Demographics-young old-65-74 middle old-75-84

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-young old—65-74

-middle old—75-84

-old old—85+

*young old increase by a factor of 8

*middle old increase by a factor of 14

*old old increase by a factor of 27this group is growing the most exponentially

--individuals over 65 increase 10x

--65+ makes up 12.7% of our population

--by 2030 1/5 of the pop will be 65+
Income and poverty

-65+ poverty rate is 12%

-1 out of 5 elders are poor

Race and poverty

-white—1 in 9 is poor

-black—1 in 4

-hispanic—1 in 5

*race makes a difference

1998 census bureau—


Health and functionality—

-research—past 5-7y we are starting to do trials with the elderly; before that, it didn’t happen

-underreporting of illness


Most common chronic conditions of the elderly

-arthritis is #1

-HTN, CAD, hearing, ortho, cataracts, sinus, DM, tinnitus
Use of medical resources by people over 65yo—national

-physician—1/3 of all

-Rx meds—1/4 of total

-acute hospital admissions—2/5 of total

ADLs and IADLs degenerate (need help / cant do) as age increases
Ethnic diversity—

-1990—13% over 65 are minorities

-2030—1 in 4 will be minorities

-1990-2030—increase in minorities will be more than 3x than non-minorities

*65+ more than white non-hispanics

7x asians and pacific islanders

2.5x american indians and eskimos

1.5x non-hispanic blacks

6x hispanics
Geography of old age—

-greatest pop of 65+ in July 2000

-Cali, Fla, Ny, Tex, Penn

Oldest per capita in the USWV #1—38.6yo

Normal aging—cohort effects—different views about issues, etc

-skin changes

-presbyopia—lens less elastichard to focus

-OA—by 40yo all have some type of it



-b/c grandparent

-deaths of parents and friends



death spouse / family

Rule of 3rds—

--aging changes = diseases + disuse + nl aging
Biological aging—

-gradual cellular damage, etc

-cell life span may be a genetically programmed process
Sex and aging—

-vaginal dryness, erectile dysfunction

problems and etiologiesboth are MULTIPLE
CV system—

-increase in BP (systolic first)

-decrease contractility

-decrease cardiac reserve

*CAD most common cause of death over 65

Pulmonary system—

-aging doesn’t deteriorate it

-toxins do


-many Sx

-BPH, uterine atrophy, etc


-dental changes are the most common

-gum recession

-tooth loss—1/2 is edentulous

-gastric acid decreased



-mass decreases by 30%

-strength, endurance, and bulk decrease

Neuro—don’t understand enough of the deterioration of structure and its relation to function

-presbycusis—hearing loss in the elderly

-cant regulate body fluids

-loss of CV responses—ortho hypo

-blunted temperature control

90% have problems sleeping

bowel habits

-e.g. UTI—present with confusion

--some test material will be from syllabus not discussed in class

--make-up classes—next Tuesday double and next thurday double and quiz—

Medicaresee the book given in class
Assessment—what should you do?


-skin—face, scalp, ears, neck, etc

-height—osteoporosis—need baseline


-eyes—see optometrist q4y; if DM qy


-mouth—TEETH, malnourishment

-neck—carotid bruits

-heart—murmurs common

-abd—don’t miss AAA (50-70yo male with HTN)


-Labs all should have—

-CBC, UA, chem 7

-remember—you need to justify these to the insurance co

-Labs / Xrays some should have—

-chest Xray—smoker, etc

-EKG—HTN, DM, any RFs

-PPD—inpatient care home—qy

-TSH—strongly consider

-LFTs—etoh, etc—palmar erythema, spider telangectasias

-B12 / Folate—etoh, malnutrition

-albumin—best to check for nutritional status

-Health Maintenance—more important for Pas

-cause of death—in order

-heart, CA, CVA, COPD, pneumonia and flu
-Principal causes of severe, chronic disability of persons 80+





-hip and other fx

-Screening for Dz—


-screening questions about RFs (smoke, exercise, diet, etc)

-maintain BP


-auscultate for carotid bruits

-EKG—sensitivity of 43%, spec of 77%

-regular exercise—stress test first


-ASA—he gives baby asa qd for secondary prevention

-moderate etoh intake


-breast—75yo is when you get it

-cervical from HPV


-oral—buccal PE if snuff

-prostate—DRE and PSA

-skin—ACS—40+skin PE qy

-lung—no big evidence to screen

-Infectious dzs—




-PPD—continuous care centers

--Leading cause of death

-heart dz, CA, stroke, COPD, pneumonia and flu

*remember—book for skipped topics—

-not much different in the elderly than in a 45yo

-food pyramid

-Kcal needs—

-height, weight, age

-compare to established norms to see if they need a change in calories

-multiply the appropriate # of calories by actual / IBW (lbs) to get an estimate of caloric needs

-activity level (normal weight)--------------------------calories/lb




-subtract 100 calories / decade for 35+

-signs / sx of poor nutrition—

-weight loss—

>5.0%bw in 1mo

>7.5%bw in 3mo

>10%bw in 6mo

>10lbs in 6 mo

-low or high weight for height—

><20% IBW

*albumin <3.5g/dL

-decrease in functional status—

-2 ADLs or one nutrition-related IADL


>1oz female / 2 oz male


-correct the problem

-referral sources—

-meals on wheels

-senior center

-look at family situation

-know the whole picture—drive, walk, etc

-need to deal with it or it gets more complicated

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