Kenneth Brummel-Smith, MD
Charlotte Edwards Maguire Professor of Geriatrics
Florida State University College of Medicine

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Hypertension
Diabetes
High cholesterol
Arthritis
Osteoporosis
Dementia
Falls
Parkinson’s
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Heart failure
Stroke
Cancer
Influenza & pneumonia
Depression
Anxiety
Sleep disorders
GERD

 Multiple pain problems – low back, hip, knee, ankles, hands
 Treatments
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Tylenol equal to Celebrex and NSAID in studies
Lower rate of GI bleeding and kidney damage
Glucosamine (Rotta-brand - Dona)
Possibly ginger
 Exercise provides greatest benefits in function
 Arthroscopy not beneficial

 USPSTF recommends screening
 Fracture risk should be calculated (FRAX)
 Exercise is the mainstay of treatment
 Calcium, (and maybe vitamin D) - initial treatment
 Medical treatments likely help high risk or very low bone density patients
 If treatment is taken, 5 years is likely enough

 Memory loss that is measurable but does not affect function
 Drugs for dementia do not prevent dementia or improve memory in MCI
 Exercise, Mediterranean diet, possibly mental games

 Many types – Alzheimer’s, vascular, Lewy body, frontotemporal
 Prevention – exercise, alcohol, Med diet
 Get a detailed diagnosis – rule out other things
 Medications usually not helpful (common side effects)
 Small benefits from a huge number of complimentary medicines

 6 th leading cause of death over age 65
 Medications often the cause – all drugs that act on the central nervous system, heart drugs
 Exercise is mainstay of prevention and treatment
 Emphasize strength and balance
 Tai Chi most effective intervention

 #1 cause of death in people over age 65
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Self-management skills significantly decrease hospital admissions
Know your “ejection fraction”
 Exercise is the most common forgotten treatment (cardiac rehabilitation)

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#3 cause of death in people over age 65
Acute thrombolysis? (“clot busting”)
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Red score on NNT – all positive studies were drug-company funded, all negative studies were not
High risk of hemorrhage
3 hour window
 Aspirin also not recommended for prevention

 All cancers are different
 Second opinion recommended
 Discuss the actual experience of treatment
 Always include palliative care – symptom control

 Annual flu shot, one-time pneumovax shot
 Personal benefit – lower risk of serious infection and death
 Community benefit – reduce spread
 Prior worries of swine flu (Guillean-Barre) have not been seen in many years

 Get an accurate diagnosis (PHQ-9 or Geriatric
Depression Scale)
 3 equally effective treatments:
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Exercise
Cognitive-behavioral therapy
Medications
 Combination of them more effective than one
 9 months of treatment after resolution, then attempt taper off medications

 Sometimes depression can present as anxiety
 Best treatment is exercise, mindfulness meditation or other means of stress reduction, massage, and cognitive-behavioral therapy
 Medications as a last resort
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All increase risk of falls and confusion
SSRI rather than a benzodiazepine

 Most common problem is lack of sleep
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Sleep apnea – daytime drowsiness, snoring, snorting, waking up with headache, high blood pressure
Weight loss, exercise, “sleep hygiene”
 A sleep study can confirm it
 CPAP effective if basic interventions fail

 Proton pump inhibitors (omeprazole) are effective but should not be used indefinitely
 No difference between types – buy the cheapest
 H2 blockers (ranitidine) can do as good sometimes and has less risk over time
 Once a course has been completed (2-3 weeks) taper off and use as needed
 Lifestyle modifications help

 Avoid aggravating foods – acidic, alcohol, caffeine, chocolate, onions, garlic
 Avoid large meals
 Medications – calcium channel blockers, nitrates, sedatives
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Stop smoking
Don’t lie down after eating, raise bed
 Lose weight