1 IntroductiontoGeriatricsVolker.pdf

Introduction to Geriatrics Clinical Sciences IV Geriatrics Paul B. Volker, MD, FAAFP Assistant Professor Dept. of Osteopathic Clinical Medicine 27 March 2024 27 March 2024 Volker Intro to Geriatrics 2 Disclosures I have no financial relationships with companies associated with the healthcare industr...

Introduction to Geriatrics Clinical Sciences IV Geriatrics Paul B. Volker, MD, FAAFP Assistant Professor Dept. of Osteopathic Clinical Medicine 27 March 2024 27 March 2024 Volker Intro to Geriatrics 2 Disclosures I have no financial relationships with companies associated with the healthcare industry other than my relationship with Des Moines University Some of my work is supported by a grant awarded to the Geriatrics Workforce Enhancement Program funded by the US Health Resources and Services Administration All people or their descendants presented in this lecture have given permission to share their pictures and stories 27 March 2024 Volker Intro to Geriatrics 3 Stephen Mally 27 March 2024 Volker Intro to Geriatrics 4 Grace Amemiya 27 March 2024 Volker Intro to Geriatrics 5 27 March 2024 Volker Intro to Geriatrics 6 27 March 2024 Volker Intro to Geriatrics 7 Grace Amemiya 27 March 2024 Volker Intro to Geriatrics 8 Des Moines Register December 14, 2015 27 March 2024 Volker Intro to Geriatrics 9 Des Moines Register 27 March 2024 Volker Intro to Geriatrics 10 “Forgiving does not erase the bitter past. A healed memory is not a deleted memory. Instead, forgiving what we cannot forget creates a new way to remember. We change the memory of our past into a hope for our future.” 27 March 2024 Volker Intro to Geriatrics Lewis B. Smedes Christian Theologian 11 “To forgive is to set a prisoner free and discover that the prisoner was you.” Lewis B. Smedes Christian Theologian 27 March 2024 Volker Intro to Geriatrics 12 In this bright future you can't forget your past. --Bob Marley Father of Reggae Died at age 36 27 March 2024 Volker Intro to Geriatrics 13 Geriatrics Gerontology – The study of aging Geriatrics – The study of health and practice of medicine within gerontology Terminology – – – – Elderly? Elder? Senior? Old(er) person? Older Adult* 27 March 2024 Volker Intro to Geriatrics 14 Older terms, on the way out Geriatric Young old Middle old Old old Centenarian ≥ 65 65-74 75-84 ≥85 ≥100 Associated Press “Anyone can get old. All you have to do is live long enough.” --Groucho Marx Comedian, Actor 27 March 2024 Volker Intro to Geriatrics 15 Why Geriatrics? Patients 65 years and older comprise: – 29% Primary Care visits – 32% Surgery – 44% Emergency Department visits – 43% Specialist consultations – 48% Hospitalizations 27 March 2024 Volker Intro to Geriatrics 16 Life Expectancy at Birth 90 80 70 Age 60 50 40 30 20 In the US, all genders and races, Data from CDC 10 0 1900 1920 1940 1960 1980 2000 2020 Year 27 March 2024 Volker Intro to Geriatrics 17 Really? Time Magazine February 23, 2015 27 March 2024 Volker Intro to Geriatrics 18 A population boom US Census Bureau 27 March 2024 Volker Intro to Geriatrics 19 A population boom US Census Bureau 27 March 2024 Volker Intro to Geriatrics 20 65+ in 2000 27 March 2024 Volker Intro to Geriatrics 21 85+ over thirty years 27 March 2024 Volker Intro to Geriatrics 22 Mortality in the US Heart disease Cancer COPD and other pulmonary disease Stroke Alzheimer’s Disease Diabetes Mellitus Renal disease, injuries, pneumonia 27 March 2024 Volker Intro to Geriatrics 23 Mortality in 2020-2022 in the US Heart disease COVID-19 Cancer COPD and other pulmonary disease Stroke Alzheimer’s Disease Diabetes Mellitus Renal disease, injuries, pneumonia 27 March 2024 Volker Intro to Geriatrics 24 27 March 2024 Volker Intro to Geriatrics 25 27 March 2024 Volker Intro to Geriatrics 26 27 March 2024 Volker Intro to Geriatrics 27 27 March 2024 Volker Intro to Geriatrics 28 What Matters? What does the patient want? What matters most? This question and implementing its answer is at the center of geriatric care 27 March 2024 Volker Intro to Geriatrics 29 Geriatric care is just normal adult care, on older patients Same diseases you are used to treating in younger patients Holistic, biopsychosocial approach (OPP) Assessment and plan are based on proficient history and physical 27 March 2024 Volker Intro to Geriatrics 30 Geriatric care is NOT just normal adult care, on older patients Often multiple chronic diseases present concomitantly Diminished “health literacy” There may be little evidence-based treatment Encounters may be lengthy Typical presenting symptoms are often absent or blunted in the older patient Emphasis is on control and secondary/tertiary prevention, not cure Your patient will end up dying on you 27 March 2024 Volker Intro to Geriatrics 31 Course Objectives To provide basic knowledge about the aging process and the essential skills and attitudes necessary to provide a better standard of health care to the older adult. To promote a philosophy of health care embedded in cultural competency that respects the dignity of the older patient, is sensitive to different cultural and ethnic values, promotes independence and stresses care rather than cure as the most important objectives. 27 March 2024 Volker Intro to Geriatrics 32 Course Objectives, con’t To embody the 4M’s as central in the care of the geriatric patient – – – – Mentation Mobility Medication What Matters To promote the student’s self-awareness of personal attitudes towards the aging process, disability and death that is essential to encourage the student’s own positive aging and delivery of a more effective health care to future older adult patients. 27 March 2024 Volker Intro to Geriatrics 33 Course Objectives, con’t To encourage the student to develop a philosophy of end-oflife care that focuses on quality of life and not the dying process and to accept that the end-of-life period and the dying process itself as intrinsic parts of the life cycle. To provide an overview of the roles of various members of comprehensive geriatric health care team. To provide a social context of the US healthcare system, and an overview of the various resources available to the geriatric health care team, the older adult patient and his or her caretakers. 27 March 2024 Volker Intro to Geriatrics 34 Our patients will all die. We will all die. Death is not our enemy, and a death is not a failure. Dying too soon, dying without dignity is our enemy. Death out of our own control, death in suffering is a failure. Volker Intro to Geriatrics Geriatrics is about caring for those older than us, those who have had the same dreams and loves and desires as us, and who have the same hopes for their future as us, knowing that the future is increasingly finite. Volker Intro to Geriatrics 27 March 2024 Volker Intro to Geriatrics 37 27 March 2024 Volker Intro to Geriatrics 38 Course outline: Core Concepts Demographics Theories of aging Homeostasis, homeostenosis Theories of longevity and cellular and tissue death Chronic disease states; “multimorbidity” Polypharmacy and iatrogenic disease Dependency, frailty, vulnerability, robustness, resilience Home environment Catastrophes Syndromes of the aging patient 27 March 2024 Volker Intro to Geriatrics 39 Course outline, con’t Activities of daily living and IADLs The geriatric assessment Spirituality, legacy, loneliness Dying and palliative care Care coordination/community resources Caregivers Osteopathic and podiatric care Competency, surrogacy, and other legal issues Financial dependency Public health policy and health care financing 27 March 2024 Volker Intro to Geriatrics 40 Mostly, though, this is a course about people Some of your patients will be like them Some topics will be more like basic science Many topics will be more “art of medicine” 27 March 2024 Volker Intro to Geriatrics 41 Life Expectancy at Birth 90 80 70 Age 60 50 40 30 20 In the US, all genders and race, Data from CDC 10 0 1900 1920 1940 1960 1980 2000 2020 Year 27 March 2024 Volker Intro to Geriatrics 42 This is a centurion Romeo models 27 March 2024 Volker Intro to Geriatrics 43 Volker Intro to Geriatrics 27 March 2024 Volker Intro to Geriatrics 45 27 March 2024 Volker Intro to Geriatrics 46 Life is divided into three terms - that which was, which is, and which will be. Let us learn from the past to profit by the present, and from the present, to live better in the future. --William Wordsworth Poet 27 March 2024 Volker Intro to Geriatrics 47 Here’s the thing… Challenges are significant but gratifying Ancestral experience is integral to the human experience, our experience Depth of relationship Why do you want to be a doctor? 27 March 2024 Volker Intro to Geriatrics 48 Resources Fillit, Howard, Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 7th Ed. 2010. Geriatrics Review Syllabus (GRS): A Core Curriculum in Geriatric Medicine, 9th Ed., American Geriatrics Society, 2016. Halter, Jeffrey [et al.], Hazzard’s Geriatric Medicine and Gerontology, 6th Ed., McGraw-Hill, 2009. Ham, Richard J. and Sloane, Philip D., Ham’s Primary Care Geriatrics – A Case-Based Approach, 6th Ed., W.B. Saunders, 2014.* Kane, Robert L., et al. Essentials of Clinical Geriatrics, 7th Ed., McGraw-Hill, 2013. Reuben, David B., et al. Geriatrics at Your Fingertips 2015, 17th Ed., American Geriatrics Society, 2015. Williams, B., et. al., Lange series, Current Geriatric Diagnosis & Treatment, 2nd Ed., McGraw-Hill, 2014. 27 March 2024 Volker Intro to Geriatrics 49 Volker Intro to Geriatrics