Health Aging. Xaviour Walker MD, MPH, DTMH UCI Geriatric Fellow Hospitalist, Public Health and Preventive Medicine Physician

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1 Health Aging Xaviour Walker MD, MPH, DTMH UCI Geriatric Fellow Hospitalist, Public Health and Preventive Medicine Physician

2 What is Healthy Aging?

3 Charles Eugster 96 years young!

4 Stanislaw Kowalski 104 at European Masters Athletics Championships

5

6

7 Baltimore Longitudinal Study of Aging People who sociable, generous, goal orientated higher levels of happiness and lower rates of depression People involved in hobbies and leisure activities lower risk for some health problems Diet rich in vegetables, fruit, low in saturated fat decreased CVD and mortality Benefits of Exercise

8 OC population by Age Group

9

10

11

12 Diabetes management in the Elderly Over 65 with DM high priority depression screening and treatment Avoid hypoglycemia Functional and cognitive intact, with long expectancy similar goals to younger pts May relaxed glycemic goals in certain individuals

13 ADA guidelines 2016 for elderly Avoid symptomatic hyperglycemia or acute hyperglycemia complications Individualize screening diabetic complications, close attention to those leading functional complications CV risk factors: HTN treatment, ASA/lipid therapy to patient with benefit

14 Pharmacologic treatment Cost with polypharmacy may be big factor Drug class Meformin 1 st line, CI CKD, significant CHF Sulfonylureas, secreatagogues Insulin* GLP-1 receptor antagonists*, DPP-4 inhibitors SGLT2 inhibitors Hypoglycemia, use with caution, glyburide CI in elderly Hypoglycemia Few side effects, costly Limited long term experience * Need cognitive ability, good eyesight, motor skills or caregiver

15 Hypertension in the elderly Elderly: lower baseline CO, Higher TPR, wider PP, lower intravascular volume and lower RBF SBP < 150 (JNC 8) SBP < 140 DM, CKD (JNC 8) SBP < 140 fit elderly with IHD

16 Non pharmacology management Exercise Modest weight reduction in obese Dietary sodium Treatment of sleep apnea

17 Hypertension Therapy Consider: fragility, ability follow instructions, complexity of current meds, supporting care Current meds: NSAIDs, decongestants Labs: Electrolytes, renal function (ACEi/ARB) Often need multiple agents at higher doses JNC8: ACEi, CCB, Diuretics, not BB ACEi: (DM, CKD with proteinuria CHF, IHD) Thiazides: HypoK, hypona

18 What screening would you do for a 65 year male and female in your clinic?

19 USPTF Grading System Grade Definition Suggestion for practice A High benefit/certainty Offer/provide B Moderate benefit/certainty Offer/provide C Individualize, moderate certainty small benefit Offer/provide on select patients D Moderate certainty no net benefit or harms > benefit Discourage I Insufficient evidence Patients to understand uncertainty

20 Colorectal screening years (A), years (C) >85 years (D) CT colonoscopy and fecal DNA testing (I)

21 Lung cancer screening years, 30pack year, smoke or quit within 15 years (B) Annual Low-dose CT scan

22 Breast Cancer screening Biennial screening with mammogram years (B) Breast cancer screening with dense breasts adjunct imaging (I)

23 Cardiovascular related screening Healthy diet and physical activity adults increased CVD risk (B) RF: HTN, HLD, Impaired fasting glucose, BMI>25 High blood pressure screening every 2 years DM type 2 screening years who are overweight or obese (B) Hb1aC, OTT, Q3years Tobacco smoking cessation behavioral and pharmacological intervention (A)

24 Cardiovascular related screening Obesity (BMI>30) offer intensive, multicomponent behavioral interventions (B) Statin use age No Cardiac history, 1 more CV risk factor, CVD risk >10% (B) AAA screening Males years smoked (>100cig) (B)

25 Mental Health screening Alcohol misuse (B) AUDIT-C Depression screening (B) Geriatric depression Scales

26 Chronic infectious diseases screening Hep B screening adults high risk: MSM, IVDU, ESRF on HD, not vaccinated, immigrant (B) Hep C screening adults born , Hx of IVDU (B) HIV screening 15 to 65 years, older increased risk (A) LTBI screening increase risk

27 Falls prevention Over 65 -> exercise (B) HHS 150min per week moderate intensity, or 75min/week high intensity + 2 days strength + 3 days/week balance (w/ falls risk) AGS 800IU/day increased falls risk (B) CDC vision, medications, home assessment Osteoporosis: Screening women > 65 years (B)

28 Summary: Healthy Aging Useful to know regional population health statistics where you practice Population/community vs individual approach Importance of social history 1o prevention = diet, exercise, healthy lifestyle.. 2o prevention = screening (USPTF) 3o prevention = prevent/reduce complications.. DM Hb1aC goals, avoid hypos, metformin, insulin HTN CCB, may need multiple, goal SBP ~150 Go low, go slow with medications Multi-disciplinary team approach

29 Questions?

30 Health Aging Xaviour Walker MD, MPH, DTMH UCI Geriatric Fellow Hospitalist, Public Health and Preventive Medicine Physician

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