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The Librarian as Gerontologist

This presentation by Dr. Rosanne M. Leipzig discusses the growing aging population in the U.S. and the essential competencies required for medical professionals to care for older adults. Focusing on demographics, health status, and living arrangements of those over 65, the talk highlights how aging impacts health and well-being. It also outlines geriatric education and the unique presentations of diseases in elderly patients, including medication management and common health issues. This resource is vital for anyone looking to improve their understanding of geriatric care.

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The Librarian as Gerontologist

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  1. The Librarian as Gerontologist Rosanne M Leipzig MD PhD Professor and Vice Chair Departments of Geriatrics and Medicine Mount Sinai School of Medicine

  2. Aging: The Numbers

  3. There were 3 million Americans over age 65 in 1900 • What’s the estimated number for 2030? A. 10 million B. 30 million C. 50 million D. 70 million ***

  4. Medical Librarians Are Also Aging Medical Library Association. Hay Group/MLA 2005 salary survey [Web document]. 2005 [cited 10/12/2007].

  5. Projected Population Distribution

  6. What percent of those 65+ are high school graduates? A. 10% B. 30% C. 50% D. 70% ***

  7. Education level of older population

  8. Percentage of all persons over 65 living in nursing homes? A. 5% B. 10% C. 15% D. 20% ***

  9. Nursing Home Population By Age: 2000 %

  10. Percentage of all persons over 65 living with their spouses? A. 20% B. 35% C. 50% D. 65% ***

  11. Living Arrangements of Persons 65+

  12. Social Activities

  13. Leisure-time Physical Activity 65+2004-5 % engaged in REGULAR ACTIVITY CDC http://209.217.72.34/aging/TableViewer/tableView.aspx?ReportId=383

  14. Reporting Good to Excellent Health

  15. Disability in Aging: The Good News in the U.S. • age 65-74: 89% report no disabilities • age 85+: 40% report no disabilities • In 1999, there were 1.4 million fewer disabled persons than there would have been if health status had not improved since 1982.

  16. The Librarian As Gerontologist:What Do You Need To Know • How does aging affect one’s health and well-being? • What might physicians and other health care professionals be asking you about aging? • What might the public be asking about aging?

  17. AAMC/John A. Hartford Foundation Consensus Conference on Geriatric Competencies: July, 2007 • Rationale: • Almost every graduate of every medical school will be providing care to older adults • Faculty who received little exposure and training in the care for the elderly are uncomfortable teaching geriatrics to students- don’t know where to start • Lists of geriatric curriculum topics exist, but are extensive and imprecise

  18. AAMC/John A. Hartford Foundation Consensus Conference on Geriatric Competencies: July, 2007 • Goal: Consensus on minimum standards for graduating medical students • Input provided by many non-geriatric educators • Results • 8 content domains identified • 26 minimum geriatric competencies identified within these domains

  19. Competency Domains • Atypical Presentation of Disease • Medication Management • Cognitive and Behavioral Disorders • Falls, Balance, Gait Disorders • Self-Care Capacity • Health Care Planning and Promotion • Palliative Care • Hospital Care for Elders

  20. Atypical Presentation of Disease

  21. Acute MI: 30 Day Mortality Adjusted ORs % 2.00 1.69 1.49 1.21 Ref Adapted from Mehta RH et al. J Am Coll Cardiol 2001;38:736-41

  22. Presentation of MI:Chest Pain 80 70 60 50 40 30 20 10 0 <70 70-74 75-79 80-84 >85 Adapted from Bayer et al JAGS 1986;34:263-266

  23. Painless MI in Patients>70 yrs: Presenting Symptoms Dyspnea Syncope Stroke Confusion Weakness Giddiness Vomiting Sweating Palpitations Bayer et al. JAGS 1986;34:263-266

  24. Atypical Presentation of Disease • Generate a differential diagnosis based on recognition of the unique presentations of common conditions in older adults, including • Acute coronary syndrome • Dehydration • Urinary tract infection • Acute abdomen • Pneumonia.

  25. Compensatory Response to Orthostatic Hypotension 1. Compensate for hypovolemia: • Thirst response • ADH secretion • Increase urine concentration 2. Increase heart rate

  26. Compensatory Response to Orthostatic Hypotension in Elders 1. Compensate for hypovolemia: • Thirst response • ADH secretion • Increase urine concentration 2. Increase heart rate

  27. Atypical Presentation of Disease • Identify at least 3 physiologic changes of aging for each organ system and their impact on the patient, including their contribution to homeostenosis (the age-related narrowing of homeostatic reserve mechanisms).

  28. Medication Management

  29. Medication Management:Drugs to Watch Out For • Identify medications, including • Anticholinergic • Psychoactive • Anticoagulant • Analgesic • Hypoglycemic • Cardiovascular drugs that should be avoided or used with caution in older adults and explain the potential problems associated with each.

  30. Medication Management • Explain impact of age-related changes on drug selection and dose based on knowledge of age-related changes in: • renal and hepatic function • body composition, • and Central Nervous System sensitivity.

  31. Why you become a cheaper drunk as you age • As you get older, • Higher blood alcohol concentrations • Worse for women than men • Less tolerance for quantities previously enjoyed • Brain more sensitive • Balance worse even without the alcohol

  32. Common Diseases 65+2004-5 % CDC http://209.217.72.34/aging/TableViewer/tableView.aspx

  33. Medication Management • Document a patient’s complete medication list, including: • prescribed, • herbal and • over-the-counter medications, and for each medication provide the dose, frequency, indication, benefit, side effects, and an assessment of adherence.

  34. Anti-Aging Medicine

  35. Growth Hormone Levels Decline with Age

  36. Growth Hormone • Review of 18 studies (31 publications) • 220 participants; Mean age 69 • Positive Results • Fat Mass decreased 2.1 kg • Lean Mass increased 2.1 kg • No change: cholesterol, BMD, other lipids Liu H et al. Annals Int Med 2007; 146:104-115

  37. Growth Hormone: Down Side • Increased • Soft tissue swelling • Joint pain • Carpal tunnel syndrome • Breast swelling • New onset diabetes • Impaired fasting glucose Liu H et al. Annals Int Med 2007; 146:104-115

  38. Cognitive and Behavioral Disorders

  39. Severe Memory Impairment

  40. Severe Depressive Symptoms

  41. Cognitive and Behavioral Disorders • Define and distinguish among the clinical presentations of delirium, dementia, and depression • Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function . • Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits cognitive impairment. • .

  42. Cognitive and Behavioral Disorders • Urgently initiate a diagnostic work-up to determine the root cause (etiology) of delirium in an older patient. • Develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients.

  43. Falls, Balance, Gait Disorders

  44. I Fall To Pieces $200% of healthy elders in the community that fall annually • 5% • 15% • 30% • 45% ***

  45. Falls, Balance, Gait Disorders • Ask all patients > 65 y.o., or their caregivers, about falls in the last year, watch the patient rise from a chair and walk (or transfer), then record and interpret the findings.

  46. Significant Risk Factors for Falls in Elders • Medications • Cognitive impairment • Lower extremity disabilities • Balance and gait abnormalities • Poor vision and/or hearing • Medical Disorders • Previous Falls • Level of activity • Upper extremity weakness

  47. Multiple Falls vs. Number of Risk Factors Percent with Two or More Falls in One Year Number of Risk Factors* * White, previous falls, arthritis, parkinsonism, difficulty rising, poor tandem gait. Nevitt JAMA, 1989. (n=325)

  48. Falls, Balance, Gait Disorders • In a patient who has fallen, construct a differential diagnosis and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment.

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