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Internal Medicine and General Surgery II

Internal Medicine and General Surgery II. GERIATRIC ASSESSMENT. Population growing old. USA. Developing countries. What is aging?. Lost of functional reserve Frailty. LONGEVITY: complex process

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Internal Medicine and General Surgery II

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  1. Internal Medicine and General Surgery II GERIATRIC ASSESSMENT

  2. Population growing old

  3. USA

  4. Developing countries

  5. What is aging? • Lost of functional reserve • Frailty LONGEVITY: complex process 1)Endogenous capability to react to ROS, under-regulation of GH and IGF1 pathways, telomere length (numeber of mitosis), many genes involved: IGF1 receptor (FIRKO) Pregnancy associated plasma protein PAPP-A GH GHRH, GHR-KO MCAT, mitochondria-specific catalase transegenic uPA, urokinase-type plasminogen activator Telomerase expression (CANCER!!) …….

  6. What is aging? 2) Exogenous stressors: -smoke!!! -polluting agents -carcinogenic agents -life-style/nutrition

  7. New Challanges • More chronic diseases to treat • Different medical conditions • Different use of economic resources to improve the quality of chronic treatment • Develop of facilities and prothesis • Education in medical school THE AIM OF GERIATRIC MEDICINE IS OFTEN THE STABILIZATION AND THE SLOWDOWN OF A CHRONIC DISEASE. TO TAKE CARE NOT NECESSARILY TO CURE

  8. New frontiers • Phamacogenetics: is the study of inherited genetic differences in drug metabolic pathways which can affect individual responses to drugs, both in terms of therapeutic effect as well as adverse effects • Nutrigenomics: is a branch of nutritional genomics and is the study of the effects of foods and food constituents on gene expression.This means that nutrigenomics is research focusing on identifying and understanding molecular-level interaction between nutrients and other dietary bioactives with the genome. 

  9. Not a mere clinical evaluation

  10. Components of GeriatricAssessment Search for specific conditions Considerable impact on function medical history physical examination

  11. Purposes • Management of clinical conditions • Legal/insurance problem

  12. Visual impairment Common but under-reportedproblem Major eyediseases in elderly: • Cataract • Age related macular degeneration • Diabeticretinopathy • gluacoma PRESBYOPIA

  13. Visual impairment High risk of: -Fall -Functional and cognitive decline -Immobility -Depression

  14. Visual impairment Sellen Eye Chart National Eye Institute Visual Functioning Questionnaire - 25 (VFQ-25)

  15. Hearing Impairment One third of over 65 complains hearing problems Reduced cognitive, emotional, social and physical functions

  16. Hearing Impairment

  17. Malnutrition Weight loss Weight gain Lorenz Formula The Lorenz formula was launched in 1929 and has two versions. One fore males and the other for females. You need to know your height and weight before you apply it. Here is the equation: Female: W(kg)= H(cm) – 100 -[H(cm) – 150]/2Male: W(kg)= H(cm) – 100 -[H(cm) – 150]/4

  18. MRI evaluation 73 years old Female (BMI = 24.5 kg/m2) 21 yearsoldFemale (BMI = 24.3 kg/m2)

  19. Malnutrition • Proteinenergyundernutrition: clinical(wasting, low body mass index) and biomedical (albumin or otherprotein) evidence of insufficientintake; • Serumalbuminand low cholesterolare prognosticfactors for mortality in community-dwelling, hospitalized and institutionalizedelderly

  20. Malnutrition Mini Nutritional Assessment

  21. Balance and GaitImpairments and Falling • Falls are indipendently associated with functional and mobility decline. • Elderly evaluation: • Number of falls in the last year • Multifactorial falls assessment • Testing balance, gait, lower extremity strength

  22. Balance and Gait

  23. Balance and Gait • Up and go test • Stability during 360-degree turn • Maintein a side-byside, semitandem, full-tandem stance for 10 seconds • Resistence to a nudge • Asking arising from a hard armless chair without the use of hands

  24. Polipharmacy Multiple providerspolipharmacy • Frequentadversedrugsriactions • Reducedadherence • Inappropriate medicationusage

  25. Cognitive assessment • Mini mental state examination (MMSE)

  26. Cognitive assessment Clock drawing test

  27. Affective Assessment

  28. Assessment of function • Measurement of functional status fundamental in geriatric medicine • Summary of measure of the overall impact health conditions in the context of patient’s environment and social support system.

  29. Assessment of function Three levels: • BasicActivitiesofDaily Living (BADLs) • Instrumental or Intermediate ActivitiesofDaily Living (IADLs) • AdvancedActivityofDaily Living (AADLs).

  30. Assessment of function

  31. Assessment of function

  32. (Advance)AADL • Using internet, everyday technology, household devices, and sophisticated kitchen activities beyond preparing daily meals, etc • Fulfill societal, community and family roles • Participate in ricreational or occupational task Administrable in 10-15 years

  33. Other test… Barthel Index

  34. Providing AID ASSESSMENT OF SOCIAL SUPPORT: -Loneliness/social net -Isolation -No more driving licence ECONOMIC ASSESSMENT: -retirement -disability pension -special needs ENVIRONMENTAL ASSESSMENT: -home architectural barrier (stairs, carpets, etc) -home lightning; -isolated house.

  35. SPIRITUALITY Aging and spirituality: Factorial structure and reliability of 2 scales INTRODUCTION: In the field of gerontology, the study of the improvement of health and quality of life, and «successfully aging», spirituality plays a key role and, is one of the current research approaches. However, its incorporation into scientific literature is arduous and slow, a fact that is in part due to the absence of developed and validated measurement tools, particularly, in the Spanish speaking area. This work aims to present evidence of the psychometric properties of two tools for the measurement of spirituality: the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being (FACIT-Sp) and the GES Questionnaire. MATERIALS AND METHODS: A sample of 224 elderly persons from Valencia (Spain) was recruited, on which two confirmatory factor analyses were estimated, with the proposed a priori structures for each tool, together with several reliability coefficients. RESULTS: Both models presented an good fit to the data: χ(2)51=104.97 (P<.01); CFI=.973; RMSEA=.076 for the FACIT-Sp, and χ(2)17=31.76 (P>.05); CFI=.996; RMSEA=.050 for the GES Questionnaire. Reliability indices also supported the use of the scales in elderly population, with alphas of .85 and .86, respectively. CONCLUSIONS: These results may be useful as a starting point to include spirituality in works that aim to discover the mechanisms involved in successful aging. RevEspGeriatrGerontol. 2016 Sep-Oct;51(5):265-9. doi: 10.1016/j.regg.2015.12.006. Epub 2016 Apr 8.

  36. Geriatric Assessment OLISTIC MEDICINE DISCUSSION IN TEAM PLANNING INTERVENTION

  37. Aging? “productively and profitably by purchasing an inner peace that consists of an intuitive system of continuous adjustment to the exigencies of daily living” Hernst Hemingway

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