Preventive Strategies for the Elderly Person

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Preventive Strategies for the Elderly Person

• Prevention 2020
• Ministry of Health, Jerusalem
• 27 Apr.,2009

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G - committee

• Committee co-head Shai Bril
• Members Jenny Brodsky, Michael Davies, Tunie
  Dweck, Johnny Lemberger, Inbal Rajuan-Galor, Iris
  Rasooly, Anat Shemesh
• Special thanks to Eli Rosenberg

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Eubie Blake (lived to 96)

• If I had known how long I was going to live, I
  would have taken better care of myself.

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Who are the elderly ?
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Why the elderly?

1. There are a lot of them
2. Presence of co-morbidity (iatrogenesis)
3. Costs to patient, family and society
4. Prevention works ! (sometimes)

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Our Mandate

• To deal with geriatric problems not covered by
  other sub-commitees (e.g., falls vs. Fallopian
  tube disorders)
• To concentrate on the old-old (80) and frail
• To finish on time
• 4. Not to embarrass ourselves

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Our Methodology
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Our Methodology

• Use of evidence,
• or the lack thereof
• 2. Use of expert opinion
• 3. Prioritisation technique (method of Rosenberg
  et al.)

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Consultation

• Prof. Howard Bergman, Chief of Geriatrics, McGill
  University, Canada.
• Prof. John Feightner, Head Of CTFPHC, Canada
• Prof. Neil Wenger ACOVE expert, UCLA, United
  States
• Prof. Chris Patterson, Head of Geriatrics,
  McMaster University, Hamilton, Canada

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What is to be done?V.I. Lenin,1902
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3 categories

1. Over-arching goals
2. Reduction of risk factors and enhancement of
   healthy lifestyles
3. Primary and Secondary Prevention (screening)

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Recommendations

• 1) Disability vs. Death ?

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RecommendationsCategory l

• 2) Improve life expectancy (LE)
• especially in
• women
• minorities
• the poor

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RecommendationsCategory l

• 3) Improve disability free life expectancy (DFLE)
• Q More important than LE?
• A It depends on whom you ask.

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RecommendationsCategory l

• 4) Increase function (ADLs and IADLs)
• This is the Geriatric clinical imperative !

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Recommendations, Category lIDecrease risk
factors and increase healthy lifestyle

• Physical activity
• Physical activity
• Physical activity

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Recommendations, Category lI

1. Decrease falls and fractures (evidence alert for
   most fracture interventions except DEXA and
   calc/vit d in institutionalized)
2. Decrease MVAs morbidity and mortality (good eg of
   need for inter-ministry(ies) coordination)

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Recommendations, Category lII

• Decrease inappropriate prescribing
• Prevent avoidable impairments of vision and
  hearing
• (evidence alert!!)

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Recommendations, Category lII, contd

• Increase uptake of flu pneumoccocal
  vaccine among elderly
• and esp. health care workers !!!

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Recommendations, Category lII, contd

• Urinary incontinence
• ( 2 on our hit parade !)
• evidence alert!!

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Ranking

1. Aerobic exercise
2. Incontinence
3. DEXA (women only)
4. Flu vaccine
5. Withdraw psychotropic meds (for falls)
6. Multi-factorial falls program