Ronald Wilson Reagan. Presidential Life Expectancies. Presidential Characteristics. U.S. Presidents Who Have Had Assassination Attempts

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1 Historic Trauma: The Enduring Health of Ronald W. Reagan A look back at how he survived significant traumatic injuries and health issues. Cynthia Blank-Reid, RN, MSN, CEN Trauma Clinical Nurse Specialist Temple University Hospital Philadelphia, PA Ronald Wilson Reagan 40th President ( ) Born: Feb. 6, 1911 in Tampico, IL Died: June 5, 2004 Beverly Hills, CA Oldest individual to be elected President (70 yrs) Governor of CA ( ) Radio announcer, television and movie actor Presidential Characteristics Public service vs. self service War hero Attorneys From Virginia, Ohio or Massachusetts Strong female in their life (mother or wife) Poor or rich Presidential Life Expectancies Earlier presidents lived longer than their expected life expectancy. They lived in to their 70s and 80s. (Avg 74) Tendency toward premature death has become more prominent in the past century (avg loss is 7-16 years) Supreme Court Justices live longer than their counterparts in the Legislative or Executive branches of government Common Presidential Conditions Medical Cardiovascular Coronary artery disease Hypertension Gastrointestinal Stomach issues Diarrhea, constipation or irritable bowel syndrome Stress Fatigue Weight Gain/Loss Injuries Orthopedics Extremity fxs from falls Gunshot wounds U.S. Presidents Who Have Had Assassination Attempts Abraham Lincoln (April 13, 1865) James A. Garfield (July 2, 1881) William McKinley (Sept. 6, 1901) Theodore Roosevelt (Oct. 14, 1912) Harry S. Truman (Nov. 1, 1950) John F. Kennedy (Nov. 22, 1963) Gerald R. Ford (Sept. 5 & 22, 1975) Ronald W. Reagan (March 30, 1981) 1

2 U.S. Presidents Who Have Died From Illness While In Office William H. Harrison 9 th President, died 30 days after inauguration of pneumonia Zachary Taylor; 12 th President, died from CV and CAD Warren G. Harding; 28 th President, died from CV and CAD Franklin Roosevelt; 31 st President, died from CV Hem Republicans Liked Him One of the worst mistakes anyone can ever make is to bet against Americans. Ronald Reagan The Democrats Liked Him Reagan s Early Years Spent most of his early life in Dixon, IL His father was a shoe salesman and the family moved a lot. Had an older brother Neil. Nickname of Dutch given to him by his father due to looking like a fat little Dutchman and his Dutch boy haircut Graduated from Dixon High School where he had interests in sports, acting and storytelling. Attended Eureka College where he was involved in campus politics, sports and theater. He was on the football team, captain of the swim team, student body president and in a fraternity Early Years Graduated in 1932 from Eureka College with a Bachelor s Degree in economics and sociology. Became a radio announcer in Iowa and in 1937 moved to LA to be an actor. College Years 2

3 Personal Life Made several films including Dark Victory, Knute Rockne, All American, Kings Row, Bedtime for Bonzo, The Killers. Spokesman for GE theater Married to actress Jane Wyman from when they divorced. Had three children -Maureen ( ) -Michael born 1945 (adopted) - Christine (Sept 26, 1947; lived 1 day) Married Nancy Davis in 1952 Had two children: Patricia Davis born 1952 Ronald P. Reagan born 1958 Personal Life Was originally a Democrat Became involved in the Board of Directors of the Screen Actors Guild in 1941 and became president in 1947 Became a member of the Republican Party in 1962 Ran for Gov of CA and won in 1966 and 1970 Defeated in run for Republican Presidential nomination in 1968 and 1976 Political Life Won 1980 Presidential election As he was giving his inaugural address 52 US hostages who had been held by Iran for 444 days were set free. Political Life The Day He Almost Died March 30, 1981-Wash D.C. Hilton giving speech when just before 2:30 PM, John Hinckley, Jr. using a Saturday night special fired several rounds. Several police and SS were wounded but James Brady was most critical. Had been in office only 69 days. 3

4 Ronald W. Reagan March 30, 1981 The bullet struck the limousine and flattened to the size and shape of a coin and then entered Reagan s body under the left arm. Originally they did not think that he was hit but then blood came from Reagan s mouth. Ronald W. Reagan March 30, 1981 Rushed to George Washington Hospital Center where he was collapsing and saying he couldn t breathe. Chest tube inserted. Ronald W. Reagan March 30, 1981 Americans saw what really happens for the first time in a Presidential assassination. Wounded people were left lying in the street. X-ray showed bullet entered left armpit, struck the 7 th rib, and burrowed three inches into the left lung. Was less than an inch from his heart. Within 3 hours he was in surgery. Had bleed out 30% of his blood volume. He is 70 years old. Ronald Reagan March 30, 1981 Ronald W. Reagan April 1981 Had his chest tube pulled, and went home on April 11, He had been in the hospital for 12 days. Early in his presidency, Reagan started wearing hearing aids First in his right ear and later in his left ear Went public with information in 1983 Small audio-amplified hearing sales had a boost in sales after he announced it. Hearing Aids 4

5 Polyp Surgery 1985 July 13, 1985 had surgery at Bethesda Naval Hospital to remove cancerous polyps from his colon. Relinquished presidential power to VP Bush for 8 hours. He was the first president to use delegation of power. Skin Cancer August 1985 had skin cancer cells removed from his nose Oct had additional skin cancer cells removed from his nose. Challenger Jan 28, 1986 The future doesn t belong to the fainthearted; it belongs to the brave.we will never forget them, nor the last time we saw them, this morning, as they prepared for their journey and waved goodbye and slipped the surly bonds of Earth to touch the face of God. Life at the White House Jan 1987 had surgery for an enlarged prostrate July 1987 had third cancer operation on his nose After The Presidency July 4, 1989 while visiting friends in Mexico, he was thrown from a horse and was unconscious. Weeks later (Sept), he was diagnosed with a chronic SDH which was removed at Mayo Clinic. Subdural Hematoma Focal brain injury Beneath the dura resulting from acceleration, deceleration, or combination forces More common than epidural hematomas 5

6 Subdural Hematoma Causes Usually venous in origin; tearing of the bridging veins Also from injuries to tissue or vessels of cerebral cortex Direct injury to brain tissue Subdural Hematoma Onset may be acute (within 48 hours) or chronic. Patient at risk to develop a SDH Elderly Those on anticoagulants Chronic alcohol users More lethal than most other brain lesions Subdural Hematoma Signs and Symptoms (onset varies) Steady decline in level of consciousness Hemiparesis or hemiplegia on opposite side of hematoma Unilateral fixed and dilated pupil on same side as hematoma August diagnosed at 83 years with Alzheimer s Disease. Nov announced his diagnosis to the public via a recorded message The Diagnosis Part of the Message He Read on His Diagnosis I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer s Disease.at the moment I feel just fine. I intend to live the remainder of the years God gives me on this earth doing the things I have always done.i now begin the journey what will lead me into the sunset of my life. I know that for Americans there will always be a bright dawn ahead. Thank you, my friends. May God always bless you. Dementia A disorder of consciousness An acquired and progressive cognitive deficit Affects the content, not the level of consciousness Increases with age may effect 5-20% of elderly over 65 yrs. Underlying pathology affects the cerebral cortex and subcortical connections 6

7 Dementia -Continued Considered to be a global cognitive disorder as opposed to an acute onset of a confused state. On CT and MRI : There is enlargement of the ventricles and cerebral cortical sulci. As the brain ages, it atrophies and there are changes. There will always be minor changes in neurologic function with memory and cognitive problems which are normal as the brain ages and atrophies with age. These changes should not be considered dementia. Must have accurate assessment with mental and physical workup. Only 10% of the dementias are reversible, but it is necessary to determine possible causes of dementia so that appropriate treatment may begin. For instance, a chronic SDH or a vitamin B 12 deficiency may be causing a problem and once corrected, the deficit should cease. Causes of Dementia Only 10% of the dementias are reversible, but it is necessary to determine possible causes of dementia so that appropriate treatment may begin. For instance, a chronic SDH or a vitamin B 12 deficiency may be causing a problem and once corrected, the deficit should cease. About 15% of patients having a pseudo dementia caused by things such as depression or alcoholism (Korsakoff Amnesic Syndrome). Common Causes of Dementia: Alzheimer s Disease (most common) Dementia with Lewy Bodies Parkinson s Vascular dementia (multi-infarct) Hydrocephalus Intracranial mass lesions Hypothyroid Pick s Disease (frontotemporal dementia) Huntingdon s disease Creutzfeldt-Jacob AID s dementia Progressive multifocal encephalopathy Lymphomas, leukemia Primary alcohol dementia Head trauma Vitamin B12 deficiency and other nutritional deficiencies Wilson s Disease Dementia Testing CT/MRI/MRA There is enlargement of the ventricles and cerebral cortical sulci. As the brain ages, it atrophies and there are changes. There will always be minor changes in neurologic function with memory and cognitive problems which are normal as the brain ages and atrophies with age. These changes should not be considered dementia. Must have accurate assessment with mental and physical workup. Psychiatric/geriatric workup Mini mental & clock drawing is very indicative of dementia. Can only definitively label Alzheimer s on autopsy, is a cluster of symptoms Clock Drawing Test Clock drawing and handwriting are two simple tests to distinguish the kind of dementia. The key to treatment is assessment and many tests are given including the mini mental and clock drawing tests. Alzheimer's has very distinct stages where the hands disappear entirely. The hallmark of ischemic vascular dementia is micrographia (tiny writing), The patient will draw a tiny little clock and cannot make a larger clock, and in late stages no numbers or hands and the circle is actually a conglomeration of small lines. Ischemic vascular dementia pts have slowed mentation so everything must be done slowly and make sure to give the patient plenty of time to finish tasks. Clock Drawing Continued Frontal lobe dementia loses track. Lewy Body Dementia pts have prominent visual hallucinations as one of their hallmarks. The clock may look hallucinatory to the patient. You may see the clock face but the hands will be inside and outside the circle, and the hands may be squiggly. These patients also may have visual-spatial skill problems early in the disease so doing the clock draw is very difficult. They might even refer to the drawing as those 3 guys went outside referring to the 3 numbers outside of the clock.* *Dementia Screening Tools: The Clock Draw-Gail Petersen PhD petersen@mhtc.net 7

8 CLOCK DRAWING* Alzheimer s stage 4 (not able to place 2 hands) Alzheimer s stage 5 (lose both hands) Alzheimer s stage 6 Micrographia OR Ischemic Vascular Dementianote the paucity of hands Frontal Lobe Dementia Lewy Body Dementia Mini Mental Exam Next slide is a depiction of Folstein and McHugh s Mini Mental exam or MMSE Scores: Normal Mild dementia Moderate dementia <10 severe dementia Max score 5 5 What is the (year) (season) (date) (day)) (month) Where are we: (state) (county) (town or city) (hospital)) (floor) REGISTRATION 3 Name 3 common objects (apple, table, penny) Take 1 second to say each. Have pt repeat after you said them. 1 pt each correct answer. Repeat until h/she learns all 3. Count trials and record. Trials: ATTENTION AND CALCULATION 5 Spell world backwards. Score of number of letters in correct order (D L R O W ) RECALL 3 Ask for the 3 objects repeated above. 1 point each correct. Cannot test if couldn t memorize above) LANGUAGE Name a pencil and watch (2 points) Repeat the following, No ifs, ands, or buts. (1 Point) Follow 3 stage command: Take a paper in right hand, fold in ½, put on floor(3 pts) Read and obey: Close your eyes (1 Point) Write a sentence (1 Point) Copy the following design: (1 point) Alzheimer's Not a disease but a collection of symptoms Onset usually in 60 s More common in women than men Etiology unknown Conclusive diagnosis done per autopsy Classic senile sticky debris of plaques Neurofibrillary tangles * After the Diagnosis Nov 1994 public announcement Remained physically active, took walks thru parks and on beaches, played golf regularly Was forgetful with names and dates 1999 stopped going to his office in Century City The Bel Air Home January 13, 2001 at the age of 89, fell at home and broke his hip. Repaired the next day with a pin, plate and screws. Daughter Maureen was a few floors away being treated for melanoma. He spent a little over a week in the hospital and then went home with PT. 8

9 August 8, 2001 Maureen died at age 60 from melanoma. Oct. 11, turned 90. Only John Adams, Herbert Hoover and Gerald Ford would reach age of Years Old June 5, Died at the age of 93 years and 120 days of pneumonia At the time of his death, he was the longest living president. Gerald Ford would die in 2006 having lived 93 years and 165 days. The End 25 th Amendment Framers of the Constitution intended for an acting President. In 1841, John Tyler became President -no one challenged him. Precedent was set and all others followed. Presidential Succession Law of 1947 provided an order of succession (Speaker of the House of Rep, President Pro Tempore of Senate, Sec of State, etc) Added to Constitution in 1967; involves inability to do the job, designating and returning of power. Conclusions Twenty-fifth amendment transfers power to the Vice President. Presidents are mortal. Most leave office in poorer health. Modern ones and their spouses now get health care for life. The Great Communicator Reaganomics Ending Cold War Berlin War Came Down Challenger Disaster Wanted a constitutional amendment requiring a balanced budget Reagan s Legacy Questions? 9

10 References Dawson, Ian (2005): Medicine in the Middle Ages. Enchanted Lion Books: New York City. Mattox K, Feliciano, D, Moore EE, (eds) Trauma (5 th edit) McGraw-Hill. References Mattox K, Feliciano, D, Moore EE, (eds) Trauma (5 th edit) McGraw-Hill. 10