THE OLDER PERSON AS A PATIENT Dr. Enrique VegaRegional Advisor in Aging and HealthPAHO/WHOvegaenri@paho.org

The Problem of Mr. Z: Mr. Z is 83 years old and functionally ok. He is the

caregiver of his 62 year old wife who has been diagnosed with dementia. He is a retired business man who is socially active, economically stable and with a good heath insurance program.

In the last three months Mr. Z has lost some strength and fell down two times, and he has arthritis in has right knee. He has taken 6 medications and he is not depressed.

Last week he fell and now he has been admitted to the hospital with two rib fractures and a trauma in his right knee.

JAMA. December 2009. Vol 302 No 24

The Problem of Mrs. Z: Mrs. Z is 62 years old and was diagnosed with Alzheimer

Disease in the last five years. She can not be alone for more than 8 hours due to her limitation in daily living activities, although she is in good economic condition and has a good heath insurance program. She has received support from social services.

She has LDL elevated and high systolic blood pressure and auricular fibrillation. She doesn’t sleep well and takes 8 medications.

Her husband suffered a fall last week and was admitted to the hospital and her two children live in another city.

JAMA, December 2009. 302 No 24

4

If Mrs. and Mr. Z were Mrs. And Mr. Thompson:

… with the same heath picture Mr. Thompson would be an informal

worker , without any economic pension and living with his wife with dementia and his single daughter and his adolescent grandson.

Without health coverage and only access to a basic primary health care in the health center.

5

Or maybe Mrs. And Mr. Parodi:

… with the same heath picture If Mr Parodi were a retired teacher, he

would have an adequate pension and would be living with his wife with dementia, a nurse, his single daughter and his adolescent grandson.

With health insurance coverage and access to the programs or service available.

Aging in Latin America and the Caribbean: Aging Population Growth IS NOW

Population in Millions

1360-69.

0

50

100

150

200

250

300

350

400

1900 1920 1950

Cardiop. IsquémicaCancerTuberculosisDisenteríaNeumonía

Mue

rtes

/100

.000

-80

-60

-40

-20

0

20

40

1950 1960 1975 1995

Cardiop. IsquémicaACVAMortalidad no CVC

ambi

o (%

)

Braunwald E, N Engl J Med 1997; 337: 1360-9

EPIDEMILOGIC TRANSITION

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Pepe Pancho

10

THE NEW PATIENT

Several Patient Types

NEW PROBLEMS

DISABILITY COMORBIDITY

FRAILTY

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NEW WAYS?

I DON’T UNDERSTAND WHAT YOUR PROBLEM IS. TALK MORE CLEARLY

PROPORTIONAL MORTALITY AND USE OF SERVICES

33.366.7

> 60 < 60

77.3

22.7

> 60 < 60

MORTALITY BY CANCER ONCOLOGY CONSULTATION

J Am Geriatr Soc 56:1796 –1801, 2008.

EDITORIAL Leading on Behalf of an Aging Society L Fried, JAGS 2008

EDITORIAL Leading on Behalf of an Aging Society L Fried, JAGS 2008

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MUST BE TEAMWORK BASED

NEVER GIVE UP