General principles of diagnosis and treatment of internal diseases in elderly patients.

Preventive medicine refers to measures taken to prevent illness or injury, rather than curing them. Primary prevention avoids the development of a disease. Secondary prevention activities are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease and emergence of symptoms. Tertiary prevention reduces the negative impact of an already established disease by restoring function and reducing disease-related complications.

Preventive Medicine focuses on disease prevention and health promotion through identifying and reducing risk factors for development or transmission of disease. Prevention Primary – prevent initial development of disease Secondary – detect early existing disease Tertiary – reduce complications of existing disease

The most wide-spread diseases

Atherosclerosis

Leading causes of preventable deaths in the United States in the year 2000 Smoking: 435,000 deaths or 18.1% of the total deaths Smoking: 435,000 deaths or 18.1% of the total deathsSmoking Overweight and Obesity: 365,000 deaths or 15.2% of the total deaths Overweight and Obesity: 365,000 deaths or 15.2% of the total deathsOverweightObesityOverweightObesity Alcohol consumption: 85,000 deaths or 3.5% of the total deaths Alcohol consumption: 85,000 deaths or 3.5% of the total deathsAlcohol consumptionAlcohol consumption Infections: 75,000 deaths or 3.1% of the total deaths Infections: 75,000 deaths or 3.1% of the total deathsInfections Toxic agents: 55,000 deaths or 2.3% of the total deaths Toxic agents: 55,000 deaths or 2.3% of the total deathsToxic agentsToxic agents Motor vehicle collisions: 43,000 deaths or 1.8% of the total deaths Motor vehicle collisions: 43,000 deaths or 1.8% of the total deathsMotor vehicle collisionsMotor vehicle collisions Incidents involving firearms: 29,000 deaths or 1.2% of the total Incidents involving firearms: 29,000 deaths or 1.2% of the totalIncidents involving firearmsIncidents involving firearms Sexually transmitted infections: 20,000 deaths or 0.8% of the total Sexually transmitted infections: 20,000 deaths or 0.8% of the totalSexually transmitted infectionsSexually transmitted infections Illicit use of drugs: 17,000 deaths or 0.7% of the total deaths. Illicit use of drugs: 17,000 deaths or 0.7% of the total deaths.Illicit use of drugsIllicit use of drugs

Age Management Medicine is in a unique position to embrace and support appropriate Preventive Medicine practices and protocols which promote and maintain health and well-being and prevent disease, disability and premature death. It is focused on lifestyle issues, physiological and biomedical conditions and diseases of aging. is in a unique position to embrace and support appropriate Preventive Medicine practices and protocols which promote and maintain health and well-being and prevent disease, disability and premature death. It is focused on lifestyle issues, physiological and biomedical conditions and diseases of aging.

Theories of Health and Disease: 1.Humoral Theory 2.Demonic Theory 3.Religious Theory 4.Magnetic Theory 5.Miasmatic Theory 6.Germ Theory 7.Christian Science Theory 8.Psychosomatic Theory 9.Stress Theory 10.Ecologic Theory

Life span refers to a theoretical limit on how long an organism might live under ideal circumstances. For humans, generally assumed to be 115 to 120 years. This figure has not changed for centuries. refers to a theoretical limit on how long an organism might live under ideal circumstances. For humans, generally assumed to be 115 to 120 years. This figure has not changed for centuries.

Compression of morbidity suggests the ideal aging process would keep disease and disability at a minimum until toward the end of life, after which one would die quickly. suggests the ideal aging process would keep disease and disability at a minimum until toward the end of life, after which one would die quickly.

Theories of Aging: Three general categories of internal or external changes that contribute to the aging process: Secular changes – the result of natural wear and tear Senescent changes – due to aging of tissues & organs, especially those with low mitotic rate Pathological changes – resulting from disease processes

Theories of Aging: Heavy Labor Theory Overcrowded Conditions Theory Wear and Tear Theory Separation Theory Hypoxia Theory Enriched Environment Theory Functional Theory Enzyme Theory Nutritional Theory Free Radical Theory Activity Theory Fixed Life Span Theory Metabolic Theory Stress Theory Autoimmune Theory Mutation / Radiation Theory

Factors that Influence Longevity: HeredityGender Race and ethnicity SmokingDisease Body weight and height Physical activity Alcohol use Marital status Psychological factors Social class Cultural factors Physical environment

Circulatory Conditions –Coronary Heart Disease Coronary Heart DiseaseCoronary Heart Disease –Stroke Stroke

Respiratory Diseases Cancer

Neurological and cognitive conditions –Dementia Dementia –Alzheimer’s Disease Alzheimer’s DiseaseAlzheimer’s Disease –Dementia with Lewy Bodies Dementia with Lewy BodiesDementia with Lewy Bodies –Parkinson’s Disease Parkinson’s DiseaseParkinson’s Disease

Sight and Hearing Degradation –Long-sightedness Long-sightedness –Glaucoma Glaucoma –Deafness Deafness

Muscular Skeletal Degradation –Osteoporosis Osteoporosis –Osteoarthritis Osteoarthritis – –Rheumatoid arthritis

Major Geriatric Concerns Weakness and falls, fractures Delirium Urinary incontinence Sleep disturbances Serious depression Comorbidities

Geriatrics as the Model for Chronic Disease Chronic disease is the major issue in health care Current organization of health care is Inappropriate Geriatrics = Chronic Care + Gerontology

Core of Geriatrics Age-specific syndromes Atypical disease presentation Management – Multiple, simultaneous, interactive problems Medical coordination

Chronic Disease Epidemiology Preventing a chronic disease will increase the absolute number of people with chronic diseases (Boult, 1996) Competitive risk Prevalence of chronic disease increases with age Age-related and aging-associated diseases

Goals of Chronic Disease Care 1. Manage the disease as well as possible to reduce the extent and frequency of exacerbations. 2. Minimize the transition from impairment to disability, and from disability to handicap. 3. Encourage patient to play an active role in managing his/her disease but avoid allowing the disease to become the dominant force in the person’s life.

More Goals 4. Provide care in a culturally sensitive manner. 5. Integrate medical care with other aspects of life without medicalizing those aspects

Components of Chronic Disease Care Patient experience of Care Care delivery teams Organizations within which delivery teams and patients interact Regulatory and payment environment

Models of Chronic Disease Care Primary care with specialty referrals Primary care from specialists Organ systems care by specialists Primary care by GNPs