OTHER CHRONIC DISEASES & CONDITIONS

11 OTHER CHRONIC DISEASES & CONDITIONS

11 “Our health always seems much more valuable after we lose it.” - Author Unknown -

11 DIMENSIONS OF CHRONIC DISEASES EPIDEMIOLOGICAL OVERVIEW • Affect women more often than they do men • Osteoarthritis, Rheumatoid Arthritis, Alzheimer Disease • 1 in 2 women age 50+ will have an osteoporosis-related fracture in her lifetime • Diabetes affects 8.2% of all U.S. women • Lupus afflicts women 9X more often than men • Hypothyroidism is 50X more common in women

11 ETHNIC & SOCIOECONOMIC DIMENSIONS • White and Asian women have osteoporosis more often than African American women • African American are more likely than white women to die following a hip fracture • Asian American women have lower rates of arthritis • African American women have highest prevalence rates of diabetes • African women have higher prevalence rate of lupus than white women

11 ECONOMIC DIMENSIONS Estimated Annual Costs

11 OSTEOPOSROSIS HEALTHY BONE vs. OSTEOPOROTIC BONE

11 NON-MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS • Being female • Increased age/postmenopausal • Small frame and thin-boned • White or Asian • Family history of osteoporosis or fractures

11 MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS • Diet low in Calcium and Vitamin D • Sedentary lifestyle • Cigarette smoking • Excessive use of alcohol • Certain medications • Glucocorticoids, Anticonvulsants • Amenorrhea • Anorexia nervosa or bulimia

11 SCREENING & DIAGNOSIS FOR OSTEOPOROSIS Women Who Should Be Tested: • All postmenopausal women younger than age 65 who have one or more additional risk factors for osteoporosis besides menopause • All women age 65 and older • Postmenopausal women with fractures • Women who are considering therapy for osteoporosis or who want to monitor the effectiveness of certain osteoporosis treatments

11 Bone Mineral Density Tests: • Dual-energy x-ray absorptiometry (DXA or DEXA) • Single-energy x-ray absorptiometry (SXA) • Peripheral dual-energy x-ray absorptiometry (pDXA) • Radiographic absorptiometry (RA) • Dual-photon absorptiometry (SPA) • Single-photon absorptiometry (SPA) • Quantitative computed tomography (QCT) • Ultrasound

11 TREATMENT & PREVENTION FOR OSTEOPOROSIS • Adequate supply of calcium • Vitamin D • Participate in weight-bearing and muscle-strengthening exercises • Estrogen replacement therapy • Drugs: Raloxifene, Fosamax, Calcitonin

11 ARTHRITIS HEALTHY JOINT vs. OSTEOARTHRITIC JOINT vs. RHEUMATOID ARTHRITIS

11 RISK FACTORS FOR ARTHRITIS • Gender: women are 2-3X greater risk than men • Obesity • Infectious Diseases: Lyme Disease • Occupations • Excessive physical activity: Repetitive joint use • Hormonal levels: Higher estrogen levels • Diet: coffee and tea

11 DIAGNOSIS FOR ARTHRITIS • No single test can diagnose arthritis • Family history and physical exam to check joints, reflexes, and muscle strength • Radiographs • Blood tests • Joint aspiration

11 TREATMENT AND PREVENTION FOR ARTHRITIS • Maintaining weight • Avoid injuries during physical activity • Avoiding contact sports • Avoid repetitive joint motion, wear braces, pads, proper shoes • Prevent lyme disease = vaccine, insect repellent • Drugs = NSAIDs, Corticosteroids, Hyaluronic Acid, Immunosuppressants

11 DIABETES TYPES OF DIABETES • Type 1:Insulin-Dependent Diabetes Mellitus (IDDM) • Type 2:Non-Insulin Dependent Diabetes Mellitus (NIDDM)

11 SYMPTOMS FOR DIABETES Type 2: • Any Type 1 symptoms • Frequent infections • Blurred vision • Cuts/bruises that are hard to heal • Numbness of hands/feet • Recurring skin, bladder infections Type 1: • Frequent urination • Unusual thirst • Extreme hunger • Unusual weight • Extreme fatigue • Irritability

11 RISK FACTORS FOR DIABETES • Having a first-degree relative with diabetes • Being overweight • Having hypertension • Abnormal high-density lipoprotein (HDL) • Racial groups: African American, Hispanics, Native Americans • Women who had gestational diabetes or delivered a baby more than 9 pounds

11 COMPARISON OF LIKELIHOOD OF DIABETES ACROSS RACIAL GROUPS

11 COMPLICATIONS OF DIABETES • Heart disease • Stroke • High blood pressure • Retinopathy • End-stage renal disease • Damage of the nervous system • Lower-extremity amputations • Periodontal disease • Congenital malformations • Neonatal mortality • Macrosomia • Diabetic ketoacidosis • Susceptibility to infections and illness such as pneumonia

11 DIAGNOSIS OF DIABETES Routine Tests: • Fasting plasma glucose test • Oral glucose tolerance test • Blood sugar level above 140 mg/dL on at least two occasions • Normal sugar level = 70-110 mg/DL

11 TREATMENT & PREVENTION OF DIABETES • Daily insulin injections • Diet control • Physical activity • Home blood glucose testing several times a day • Oral medications

11 AUTOIMMUNE DISEASES FEMALE-TO-MALE RATIO OF CERTAIN AUTOIMMUNE DISEASE

11 CHARACTERISTICS OF LUPUS • Immune system forms antibodies that target healthy tissues and organs • Primarily a disease of young women of childbearing age • Affects women 9X more often than men • Affects American women 3X more often than white women • Types • Cutaneous Lupus • Systemic Lupus

11 SYMPTOMS OF LUPUS • Painful, swollen joints • Skin rash • Butterfly-shaped across face • Triggered by sun exposure • Arthritis • Seizures • Psychosis • Raynaud’s phenomenon • Extreme fatigue

11 RISK FACTORS OF LUPUS • Exact cause is unknown • Genetic factors • Occurs within families • Environmental factors • Infections • Exposure to sunlight • Stress • Certain medications

11 DIAGNOSIS OF LUPUS • Take note of symptoms • Skin rash, joint pain, chest pain, seizures, photosensitivity, review of history of medications • Blood count • Antinuclear antibody test (ANA) • Urinalysis

11 TREATMENT AND PREVENTION OF LUPUS • Avoid sun exposure and use sunscreen • Exercise • Non-steroidal anti-inflammatory drugs (NSAIDs) • Corticosteroids • Antimalarial agents • Immunosuppressant drugs • Steroids

11 THRYOID DISEASE Symptoms of Hashimoto’s Disease and Graves’ Disease

11 RISK FACTORS OF THYROID DISEASE • Inherited • Family history of a family member with thyroid disease • Hashimoto’s occurs with greater frequency in people older than 60 years of age

11 DIAGNOSIS OF THYROID DISEASE • Baseline testing to monitor thyroid function • Thyroid-stimulating hormone (TSH) test • Blood tests measuring levels of thyroxine (T4) can confirm presence of disease

11 TREATMENT AND PREVENTION OF THYROID DISEASE • Annual check-ups • Thyroxine for Hashimoto’s Disease • Antithyroid drugs for Graves’ Disease

11 ALZEIMER’S DISEASE A Women’s Risk Doubles Every Five Years Beyond Age 65

11 RISK FACTORS FOR ALZEIMER’S DISEASE • Age • Genetic background • Lifestyle • Severe or repeated head injuries • Lower education levels • Environmental agents • Familial Alzheimer’s Disease (FAD)

11 SYMPTOMS OF ALZEIMER’S DISEASE • Memory loss • Decline in ability to perform simple tasks • Think less clearly • Affected language and reasoning skills • Lack of ability to make judgments • Personality changes • Emotional outbursts • Wandering and agitation

11 TREATMENT AND PREVENTION OF ALZEIMER’S DISEASE • Controlling symptoms with drugs • Haloperidol (aggressive behavior) • Sertraline (depression) • Zolpidem, Diphenhydramine (insomnia) • Alzheimer’s Drugs • Cogrex, Aricept, Exelon • Antioxidants: Vitamin E (reduce nerve cell damage)

11 SUMMARY Of MEDICATIONS USED TO TREAT CHRONIC CONDITIONS

11 INFORMED DECISION MAKING SECONDARY PREVENTION FOR SENIORS • Annual blood pressure screening • Cholesterol screening • Height:Weight Measurements • Clinical breast examinations annually • Cognitive function tests • Behavioral Assessment • Routine Mammography screening • Annual fecal occult blood test • Sigmoidoscopy every 5 years • Annual pap smear • Evaluation for hearing loss • Evaluation for visual acuity • Thyroid-stimulating thyroid test • Bone mineral density test

OTHER CHRONIC DISEASES & CONDITIONS