2.  To discuss three of the most common causes of death in the elderly population  To describe heart attacks, strokes, and falls and how they occur  To demonstrate what surgical interventions are available to treat heart attacks, strokes, and falls

3.  Heart Disease  Cancer  Stroke  COPD  Flu/ Influenza  Diabetes  Injuries

4.  Heart Attacks  Strokes  Falls

6.  Heart disease and cancer › Leading causes of death for >65 for 2 decades  35% of all deaths are due to heart disease, including heart attacks and chronic ischemic heart disease

7.  Damage and death of heart muscle from the sudden blockage of a coronary artery by a blood clot  Sudden blockage= blood and oxygen deprivation-> injury to the heart muscle= chest pain and chest pressure

8.  Coronary arteries provide heart with blood  Blood= oxygen and nutrients  CAD= Coronary Artery Disease › Fatty matter, calcium, proteins, inflammatory cells= plaque › Plaque is hard on the outside, mushy on the inside  When the plaque is hard, outer shell cracks= plaque rupture -> platelets form around rupture = blood clot **Total or near-total occlusion by blood clot = heart attack

10.  Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone  Discomfort radiating to the back, jaw, throat, or arm  Fullness, indigestion, or choking feeling  Sweating, nausea/ vomiting, or dizziness  Weakness, anxiety, or shortness of breath  Rapid or irregular heartbeat *No symptoms= silent heart attack

11.  Why is time important in treatment of heart attacks? › 20-40 minute window  Lack of blood flow restoration= irreversible death of the heart muscle begins › Muscle continues to die for 6-8 hours, or until the heart attack usually is "complete.“

12.  Amount of damage depends on size of area supplied by the blocked artery and time between injury and treatment  Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. › Scar tissue will form in the damaged area › Scar tissue does not contract= the heart's pumping ability is lessened after a heart attack

13.  Medications › Aspirin  Prevent additional clotting  Heart Codes › Cardiac Catheterizations  Angioplasty and stenting › Surgical intervention  Coronary Artery Bypass Grafting (CABG)  Depending upon blockage location and severity

14.  CABG is one treatment for CAD › A healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. › The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. › This creates a new path for oxygen-rich blood to flow to the heart muscle.  Surgeons can bypass multiple coronary arteries during one surgery.

15. CABG Surgery

16.  Results are usually excellent  Improves or completely relieves angina symptoms  Most people remain symptom-free for as long as 10 - 15 years  May lower your risk of having a heart attack and help you live longer  You may need repeat surgery if blockages form in the grafted arteries or veins or in arteries that weren't blocked before.

17.  Treatments do not cure CAD  It CAN happen again › Take medicines  Reduce blood pressure  Relieve work of heart  Prevent blood clots  Lower cholesterol › Make lifestyle changes  Dietary changes  Exercise  Quit smoking

19.  The third leading cause of death in America is stroke  Strokes are debilitating and lethal  Stroke kills almost 130,000 Americans each year—that’s 1 out of every 19 deaths.  On average, one American dies from stroke every 4 minutes.  Every year, more than 795,000 people in the United States have a stroke.

20.  A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food.  Within minutes, brain cells begin to die.  Strokes are treatable and preventable

21.  Sudden severe headache  Weakness  Numbness  Vision problems  Confusion  Trouble walking  Difficulty talking  Dizziness  Slurred speech

22.  When blood supply to the brain is interrupted or reduced-> oxygen and nutrient deprivation= brain cell death  Two types › Ischemic stroke -> blocked artery › Hemorrhagic stroke -> leaking or burst blood vessel

23.  85% of strokes are ischemic › Occur when one or both carotid arteries (supplying the brain with blood) become narrowed or blocked= severely reduced blood flow (ischemia)  Thrombotic stroke › A blood clot (thrombus) forms and blocks vessel › Blood clot= fatty deposits (plaque)  Embolic stroke › A blood clot or other debris is swept through your bloodstream to lodge in narrower brain arteries  This type of blood clot is called an embolus.

25.  A stroke is a MEDICAL EMERGENCY  Prompt treatment is crucial to survival  Early action can minimize brain damage and potential complications

26.  To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.  Medications › TPA- Clot buster  W ithin 4.5 hours › Aspirin  Reduce additional clotting  Emergency procedures › Catheter- administered TPA  Directly into the area where the stroke is occurring › Mechanical clot removal= = thrombectomy › Angioplasty and stenting the carotid artery › Carotid endarterectomy

27.  Surgical removal of plaque from arteries that run along each side of your neck to your brain (carotid arteries)  May be done for someone that had a stroke, or someone at high risk for stroke › Determined by vascular ultrasound  Steps include: › Incision along side of neck › Opens up carotid artery › Blood may be rerouted temporarily through a shunt › Scrape out plaque › Stitch or patch artery shut › Close incision

29.  CEA can be done several months after a stroke or TIA  Most benefit from the surgery within 2 weeks of the stroke or TIA  > 2 week surgery delay increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.

30.  Symptomatic patients with blockages of 70% or more benefit greatly  Less than 50% narrowing of the carotid do not seem to benefit from surgery  CEA works better than treatment with medicine alone in preventing stroke › (For people who have symptoms that can be attributed to a 70% to 99% blockage of the carotid arteries)

31.  Medications › Aspirin › Anti-platelet (prevent clots) › Cholesterol lowering  Exercise  Diet › Low fat, low cholesterol  Quit Smoking

33.  Falls are one of the top causes of death among people 65 years of age and older  One in three older adults falls every year › Less than half report it  Falls are the leading cause of both fatal and nonfatal injuries in older adults  In 2010, the direct medical costs of falls was $30 billion

34.  A fall can change your life  Falls lead to: › Disability › Loss of independence › Breaking bones and hips  Falls seldom “just happen’ › Preventing falls is important  Regular eye exams  Eliminating tripping hazards  Wearing non-skid shoes  Using assistive deices

35.  Each year, more than 1.6 million older U.S. adults go to emergency departments for fall- related injuries.  Falls are the number one cause of fractures in older adults  Fall- related Fracture injuries: › Hip › Pelvis › Spine › Arm › Hand › Ankle

36.  One of the most serious types of fall injuries  Leading cause of injury and loss of independence among older adults  Healthy, independent older adults may be able to return home or live on their own after treatment and rehab  Long term care is always necessary

37.  A hip fracture is a break in the upper quarter of the femur (thigh) bone  The extent of the break depends on the forces that are involved  Type of surgery required › Bones and soft tissues involved › Level of fracture

38.  Most commonly from a fall or from a direct blow to the side of the hip  Some medical conditions increase susceptibility › Osteoporosis › Cancer › Stress injuries  In severe cases, standing on a leg and twisting

39.  Type of surgery depends on location, severity, and age › Repair with hardware  Metal screws into bone to hold it together until healed  Screws to metal plates along bone  Rods down center of bone through marrow (aka nails) › Replace femur  Partial hip replacement  If ends aren’t properly aligned, head and neck of femur removed and replaced › Replace hip joint  Total hip replacement  Replace upper femur and socket in pelvis **If blood supply to ball joint is damaged, bone healing compromised-> hip replacement necessary

42.  Take medications › Pain › Clot prevention  Rehabilitation › Programs available  Lifestyle adjustment › Long-term care and rehab › Assistive devices  Future fall prevention

43.  Preventing falls is key to older adults › Exercise regularly  Leg strength increases, balance improves › Review medications  Dizziness side effect › Regular eye exams  Maximizes vision during age-related changes › Lower hip fracture risk  Enhance calcium and vitamin D intake  Weight bearing exercises  Screening and treatment for osteoporosis

44.  http://www.cdc.gov/nchs/data/ahcd/agin gtrends/01death.pdf http://www.cdc.gov/nchs/data/ahcd/agin gtrends/01death.pdf  www.webmd.com www.webmd.com  www.medicinenet.com www.medicinenet.com  https://www.nhlbi.nih.gov/health/health- topics https://www.nhlbi.nih.gov/health/health- topics  www.mayoclinic.com www.mayoclinic.com  www.stoke.org www.stoke.org  http://www.nlm.nih.gov/medlineplus http://www.nlm.nih.gov/medlineplus  http://nihseniorhealth.gov http://nihseniorhealth.gov