1. Kathy Sykes Senior Advisor, US EPA Aging Initiative October 31, 2007 Improving Patient Safety Through Informed Medication Prescribing and Disposal Practices

2. Why Should Aging and the Environment Be a Research Priority?  The Demographic Imperative By 2030, the 65+ population will double to 70 million The population 85+ is the frailest and most rapidly increasing cohort  4 million today; 19 million by 2050 These increases are projected to be long-lasting features of American demographics

3. Why Focus on Older Adults?  Demographics  Decrease in organ function & reserves  Impaired chemical clearance and detoxification  Vulnerable to medication-environment adverse interactions (example - heat/psychotropic drugs)  Legacy of past occupational and environmental cumulative exposures to persistent agents.

4. Interactions with Environmental Agents: Concern about Polypharmacy The body uses the same biological processes to “clear” medications as it does environmental toxicants. Older persons take multiple medications. Could be at increased risk of adverse reactions due to unknown interactions between medications and concurrent environmental exposures.

5. Indicator 30 - Prescription Drugs

6. Indicator 27 - Air Quality

8. The public health concern WHO estimates 4% of all deaths and 5% of health loss to disability is caused by diarrhea. It is most commonly caused by gastrointestinal infections which kill around 2.2 million people globally. Contaminated water is an important cause of diarrhea.

9. Burden of Gastrointestinal Illness in the United States  CDC estimates 211 million episodes of acute gastrointestinal (GI) illness occur each year in the US resulting in over 900,000 hospitalizations and 6,000 deaths.  Many of these cases may be of infectious origin due to food or waterborne transmission—teasing apart this difference is a key reason for doing trials. Source: Mead 1999

10. Older adults at increased risk for GI illness  Decline in immunity, changes in GI functions, and dehydration associated with aging lead to an increased susceptibility of enteric infections  Older adults may be at increased risk for infectious GI illness, severe diarrhea, or dying from diarrheal illness (Peterson 2003, Mounts 1999, Gerba 1996, Lew 1991)  Older adults are recognized by the USEPA as a sensitive subpopulation for waterborne diseases (USEPA 2000)

11. Burden of Waterborne Disease  Studies by Payment found that 1/3 of GI illness cases are related to drinking water, suggesting that up to 70 million cases of GI illness may be caused by waterborne pathogens. Source: Payment 1991 & 1997

12. Gastroenteritis Costs In the US, i nfectious gastroenteritis costs are estimated to exceed $20 billion annually.  Source: Peterson 2003

13. Bacterial and Viral Enteric Diseases as Contributing Causes of Death by Age, 1989 - 1996 Viral ’89-90 ’91-’92 ’93-’94 ’95-’96 Bacteria ’89-90 ’91-’92 ’93-’94 ’95-’96

14. GI Hospitalizations  Older adults are at the highest risk of dying during an gastroenteritis- related hospitalization, even when compared to infants 65-74: 14.4 deaths/1000 discharges; 75+: 24.9 deaths/ 1000 discharges) Source: Mounts 1999

15. GI Hospitalizations 65+ Population Persons over 65+ years of age account for over 75% of hospitalizations due to gastroenteritis Source: Mounts 1999

16. Deaths Due to Enteric Disease Highest rates of death related to enteric disease: 75+ years Deaths related to bacterial enteric disease in older adults are increasing at a greater rate than in any other age category Source: Peterson 2003

17. Major GI Pathogens Morbidity Parasites- Cryptosporidium, Cyclospora, Giardia, Microsporidia Morbidity and Mortality Bacteria - Salmonella, Pseudomonas, Clostridium difficile, Campylobacter, Mycobacterium avium complex, E.Coli Viruses- Norwalk and Norwalk-like viruses, enteroviruses, rotavirus, adenovirus Cryptosporidium spores

18. Susceptible populations include those with: A dvanced age Immune suppression due to disease Immune suppression due to taking pharmaceuticals Intervention: Identify & Educate People at Risk

19. Building Healthy Communities for Active Aging

20.  Can improve air & water quality in the community and improve the health of older adults and all citizens through intentional community design and systematic programming for active aging.  Change Behavior at the Community Level

21. Aging Initiative Fact Sheets and Posters  Age Healthier, Breathe Easier Fact sheet and poster  Effective Control of Household Pests  It’s Too Darn Hot--Planning for Excessive Heat Events  Environmental Hazards Weigh Heavy on the Heart  Water Works  Diabetes and Environmental Hazards Spanish, Portuguese, Chinese, Korean, Vietnamese, Russian, Japanese, Italian, French and Arabic and Haitian Creole  Low Vision Large font  Purple Series: for persons with limited reading ability

22. Aging Initiative List Serve Join EPA’s Aging Initiative monthly list serve www.epa.gov/aging