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Treatment of Common Conditions

Treatment of Common Conditions. Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine. Common Conditions and Aging. Hypertension Diabetes High cholesterol Arthritis Osteoporosis Dementia Falls Parkinson’s.

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Treatment of Common Conditions

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  1. Treatment of Common Conditions Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine

  2. Common Conditions and Aging • Hypertension • Diabetes • High cholesterol • Arthritis • Osteoporosis • Dementia • Falls • Parkinson’s • Heart failure • Stroke • Cancer • Influenza & pneumonia • Depression • Anxiety • Sleep disorders • GERD

  3. Arthritis • Multiple pain problems – low back, hip, knee, ankles, hands • Treatments • Tylenol equal to Celebrex and NSAID in studies • Lower rate of GI bleeding and kidney damage • Glucosamine (Rotta-brand - Dona) • Possibly ginger • Exercise provides greatest benefits in function • Arthroscopy not beneficial

  4. Osteoporosis • USPSTF recommends screening • Fracture risk should be calculated (FRAX) • Exercise is the mainstay of treatment • Calcium, (and maybe vitamin D) - initial treatment • Medical treatments likely help high risk or very low bone density patients • If treatment is taken, 5 years is likely enough

  5. Mild Cognitive Impairment • Memory loss that is measurable but does not affect function • Drugs for dementia do not prevent dementia or improve memory in MCI • Exercise, Mediterranean diet, possibly mental games

  6. Dementia • Many types – Alzheimer’s, vascular, Lewy body, frontotemporal • Prevention – exercise, alcohol, Med diet • Get a detailed diagnosis – rule out other things • Medications usually not helpful (common side effects) • Small benefits from a huge number of complimentary medicines

  7. Falls • 6th leading cause of death over age 65 • Medications often the cause – all drugs that act on the central nervous system, heart drugs • Exercise is mainstay of prevention and treatment • Emphasize strength and balance • Tai Chi most effective intervention

  8. Heart Failure • #1 cause of death in people over age 65 • Self-management skills significantly decrease hospital admissions • Know your “ejection fraction” • Exercise is the most common forgotten treatment (cardiac rehabilitation)

  9. Stroke • #3 cause of death in people over age 65 • Acute thrombolysis? (“clot busting”) • Red score on NNT – all positive studies were drug-company funded, all negative studies were not • High risk of hemorrhage • 3 hour window • Aspirin also not recommended for prevention

  10. Cancer • All cancers are different • Second opinion recommended • Discuss the actual experience of treatment • Always include palliative care – symptom control

  11. Influenza & Pneumonia • Annual flu shot, one-time pneumovax shot • Personal benefit – lower risk of serious infection and death • Community benefit – reduce spread • Prior worries of swine flu (Guillean-Barre) have not been seen in many years

  12. Depression • Get an accurate diagnosis (PHQ-9 or Geriatric Depression Scale) • 3 equally effective treatments: • Exercise • Cognitive-behavioral therapy • Medications • Combination of them more effective than one • 9 months of treatment after resolution, then attempt taper off medications

  13. Anxiety • Sometimes depression can present as anxiety • Best treatment is exercise, mindfulness meditation or other means of stress reduction, massage, and cognitive-behavioral therapy • Medications as a last resort • All increase risk of falls and confusion • SSRI rather than a benzodiazepine

  14. Sleep Disorders • Most common problem is lack of sleep • Sleep apnea – daytime drowsiness, snoring, snorting, waking up with headache, high blood pressure • Weight loss, exercise, “sleep hygiene” • A sleep study can confirm it • CPAP effective if basic interventions fail

  15. GERD • Proton pump inhibitors (omeprazole) are effective but should not be used indefinitely • No difference between types – buy the cheapest • H2 blockers (ranitidine) can do as good sometimes and has less risk over time • Once a course has been completed (2-3 weeks) taper off and use as needed • Lifestyle modifications help

  16. GERD - Lifestyle • Avoid aggravating foods – acidic, alcohol, caffeine, chocolate, onions, garlic • Avoid large meals • Medications – calcium channel blockers, nitrates, sedatives • Stop smoking • Don’t lie down after eating, raise bed • Lose weight

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