Challenging Patient

The Older Patient with Multiple Co-Morbidities

Objectives for the Day

Role of FM in caring for an aging population

Aging Chronic disease and aging Prescribing for older adults

3 million

35 million

70 million

4.2 million

21 million

Increases in the Oldest OldU.S. Population Aged 85+ (millions)

Source of data: U.S. Census Bureau, “We the American Elderly,” September 1993.

Percentage of Americans Age 65 Expected to Survive Age 90

Source of data: US Census Bureau

Prevalence of Chronic Conditions

0%5%

10%15%20%25%30%35%40%45%50%

Pre

vale

nce (

%)

HTN Arthritis CVD COPD Cancer Diabetes

Disease

NHIS, 2000, 2007

Percentage of Medicare Beneficiaries with 2 Chronic Conditions

0%10%

20%

30%

40%50%

60%

70%

80%

Perc

en

tag

e

65-74 75-84 85+

Age Group

>1 conditionFair or poor health

Medicare Beneficiary Survey, 2000

Health Affairs, 2004

Health Affairs, 2004

Case 1

Mr. D is a 70 y/o patient with h/o HTN and hyperlipidemia.

Recent lab includes FBS of 140 and 176. He presents for follow-up of lab.

Your task: “Outline” your visit -what will you ask, look for on examwhat is your initial assessment? Your plan?

Case 1 - More data

Meds: HCTZ 25, Simvastatin 20 mg VS: BP 144/84, P 72, Wt 85 kg, Ht

170 cm Lab: BUN 18, Cr 0.8, TC 200, LDL

130, HDL 44