Aging med revised

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The demographics and biology of Aging: 

The demographics and biology of Aging Lotta Granholm Center on Aging MUSC

1. Demographics: 

1. Demographics

Slide 4: 

Older persons, 65 years of age and older, represent 13% of U. S. population - 33.9 million persons or about 1/8 Americans. By 2030, it is expected that there will be 70 million, and that the population > 85 will increase 5-fold. In South Carolina, there are more than 600,000 individuals in this age group and this number is expected to triple by the year 2030. SC is ranked 8th in growth of senior citizens in the US. Demographics in the US

Health Care to the elderly: 

Health Care to the elderly 1 of 5 get prescribed inappropriate meds When examining an elderly, assume that medical problems are associated with side effects of medication ½ physician time ½ prescription meds ½ hospital stays

The sad truth…: 

The sad truth… Of 700,000 physicians 9,000 board cert. Geriatricians (decreasing to 6,000) < 1% of nurses have adequate geriatric training Of 100,000 researchers, < 600 list Aging as main interest! Of 144 med schools, 5 have Dept Geriatrics, and < 30 have Aging Centers Summary: < 0.5% of health professionals have adequate geriatric training According to: American Federation for Aging Research

The 10 Top Reasons why we are so ill prepared…: 

The 10 Top Reasons why we are so ill prepared… # 10. No sense of urgency # 9. Little research on basic biology of aging # 8. Clinical trials not on old/frail # 7. Lack of coordination in care and research # 6. Inadequate reimbursement # 5. Geriatric medicine not valued

Slide 8: 

# 4. Scarcity of academic leaders # 3. Lack of public awareness # 2. Older people are marginalized

…and # 1: Western society is engaged in Age-denial Peter Pan medicine

“Ageism”: 

“Ageism” Can be defined as a prejudgement toward the elderly based on stereotypes and misconceptions. Within this concept, it is assumed that one’s personality, character, behavior and social traits are determined by chronological age. The elderly are often seen as being different from and inferior to other age groups. GRECC, Los Angeles, CA, 2000

Doing nothing is an Rx for disaster!: 

Doing nothing is an Rx for disaster!

Slide 12: 

What are we doing at MUSC? Formation of a regional Alzheimer consortium (ADRC) Building a Center for Excellence in Parkinson’s disease at MUSC Designing a resource center on the web for the public,researchers and health professionals (www.MUSC.edu/aging) Geriatrics/gerontology curriculum for all colleges AFAR summer program for medical students (with UAB and Emory)

2. The Aged Brain: 

2. The Aged Brain

The Aged Brain: 

The Aged Brain A series of subtle but progressive alterations that eventually lead to behavioral changes: 1. Dementia: risk double every 5 years; > 50% in people over 85 years of age 2. Motor function also steadily deteriorates in elderly individuals. Prevalence of extrapyramidal symptoms: 15% in 65-74 years of age 30% in 75-84 years of age >50% in > 85 year olds

Common Risk factors:: 

Common Risk factors: Oxidative stress (reactive oxygen species, ROS) Inability to break down proteins (amyloid, a-synuclein, lipofuchsin) Age Heredity Lifestyle Neuroinflammation Gender Education, activity, food etc…

The Bad…..: 

The Bad…..

On the top of the list…: 

On the top of the list… From Joel Posner

How bad is it for your brain?: 

How bad is it for your brain? 1. 16 mo male rats on 2% cholesterol+2% hydrogenated coconut oil for 8 weeks (controls isocaloric) 2. Rats were subjected to radial arm maze, and sacrificed

No effect on food intake or weight:: 

No effect on food intake or weight:

Working memory deficits:: 

Working memory deficits:

One possible mechanism: Oxidative stress: 

One possible mechanism: Oxidative stress Brain produces a large amount of ROS Free radicals are normal products of metabolism Predominant cellular free radicals are: - superoxide (O2 -) - hydroxyl (OH-) Other molecules, such as hydrogen peroxide, can form ROS in the presence of eg. reduced metal Problem occurs: imbalance between production and breakdown of ROS

… The Good….: 

… The Good….

The brain has a natural defense against ROS:: 

The brain has a natural defense against ROS: Antioxidant scavengers: Glutathione Ascorbate Vitamin E (a-tocopherol; inhibits lipid peroxidation) Carotenoids, flavonoids (present in brain??) Antioxidant enzymes: - Cu/Zn superoxide dismutase (SOD-1) - Mn superoxide dismutase (SOD-2)

Flavonoids:: 

Flavonoids: Most widely occurring group of phenolic phytochemicals Flavones, Flavanones, Catechins, and Anthocyanines Flavonoids are oxidized by ROS, providing are more stable radical Exist in large amounts in: - Wine, green tea, strawberries, blueberries, spinach,Ginkgo biloba, muscadine grape

Blueberries….: 

Blueberries…. Can block oxidative stress in the brain Can enhance neurogenesis and block cell death and degeneration Can prevent and/or reduce cancer Can affect cardiovascular health

Oxidative stress-related pathways: 

Oxidative stress-related pathways Increased activity of stress-resistance genes Decreased levels of Reactive Oxygen species Decreased tissue damage and neuro- inflammation Increased longevity Artificial selection for longevity Caloric restriction pharmaceuticals Genetic engineering

What can we do?: 

What can we do? Nutritional antioxidants (food, supplements) and/or caloric restriction Symptomatic treatment (L-DOPA, AChEI etc) Anti inflammatory (Minocycline, NSAIDS) Cholesterol lowering (Statins) Hormone replacement therapy Enzyme inhibitors (g-secretase etc) Genetic engineering? Gene delivery?

…And the Ugly…: 

…And the Ugly…

Slide 29: 

Demographics in South Carolina South Carolina Nation

Slide 31: 

The ethnic elderly population will increase dramatically by year 2030. Older minorities are expected to increase by 328%, and will constitute 1/3 of the total elderly population in the U. S. by 2050. South Carolina has a high poverty and minority rate, low level of medical access etc. Of 46 counties, 44 are considered medically underserved. Poverty, minorities, and rural communities

Life Styles of the old and healthy…: 

Life Styles of the old and healthy…

Slide 33: 

All five senses, physical strength, and organ capacity tend to somewhat decline with age. Incremental declines with normal aging must be differentiated from illness through appropriate geriatric assessment. Other systems that are affected by normal aging: - Liver function - Kidney function - Basal metabolism - Hormone production/metabolism - Higher order functions (brain/cognition/motion)

Slide 34: 

Adults do not tend to become more religious as they age. The majority of older adults prefer to live independently. Recent figures show that 32% of all older persons live alone, while the majority live with a spouse. Only 9% live with children, siblings, relatives, or non-relatives. Only 5% of older adults reside in nursing homes Preconceptions and ideas about older adults:

Slide 35: 

Over half of all older adults work as volunteers or for pay and continue in the work force or as caregivers. Older adults engaged in volunteer activities do better on behavioral tasks The older adults are slightly more productive, have better absentee records and fewer accidents on the job than younger employees. Older adults in the work force…

Slide 36: 

The majority of older Americans are free of disabilities, fully functioning, self-sufficient and healthy. Older adults are more diversified and heterogeneous than any other age group. As we age, each individual develops a uniqueness as a result of having had more varied experiences in life. What about healthy aging???

What people need…: 

What people need… #1 A caring person to take the time and to listen to their problems. It could be a nurse, a P.A., or a minister, but they have to be heard. #2 They need a person who is well versed in pharmacology who knows side effects, interactions and how they can be taken correctly. They need to know the possibilities for alternative medicines in lieu of prescription drugs. #3 They need a dietician specialized on geriatrics. #4 They need to be trained in physical therapy and exercise to prevent injury and pain and incapacitation.

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