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Kathy Sykes
Senior Advisor, US EPA Aging Initiative
October 31, 2007
Improving Patient Safety Through Informed
Medication Prescribing and Disposal Practices
Why Should Aging and the Environment Be a
Research Priority?
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The Demographic Imperative
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By 2030, the 65+ population will double
to 70 million
The population 85+ is the frailest and
most rapidly increasing cohort
 4 million today; 19 million by 2050
These increases are projected to be
long-lasting features of American
demographics
Why Focus on Older Adults?
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Demographics
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Decrease in organ function & reserves
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Impaired chemical clearance and detoxification
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Vulnerable to medication-environment adverse
interactions (example - heat/psychotropic drugs)
Legacy of past occupational and environmental
cumulative exposures to persistent agents.
Interactions with Environmental Agents:
Concern about Polypharmacy
The body uses the same biological processes
to “clear” medications as it does
environmental toxicants.
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Older persons take multiple
medications.
Could be at increased risk of
adverse reactions due to
unknown interactions between
medications and concurrent
environmental exposures.
Indicator 30 - Prescription Drugs
Indicator 27 - Air Quality
Indicator 27 - Air Quality
The public health concern
WHO estimates 4% of all deaths and 5% of health loss to
disability is caused by diarrhea. It is most commonly
caused by gastrointestinal infections which kill around 2.2
million people globally. Contaminated water is an
important cause of diarrhea.
Burden of Gastrointestinal Illness
in the United States
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CDC estimates 211 million episodes of acute
gastrointestinal (GI) illness occur each year in
the US resulting in over 900,000 hospitalizations
and 6,000 deaths.
Many of these cases may be of infectious origin
due to food or waterborne transmission—teasing
apart this difference is a key reason for doing
trials.
Source: Mead 1999
Older adults at increased risk for GI
illness
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Decline in immunity, changes in GI functions, and
dehydration associated with aging lead to an
increased susceptibility of enteric infections
Older adults may be at increased risk for
infectious GI illness, severe diarrhea, or dying
from diarrheal illness (Peterson 2003, Mounts
1999, Gerba 1996, Lew 1991)
Older adults are recognized by the USEPA as a
sensitive subpopulation for waterborne diseases
(USEPA 2000)
Burden of Waterborne Disease
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Studies by Payment found that 1/3
of GI illness cases are related to
drinking water, suggesting that up
to 70 million cases of GI illness may
be caused by waterborne
pathogens.
Source: Payment 1991 & 1997
Gastroenteritis Costs
In the US, infectious gastroenteritis
costs are estimated to exceed
$20 billion annually.
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Source: Peterson 2003
Bacterial and Viral Enteric Diseases as Contributing
Causes of Death by Age, 1989 - 1996
Viral
Bacteria
’91-’92
’89-90
’91-’92
’93-’94
14
’95-’96
’93-’94
’95-’96
Rate of Report / 100,000 Population
’89-90
12
10
8
6
4
2
0
<5
5-24
25-34
35-44
45-54
Age Categories
55-64
65-74
75+
GI Hospitalizations
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Older adults are at the highest risk
of dying during an gastroenteritisrelated hospitalization, even when
compared to infants
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65-74: 14.4 deaths/1000 discharges;
75+: 24.9 deaths/ 1000 discharges)
Source: Mounts 1999
GI Hospitalizations
65+ Population
Persons over 65+ years of age account
for over 75% of hospitalizations due to
gastroenteritis
Source: Mounts 1999
Deaths Due to Enteric Disease
Highest rates of death related to enteric
disease: 75+ years
Deaths related to bacterial enteric
disease in older adults are increasing at
a greater rate than in any other age
category
Source: Peterson 2003
Major GI Pathogens
Morbidity
 Parasites- Cryptosporidium, Cyclospora, Giardia,
Microsporidia
Morbidity and Mortality
 Bacteria- Salmonella, Pseudomonas, Clostridium
difficile, Campylobacter, Mycobacterium avium
complex, E.Coli
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Viruses- Norwalk and Norwalk-like viruses,
enteroviruses, rotavirus, adenovirus
Cryptosporidium spores
Intervention: Identify & Educate
People at Risk
Susceptible populations include
those with:
 Advanced age
 Immune suppression due to disease
 Immune suppression due to taking
pharmaceuticals
Building Healthy
Communities for
Active Aging
Building Healthy Communities for Active
Aging
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Can improve air & water quality in the
community and improve the health of older
adults and all citizens through intentional
community design and systematic
programming for active aging.
Change Behavior at the Community Level
Aging Initiative Fact Sheets and Posters
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Age Healthier, Breathe Easier Fact sheet and poster
Effective Control of Household Pests
It’s Too Darn Hot--Planning for Excessive Heat
Events
Environmental Hazards Weigh Heavy on the Heart
Water Works
Diabetes and Environmental Hazards
Spanish, Portuguese, Chinese, Korean, Vietnamese,
Russian, Japanese, Italian, French and Arabic and
Haitian Creole
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Low Vision Large font
Purple Series: for persons with limited reading ability
Aging Initiative List Serve
Join EPA’s Aging
Initiative monthly list
serve
www.epa.gov/aging