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Emory Reynolds Program

This workshop aims to provide an introduction to geriatric medicine, focusing on the BIG 10 principles of care. Participants will learn about the unique aspects of caring for older patients and explore case studies in geriatrics. The workshop also covers key medical issues, prevention of iatrogenesis, and the impact of comorbidities on quality of life. Additionally, participants will engage in a gerontology quiz to test their knowledge of aging demographics around the world.

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Emory Reynolds Program

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  1. Emory Reynolds Program PGY-1 Workshop Created by: Jonathan M. Flacker, M.D. jflacke@emory.edu

  2. Objectives • Warm-up • Describe Traditional Medical Thinking • Identify Important Principles of a Geriatric Medicine Approach (BIG 10) • Have fun

  3. What’s Different? • So, what’s different about taking care of older patients? • What’s different about Geriatrics?

  4. Case Study(ies) in Geriatrics • Describe the last senior patient you saw • What are the key important points of this patient’s care?

  5. Key Medical Issues? • Pick a Disease, Any Disease…. • Epidemiology • Pathophysiology • Approach • Testing • Medications • Interventions

  6. Prevention Of Iatrogenesis Appropriate Site Cognitive Affective Issues Collaborators Medication Age Appropriate Expectations Testing Identification of Problem Interventions Quality of Life Impact of Comorbidities Ethically Appropriate Social Situation TREATMENT SUCCESS!!

  7. Gerontology Quiz THE MOST "AGED" NATION (HIGHEST % OVER AGE 65) IS_______________? SWEDEN Adapted From Sokolovsky's Comparative Gerontology Quiz; by Jay Sokolovsky, Professor of Anthropology, University of South Florida

  8. Gerontology Quiz WHAT IS THE ONLY COUNTRY IN THE WORLD (PERHAPS IN HISTORY) WHERE THERE ARE MORE PEOPLE OVER 60 THAN UNDER 20? ITALY Adapted From Sokolovsky's Comparative Gerontology Quiz; by Jay Sokolovsky, Professor of Anthropology, University of South Florida

  9. Gerontology Quiz NAME THE TWO COUNTRIES WHICH ARE CURRENTLY AGING THE FASTEST: JAPAN and CHINA

  10. Gerontology Quiz IN THIRD WORLD COUNTRIES, BETWEEN NOW AND THE YEAR 2020 THE POPULATIONS OVER AGE 60 WILL GROW TWICE AS FAST AS THE PART OF THE POPULATION BETWEEN 5 AND 15. [True or False] TRUE

  11. Gerontology Quiz THE SOCIETY WITH THE HIGHEST LONGEVITY IS __________? JAPAN Adapted From Sokolovsky's Comparative Gerontology Quiz; by Jay Sokolovsky. Professor of Anthropology, University of South Florida

  12. Gerontology Quiz THE MAJORITY OF THE WORLD'S AGED POPULATION, OVER 65 YEARS OF AGE, LIVE IN THE INDUSTRIALIZED NATIONS OF NORTH AMERICA, EUROPE, JAPAN AND THE FORMER SOVIET UNION.[True or False] FALSE Adapted From Sokolovsky's Comparative Gerontology Quiz; by Jay Sokolovsky, Professor of Anthropology, University of South Florida

  13. Gerontology Quiz THE AVERAGE MARRIED COUPLE, IN THE U.S. NOW HAS MORE PARENTS ALIVE THAN CHILDREN IN THEIR FAMILY. [True or False] TRUE Adapted From Sokolovsky's Comparative Gerontology Quiz; by Jay Sokolovsky, Professor of Anthropology, University of South Florida

  14. Intro to the Basics in Geriatrics 10 (“BIG” 10) Developed by the Emory Reynolds Program

  15. SO, WHAT DO YOU THINK?

  16. The BIG 10 • Aging is not a disease

  17. Peripheral Vascular Disease Newman: J Am Geriatr Soc, Volume 48(9).September 2000.1157-1162

  18. But, What Does Happen With Aging?

  19. Homeostenosis The depletion in physiologic reserves or diminished responsiveness to external stimuli with aging

  20. The Average Younger Person RESERVE REQUIRED LEVEL OF FUNCTION RESERVE Brain Balance Lungs Bladder Muscles

  21. Older Person: Illness=Delirium RESERVE REQUIRED LEVEL OF FUNCTION RESERVE Brain Balance Lungs Bladder Muscles

  22. SO, WHAT DO YOU THINK?

  23. Aging is not a disease The BIG 10 2. Medical conditions in older patients are commonly chronic, multiple, and multifactorial

  24. Traditional Medical Syndrome Specific Morbid Process Multiple Phenomenologies “Moon facies” “Buffalo Hump” Truncal obesity Cortisol Excess Proximal muscle weakness Easy bruisability Skin thinning Osteoporosis Flacker J. J Am Geriatr Soc 2003

  25. The Geriatric Syndrome Multiple Morbid Processes Specific Phenomenology Dementia Dehydration Severity of illness Sensory impairment Delirium Syndrome Medication effects Sleep disturbance Older age Flacker J. J Am Geriatr Soc 2003

  26. Multifactorial Health Conditions • Falls • Depression • Dizziness • Delirium • Incontinence

  27. SO, WHAT DO YOU THINK?

  28. Aging is not a disease The BIG 10 2. Medical conditions in older patients are commonly chronic, multiple, and multifactorial 3. Reversible and treatable conditions are often underdiagnosed and under treated in older patients

  29. Put In Order (Low to high) • % Hospitalized Elderly Patients That Experience Delirium • % Elderly Patients After Surgical Repair Of Hip Fracture Who Were Discharged With Delirium • % Delirious Elderly Patients That Is Not Recognized By Physicians And Nurses • % Elderly Patients Admitted To A Nursing Home Suffering From Some Degree Of Delirium

  30. Put In Order • % Hospitalized Elderly Patients That Experience Delirium (20%) • % Elderly Patients After Surgical Repair Of Hip Fracture Who Were Discharged With Delirium (29%) • % Delirious Elderly Patients Not Recognized By Physicians And Nurses (54%) • % Elderly Patients Admitted To A Nursing Home Suffering From Some Degree Of Delirium (46%)

  31. More To Put In Order (Low to high) • %Prevalence Rate Of Osteoporosis In USA • % Of Men Over 50 In The USA Who Will Have An Osteoporosis Related Fracture During Their Lifetime • % Prevalence Of Undiagnosed Osteoporosis In Seniors In USA • % Of White Women Over 50 Who Have Osteoporosis In The USA

  32. More To Put In Order • % Prevalence Rate Of Osteoporosis In USA (10%) • % Of Men Over 50 In The USA Who Will Have An Osteoporosis Related Fracture During Their Lifetime (25%) • % Prevalence Of Undiagnosed Osteoporosis In Seniors In USA (6.6%) • % Of White Women Over 50 Who Have Osteoporosis In The USA (15%)

  33. Still More To Put In Order (Low to High) • % Prevalence Of Isolated Systolic Hypertension in Women > 65 Years Old in USA • % Prevalence Of Isolated Systolic Hypertension in Men > 65 Years Old in USA • % Reduction In Occurrence Of Congestive Heart Failure As A Result Of HTN Treatment For 3-5 Years • % Reduction in Occurrence Of Strokes Among Treated Older Patients With Blood Pressure Reductions Of 12 to 14 mm Hg Systolic and 5 to 6 mm Hg Diastolic

  34. Still More To Put In Order • % Prevalence Of Isolated Systolic Hypertension in Women > 65 Years Old in USA (30%) • % Prevalence Of Isolated Systolic Hypertension in Men > 65 Years Old in USA (20%) • % Reduction In Occurrence Of Congestive Heart Failure As A Result Of HTN Treatment For 3-5 Years (48%) • % Reduction in Occurrence Of Strokes Among Treated Older Patients With Blood Pressure Reductions Of 12 to 14 mm Hg Systolic and 5 to 6 mm Hg Diastolic (30%)

  35. What Else?

  36. SO, WHAT DO YOU THINK?

  37. Aging is not a disease The BIG 10 2. Medical conditions in older patients are commonly chronic, multiple, and multifactorial 3. Reversible and treatable conditions are often underdiagnosed and under treated in older patients 4. Functional ability and quality of life are critical outcomes in the geriatric population

  38. ADL OR IADL? EATING ADL

  39. ADL OR IADL? HOUSEKEEPING IADL

  40. ADL OR IADL? TELEVISION REMOTE USE OK, Neither

  41. ADL OR IADL? SHOPPING IADL

  42. ADL OR IADL? DRESSING ADL

  43. ADL OR IADL? BABYSITTING OK, Neither

  44. ADL OR IADL? HYGEINE ADL

  45. ADL OR IADL? ACCOUNTING IADL

  46. ADL OR IADL? TRANSPORTATION IADL

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