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� Victoria L. Braund MD, FACP, CMD

� Division of Geriatrics,

NorthShore University HealthSystem

� Assistant Clinical Professor

University of Chicago Pritzker School of Medicine

� Many are “people pleasers”

� They tell you want they think you want to hear

� In early dementia, social skills are well-preserved

� They sound better than they are

� You need to observe and check things out

� But don’t get caught!

What you need to do to care for your person

�Feeding

�Ambulation

�Toileting

�Dressing

�Transferring

�Bathing

What you need to do to run a household!

�Use a telephone

�Perform housework

�Shop for food

�Prepare meals

�Transportation

�Manage medications

�Manage finances

� As teens, we learn…

� Finances

� Driving

� (medications)

� Organization, planning, schedules, etc

Watch for these issues

in your parents!!!

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One third of seniors fall every year

Half are “frequent fallers”

Risk of falls increases each decade

�Landing on the ground (or some other surface) when you didn’t intend to be there

� Includes trips, and stumbles

� 1% of falls� hip fractures

� 6% of falls� any fracture

� Soft tissue injuries

� Fear of falling

Intrinsic Extrinsic

Age Medications

Vision Assistive devices

Hearing Environment

Medical Issues

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Multifactorial assessment

Falls history

Medication review

Functional ability/

fear of falling

Neurological examination

Urinary continence

Osteoporosis risk

Cardiovascular examination

Cognitive impairment

Visual impairment

Gait, balance and mobility

Risk factor Relative risk ratio/Odds ratio

Muscle weakness

History of fallsGait deficit

Balance deficit

Walking aid useVisual deficit

Arthritis

Impaired ADLDepression

Cognitive impairment

Psychoactive drugsAge >80

4.4

3.02.9

2.9

2.62.5

2.4

2.32.2

1.8

1.71.7

J Amer Geriatr Soc 2001

Intrinsic Extrinsic

Age Medications

Vision Assistive devices

Hearing Environment

Medical Issues

� Most important: Medications !!

� Why??

� Change in blood pressure

� Dizziness

� Sedation

�Got ‘em??

�Use ‘em!!

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� Check blood pressure

� Lying, standing, standing at 3”

� Medication review—see next slide

� Vision, hearing

� Check feet

� Check gait

� Osteoporosis Evaluation

� Yes, men too!

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� Men and women

� Osteoporosis can increase the risk of fractures

� Screening can direct osteoporosis therapy

� Age

� Frame size

� Women

� Asians & Caucasians

� Dietary

� Low calcium or Vit D

� Lifestyle

� Smoking, excessive alcohol

� Sedentary

� Medications

� Estrogen (lack thereof)

� Prednisone (steroids)

� Too much thyroid replacement

� DEXA is easy, painless

� Covered under Medicare every 2 years

� Can direct treatment

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� Weight bearing exercises

� Walking

� Calisthenics

� T’ai Chi� This helps prevent falls too!

Getting your Getting your Getting your Getting your calcium calcium calcium calcium

from food is from food is from food is from food is best best best best

� For patients who cannot eat dairy, or who have a low calcium diet, consider calcium supplements

� Bisphosphonates are the most common medications prescribed for osteoporosis treatment.

� Alendronate (Fosamax®)-once a week

� Risedronate (Actonel®)- once a week

� Ibandronate (Boniva®)- once a week

� Zoledronic acid (Reclast®)-once a year

� New data suggest bisphonates should be limited to a total of 5 years

� Hormones, such as estrogen--for women

� Raloxifene (Evista®) --for women

� Other new treatments used by specialists

� Teraparatide (Forteo® )

� Denosumba(Prolia®)

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�Common sense…

�Keep Moving!

�Hip protectors

�They work, but…

�Better heart and lung function

�Muscle strength

�Fewer falls

�Better sleep

�Better mood

�And many more….

�Make sure to stay hydrated!

�As we get older, we lose our sense of thirst

�Especially important in the morning

�Can help prevent dizziness and falls!

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�Heart and lung issues

� In and out of the hospital and ER

�This was puzzling to her doctors..

�Was asked to bring her pill bottles in to her PCP

� Working with your doctor

� Medications

� Advance directives

� Resources

�Make sure know what your pts are really taking!

�Once a year � (at least)

�Bring all your pill bottles

� Include vitamins and supplements

� Use a pill box if you have more than just one or two pills� Even for your vitamins

� Use one pharmacy so they can check all your pills together

� Get to know your pharmacist; they know everything about pills!!

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� Magazines

� Direct mail

� The internet

� TV

� Your next door neighbor

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� Coconut oil

� Gingko biloba

� Huperzine

� CoQ

� Taurine

� Many others

� Not FDA approved!!!

� FDA approved meds go through a rigorous scientific approval process

� Effectiveness ???

� Safety???

� Purity???

� Medication interactions??

� Warfarin???

�There is no pill that has the benefits of a healthy lifestyle

�Sorry…..

� Just like your mother said…�

� “Everything in moderation”

� “Get involved”

� “Don’t just lay around here… go out and play”

� “Don’t you have something better to do?”

� Brain games

� Vitamins and supplements

� Ginkgo biloba has been disproven multiple times!

There is a good chance that you may have heard of or come across an app or two that claims if you play their game, you will improve your brain’s performance, or at least help keep you sharp and alert which might be an appealing prospect for the elderly or for those suffering from Alzheimer’s.

Unfortunately it seems that most of these claims are untrue, at least for one developer that goes by the name Luminosity. So much so that the Federal Trade Commission (FTC) has slapped them with a massive $2 million fine for engaging in what they are calling deceptive trade practices.

Ubergizmo.com 1/11/15

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� Move it!

� Feed your brain!

� Get good sleep

� Wear your hearing aids

� Use it or lose it!

� Heart health

� Be cool!

� If we could put the benefits of exercise in a pill, it would be the best selling pill of all time…

�Never to old to start!

�Find something you like to do

� There is no pill that can give the benefits of a regular exercise program

� Improves circulation, balance, strength

� Linked to better thinking!

� More and more studies point to good nutrition as a cornerstone of health

� Focus on fresh, “real” foods!

Management of these…

�Blood pressure

�Lipids

�Obesity

�Diabetes

�Smoking

…can lead to this

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Date of download: 1/12/2016Copyright © 2016 American Medical

Association. All rights reserved.

From: Sleep-Disordered Breathing, Hypoxia, and Risk of Mild Cognitive Impairment and Dementia in Older

Women by Dr Yaffe

JAMA. 2011;306(6):613-619. doi:10.1001/jama.2011.1115

We found that among women with a mean age of 82 years, sleep-disordered breathing was associated with an increased risk of cognitive impairment.

Our results indicate that this relationship seems to be related primarily to measures of hypoxia.

� Many recent studies link hearing problems to brain shrinkage

� Use of hearing aids keeps people aware and connected

� Pay attention

� Never stop learning

� Word games; crossword puzzles

� Stay active socially

� Keep organized

� Focus your attention� Quit multitasking

� Reduce stress

� Choose to snooze

� Structure your environment� Calendars, key rack

� The best website! www.alz.org

� www.AARP.org

� The Memory Bible and The Memory

Prescription by Dr. Gary Small

� The 36 Hour Day—the caregiving bible

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