Let’s Play

1. Let’s Play Geriatric Jeopardy Brought to you by The UCLA School of Medicine Division of Geriatrics

3. TODAY'S CATEGORIES Physiology Pharmacology Nursing Homes Famous Seniors Longevity & Survival

4. Physiology Pharmacology Nursing Homes Famous Seniors Longevity & Survival Geriatric Jeopardy $200 $200 $200 $200 $200 $400 $400 $400 $400 $400 $600 $600 $600 $600 $600 $800 $800 $800 $800 $800 $1000 $1000 $1000 $1000 $1000

6. Physiology - $200 The effect of agingon renal function

7. Physiology - $200 The effect of aging on renal function Decreased • Renal function decreases with aging. • Glomerular filtration rate decreases about 1% per year after age 30. • Urine concentrating ability also decreases

8. Physiology - $400 The effect of agingon resting heart rate

9. Physiology - $400 The effect of aging on resting heart rate Decreased • Normal aging results in: • decreased resting heart rate • decreased maximum predicted heart rate with exercise • decreased VO2 Max and maximum CO with exercise • Cardiac output remains normal at rest largely related to increased stroke volume

10. Physiology - $600 This physiologic effect is the result of eating a large meal and is associated with drowsiness and unsteady balance.

11. Physiology - $600 This physiologic effect is the result of eating a large meal and is associated with drowsiness and unsteady balance Post-prandial Hypotension • Post-prandial hypotension (orthostatic hypotension) often follows a large meal, presumably as a result of shift in blood flow from the periphery to the mesenteric bed and can be an important cause of falls a6a

12. Physiology - $800 The effect of aging on gastric acid secretion

13. Physiology - $800 The effect of aging on gastric acid secretion None • Until recently it was widely thought that gastric secretion diminished as a result of normal aging processes. Recent studies, excluding those with atrophic gastritis, smoking and H.pilori have shown no change in acid secretion with aging.

14. Physiology - $1000 The effect of aging on collagen

15. Physiology - $1000 The effect of aging on collagen Increased Crosslinking • Aging results in abnormal collagen and elastin metabolism. The result is increased collagen crosslinking which may explain decreased tensile strength, fragility, tissue strains and tears. • Elastin also undergoes increased cross linking and results in decreased elastic recoil in skin and other tissues. a10a

16. Pharmacology - $200 Term for multiple drug use in elderly people associated with increased risk for adverse drug reactions

17. Pharmacology - $200 The term for multiple drug use in elderly people associated with increased risk of adverse drug reactions Polypharmacy • The risk of adverse drug events in elderly people rises with number of medications. ADR’s occur in 4% of those taking 5 drugs; 10% in those taking 6-10 drugs; 28% in those taking 11-15 drugs and 54% in those taking 16 or more drugs.

18. Pharmacology - $400 This single drug can be effective for both incontinence and hypertension in elderly men

19. Pharmacology - $400 This single drug can be effective for both incontinence and hypertension in elderly men doxazocin (Cardura), prazocin (Minipress), terazocin (Hytrin) • Alpha adrenergic blockers are known to decrease the effect of BPH and bladder outlet obstruction as well as decrease blood pressure.

20. Pharmacology - $600 Drug commonly used to treat congestive heart failure in therapeutic doses can cause anorexia, delirium and depression

21. Pharmacology - $600 Drug commonly used to treat congestive heart failure in therapeutic doses can cause anorexia, delirium and depression Digoxin • Digoxin even with normal therapeutic drug levels can cause anorexia, delirium and depression in elderly people.

22. Pharmacology - $800 The effect of aging on adipose tissue

23. Pharmacology - $800 The effect of aging on adipose tissue Increased • Aging is associated with an increase in fat/lean body weight ration. Muscle mass tends to decrease and fat tends to increase. This effect can have a significant effect on drug distribution and elimination. b8a

24. Pharmacology - $1000 The MS Contin doseequivalent toMS elixir 30mg q6h

25. Pharmacology - $1000 The MS Contin doseequivalent toMS elixir 30mg q6h MS Contin 60mg q12h • The conversion from MS elixir to MS Contin is 1:1 • The 24 hr dose of MS elixir is 120mg • The equivalent dose of MS Contin is 120mg or 60mg q12h

26. Nursing Homes - $200 The majority of elderly people live innursing homes True or False

27. Nursing Homes - $200 The majority of elderly people live in nursing homes False • Less than 5% of all elderly people live in nursing homes. • About 20% of those over age 85 reside in nursing homes • The lifetime chance of spending some time in a nursing home is abut 20%

28. Nursing Homes - $400 Term for this skin lesion that has become an important indicator of quality of care

29. Nursing Homes - $400 Term for this skin lesion that has become an important indicator of quality of care Pressure Sore(Bed Sore, Decubitus Ulcer or Pressure Ulcer) • Pressure sores are caused by unrelieved pressure or shear • They are considered predictable and preventable • Nursing homes can be liable for their development

30. The source of reimbursement for care of most nursing home residents Nursing Homes - $600

31. Medicaid (Medical) Nursing Homes - $600 The source of reimbursement for care for most nursing home residents • Only about 5% of care in nursing homes is reimbursed by Medicare. • About 50% of nursing home residents are paid by Medicaid (Medical) • About 45% are paid out of pocket

32. Nursing Homes - $800 The number of nursing home residents that have dementia

33. 50% Nursing Homes - $800 The number of nursing home residents that have dementia • Dementia and psychological problems are common in the nursing home • It has been estimated that 50% of all nursing home residents have some dementia

34. Nursing Homes - $1000 The national standardized assessment of patients required within 2 weeks of admission to any nursing home

35. Nursing Homes - $1000 Nursing Homes - $1000 The national standardized assessment of patients required within 2 weeks of admission to any nursing home Minimum Data Set (MDS) • The Minimum Data Set is a national standardized assessment of each nursing home resident within 2 weeks of admission, at regular intervals or on any significant change in overall condition • Usually completed by staff nurses or other nurses hired by each facility

36. Famous Seniors - $200 Common geriatric problem that prevented this elderly comedian from playing the London Palladium on his 100th birthday d2

37. Famous Seniors - $200 Fractured Hip • Comedian/actor, George Burns, preformed professionally up until a few months prior to his 100th birthday when he suffered a fall and fractured hip resulting in his inability to fulfill a contract signed years earlier to play the London Palladium on his 100th birthday

38. Famous Seniors - $400 Common geriatric problem suffered by this famous athlete

39. Famous Seniors - $400 Common geriatric problem suffered by this famous athlete Parkinson’s Disease • Mohammad Ali suffered severe disability for many years from Parkinson’s disease • Pugilism or Pugilistic Parkinsonism is a condition mimicking Parkinson’s disease associated with boxing or a history of repeated head trauma

40. Daily Double Make a Wager

41. Famous Seniors The Daily Double This famous senior invented bifocal glasses at the age of 78

42. Famous Seniors The Daily Double This famous senior invented bifocal glasses at the age of 78 Benjamin Franklin • Inventor, statesman, ambassador, framer of the constitution was the inventor of bifocal glasses when he we 78 years of age.

43. Famous Seniors - $800 This famous grandmother gave up making quilts in her 70’s when afflicted by arthritis and took up painting miniatures.

44. Famous Seniors - $800 This famous grandmother gave up making quilts in her 70’s when afflicted by arthritis and took up painting miniatures. Grandma Moses • Born Anna Mary Robertson on September 7, 1860, she lived 101 years and 3 months until December 13, 1961. • A remarkable lady, a mother of ten who started painting in earnest in her late 70's and continued until the summer of 1961 • Also known for folk wisdom: Life is what we make it; always has been, always will be.

45. Famous Seniors - $1000 Despite (some say because) of this affliction, Claude Monet, painted this and other masterpieces after age of 60

46. Famous Seniors - $1000 Despite (some say because) of this affliction, Claude Monet, painted this and other masterpieces after age of 60 Cataracts • Claude Monet (1840-1926) suffered for over 30 years from severe cataracts for which he refused surgical extraction. • At age 84 visitors found him robust, vibrant and still painting.

47. Longevity and Survival - $200 Percent of U.S. population over age 65

48. Longevity and Survival - $200 Percent of U.S. population over age 65 13% • In 1998, 12.7% of the population was over age 65. • Those over age 85 are the fastest growing segment. • By 2030, elderly will account for about 20% of the population, equal to the number below 5 years.

49. Longevity and Survival - $400 Life expectancy at birth

50. Longevity and Survival - $400 Life expectancy at birth 76.5 years • The life expectancy for a child born 1997 was 76.5 years • For males 71 years; for females 78 years • The gender differential in life expectancy is largely related to cumulative differences in disease specific mortality