Seniors

Most health care expenditures are in the last six months

Populations are aging; baby boomers

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Forest and trees

Need to identify problem list, but then also summarize the overall state.

Care plan: feasible, sustainable? WHose goal is it?

It is key to ensure that those who cannot be healed are still respected.

It is no ones job to do this; it is everyones job.

Not everyone is frail, but many people are.

Atypical Disease Presentation

Need to make the diagnosis.

Frailty and delerium, and dementia are all very common and impact

Delirium, falls, immobility, incontinence, functional decline, breakdown of social supports

As people age, the atypical become typical

<50% of older patients present with non-traditional sx

idea: get students (ie from English) to go interview seniors in retirement homes etc and write their stories...

strokes can occur.

Depression is underrerpoted because there is a stigma of aging, symptoms can be masked by co-morbid illness, and there is a cohort effect for depression.

There is a myth

Seniors and Community

Health Concerns Affecting Seniors

falls

Musculoskeletal system

As the population ages, the prevalence of disability rises

There is some debate between aging (programmed/cumulative problems) and degeneration (excessive rate, extent, or setting).

Aging leads to decreased collagen, excessive cross-linking, decreased hyaluronic acid, and dystrophic calcification. Stiffness results.

Earles lengthen and the nose broaden

Muscles have a reduced number of Type 2A fibres and size (Type 2B). There is a greater effect on lower extremities and superficial fibres. There can be patchy degeneration of myofibrils. SR can proliferate and dilate, and tehre isa shift toward anaerobic metabolism.

The function of individual fibres is maintained, but there is fallout of the motor unit and muscle fibre. This leads to reduction of performance and Vo2 max.

This decrease in stength and power begines to decline after age 50

Tendons

fraying and fibrillation occurs, and dystrophic calcification (hydroxyapetite) can decrease strength, leading to risk of rupture

bone shinkage lowers height 1.2 cm over 20 years

loss of height comes from decrease in intervertebral disc space.

get kyphosis, increased arm/height ratio

Gibbus deformity

Seniors and Transportation

Transportation is fundamental to social involvement and is related to the built environment and people's abilities.

Senior and Driving

Some seniors with medical conditions should have their driving assessed. Medications can cause trouble as well.

When discussing changes to people's driving, tell them 'driving is a priviledge, not a right...' and say 'its not due to health, not age'