daily Double This famous senior invented bifocal glasses at the age of 78 Benjamin Franklin • Inventor, statesman, ambassador, framer of the constitution was the inventor of bifocal glasses when he we 78 years of age. Famous Seniors - $800 This famous grandmother gave up making quilts in her 70’s when afflicted by arthritis and took up painting miniatures. Famous Seniors - $800 This famous grandmother gave up making quilts in her 70’s when afflicted by arthritis and took up painting miniatures. Grandma Moses • Born Anna Mary Robertson on September 7, 1860, she lived 101 years and 3 months until December 13, 1961. • A remarkable lady, a mother of ten who started painting in earnest in her late 70's and continued until the summer of 1961 • Also known for folk wisdom: Life is what we make it; always has been, always will be. Famous Seniors - $1000 Despite (some say because) of this affliction, Claude Monet, painted this and other masterpieces after age of 60 Famous Seniors - $1000 Despite (some say because) of this affliction, Claude Monet, painted this and other masterpieces after age of 60 Cataracts • Claude Monet (1840-1926) suffered for over 30 years from severe cataracts for which he refused surgical extraction. • At age 84 visitors found him robust, vibrant and still painting. Longevity and Survival - $200 Percent of U.S. population over age 65 Longevity and Survival - $200 Percent of U.S. population over age 65 13% • In 1998, 12.7% of the population was over age 65. • Those over age 85 are the fastest growing segment. • By 2030, elderly will account for about 20% of the population, equal to the number below 5 years. Longevity and Survival - $400 Life expectancy at birth Longevity and Survival - $400 Life expectancy at birth 76.5 years • The life expectancy for a child born 1997 was 76.5 years • For males 71 years; for females 78 years • The gender differential in life expectancy is largely related to cumulative differences in disease specific mortality Longevity and Survival - $600 The oldest age to which any human has ever lived Longevity and Survival - $600 Oldest age to which any human has ever lived 122 years • The oldest fully authenticated age to which any human has ever lived is 122 years and 164 days, by Jeanne Louise Calment. She was born in France on February 21, 1875, and died at a nursing home in Arles, southern France on August 4, 1997. Longevity and Survival - $800 Name for landmark observation that human diploid cells cease to grow after a limited number of doublings Longevity and Survival - $800 Name for landmark observation that human diploid cells cease to grow after a limited number of doublings Hayflick Phenomenon (Clonal Senescence) • Leonard Hayflick made the important discovery relevant to aging and cancer, that normal human cells are not immortal and will cease to divide after a finite number of doublings • Cells from older donor survived fewer doublings that cells from younger donors. Longevity and Survival - $1000 The only intervention proven to increase maximum life potential in mammalian species Longevity and Survival - $1000 The only intervention proven to increase maximum life potential in mammalian species Caloric Restriction • Mice, rats and primates have been shown to live 40% longer if they are restricted to a diet that contains adequate levels of all micronutrients and only 60% of the calories they would normally eat. Final Jeopardy Category: “Geriatric Organizations” Make a Wager Final Jeopardy The Nation’s largest organization of older people Final Jeopardy The nations largest organization of older people AARP The American Association of Retired Persons • Founded in 1958, the organization boasts more than 30 million members over age 50 • One year dues are $10 (including spouse) • Activities include: information and education; community service; and legislative, judicial, and consumer advocacy Thanks for Playing Brought to you by The UCLA School of Medicine Division of Geriatrics