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CKD – a disease of older people
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• Aging 204,274
• Nephrology 4435
• Nephrology and Aging 19
• Nephrology and Geriatrics 32
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• What are we going to do about it?
• What does it mean? How do I relate to it?
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• Social
• Psychology
• Biology
• Health
• Cultural
Geriatric medicineGerontological NursingOld Age PsychiatryGerodontologyGeronephrologists?…
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We are born copies….…but die as originals
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● Ageing = Complexity
● Growth AND Loss at all ages
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Association Between Positive Age Stereotypes and Recovery
From Disability in Older Persons
Becca R. Levy, PhD, Martin D. Slade, MPH, Terrence E. Murphy, PhD, and Thomas M. Gill,
MD
Division of Social and Behavioral Sciences, Yale School of Public Health (Dr Levy;
[email protected]) and Department of Internal Medicine, Yale School of Medicine (Mr Slade
and Drs Murphy and Gill), New Haven, Connecticut
To the Editor
Little research has been conducted on factors that account for why some older persons
recover from disability and others do not. We considered a new culture-based explanatory
factor: age stereotypes (defined as beliefs about old people as a category). 1 Positive age
stereotypes may promote recovery from disability through several pathways: limiting
cardiovascular response to stress,2 improving physical balance,3 enhancing self-efficacy,4
and increasing engagement in healthy behaviors. 1,4 We hypothesized that older persons with
positive age stereotypes would be more likely to recover from disability than those with
negative age stereotypes. Recovery was based on 4 essential activities of daily living
(ADLs; bathing, dressing, transferring, and walking) that are strongly associated with use of
health care services and longevity.5,6
Methods
The sample was drawn from the Precipitating Events Project, a study with high participation
(75.2%) and follow-up (95.4%) rates. Participants were recruited from a health plan in
greater New Haven, Connecticut, interviewed monthly for up to 129 months, and completed
home-based assessments every 18 months from March 1998 through December 2008. 5,6
Inclusion criteria were age of 70 years or older, English-speaking, community-living,
nondisabled (ie, independent in the 4 ADLs at baseline), responded to the baseline age-
stereotype measure, and experienced at least 1 month of ADL disability during follow-up
(117 participants remained nondisabled). The final sample consisted of 598 participants
(79.3% of the Precipitating Events Project cohort). The Yale University Human Subjects
Committee approved the study; all participants provided verbal informed consent.
©2012 American Medical Association. All rights reserved.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of
Interest and none were reported.
Author Contributions: Dr Levy had full access to all of the data in the study and takes responsibility for the integrity of the data and
the accuracy of the data analysis.
Study concept and design: Levy, Slade, Gill.
Acquisition of data: Levy, Gill.
Analysis and interpretation of data: Levy, Slade, Murphy, Gill.
Drafting of the manuscript: Levy, Slade.
Critical revision of the manuscript for important intellectual content: Levy, Slade, Murphy, Gill.
Statistical analysis: Levy, Slade, Murphy.
Obtained funding: Levy, Gill.
Study supervision: Levy, Gill.
NIH Public AccessAuthor ManuscriptJAMA. Author manuscript; available in PMC 2013 April 02.
Published in final edited form as:
JAMA. 2012 November 21; 308(19): 1972–1973. doi:10.1001/jama.2012.14541.
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Thanks to us oldies, the world economy is threatened, China’s prospects are stagnating and inequality is rising That’s nice, dear
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Economic Longevity Dividend
• $3.2 trillion/year to US economy 1970-2000
• Bonus of $1.3 million for each US citizen
• £40 billion a year to UK economy
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Damned
nuisance,
all those windows….
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The tragedy of old age is not the fact that each of us must grow old and die, but that the process of doing so has been made unnecessarily and at times excruciatingly painful, humiliating, debilitating, and isolating through insensitivity, ignorance, and poverty
Why Survive? Being Old in America
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25
.
Lancet 2011;377:1828-9.
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Grandparents Driving Grandchildren: An Evaluation ofChild Passenger Safetyand Injuries
WHAT’SKNOWNONTHISSUBJECT: Appropriate child-restraint
and seating practices reducechild-passenger injury risk, and
child-passenger safety education typically targets parent drivers.
Grandparents also drivewith their grandchildren, yet little is
known about their child-passenger safety practices or injuries
after crashes.
WHATTHISSTUDYADDS: In this study, grandparents
represented nearly10%of drivers in crashes involving child
occupants. Theadjusted risk of child injury for grandparent
drivers was 50%lower than that for parent drivers, despite less
optimal useof child restraint in grandparent-driver crashes.
abstractOBJECTIVES: To compare restraint-use practices and injuries among
children in crashes with grandparent versus parent drivers.
METHODS: This was a cross-sectional study of motor vehicle crashes
that occurred from January 15, 2003, to November 30, 2007, involving
children aged 15 years or younger, with cases identified via insur-
ance claims and data collected via follow-up telephone surveys. We
calculated the relative risk of significant child-passenger injury for
grandparent-driven versusparent-driven vehicles.Logistic regression
modeling estimated odds ratios (ORs) and 95%confidence intervals
(CIs), adjusting for several child occupant, driver, vehicle, and crash
characteristics.
RESULTS: Children driven by grandparents comprised 9.5% of the
sample but resulted in only 6.6%of the total injuries. Injuries were
reported for 1302 children, for an overall injury rate of 1.02 (95%CI:
0.90–1.17) per 100 child occupants. These represented 161 weighted
injuries (0.70%injuryrate) withgrandparent driversand2293injuries
(1.05%injury rate) with parent drivers. Although nearly all children
werereportedtohavebeenrestrained,childrenincrasheswithgrand-
parent drivers used optimal restraint slightly less often. Despite this,
children in grandparent-driven crashes were at one-half the risk of
injuries as those in parent-driven crashes (OR: 0.50 [95% CI: 0.33–
0.75]) after adjustment.
CONCLUSIONS: Grandchildren seem to be safer in crashes when
driven by grandparents than by their parents, but safety could be
enhanced if grandparents followed current child-restraint guidelines.
Additional elucidation of safegrandparent drivingpractices whencar-
rying their grandchildren may inform future child-occupant driving
education guidelines for all drivers. Pediatrics 2011;128:289–295
AUTHORS: FredM. Henretig, MD,a,bDennisR. Durbin, MD,
MSCE,a,b,c,d Michael J. Kallan, MS,c,dand FlauraK.
Winston, MD, PhDb,c,d,e,f
aDivision of Emergency Medicine, cCenter for Injury Research
and Prevention, and eDivision of General Pediatrics, Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania;bDepartment of Pediatrics and dCenter for Clinical Epidemiology
and Biostatistics, University of Pennsylvania School of Medicine,
Philadelphia, Pennsylvania; and fLeonard Davis Institute for
Health Economics, University of Pennsylvania, Philadelphia,
Pennsylvania
KEYWORDS
child passenger safety, family issues, motor vehicle accidents,
motor vehicle safety
ABBREVIATIONS
NHTSA—National HighwayTrafficSafety Administration
PCPS—Partners for Child Passenger Safety
OR—odds ratio
CI—confidence interval
All theauthors contributed substantially to this article, including
participation in theconception and design of thestudy, drafting
and revision of thearticle, and providing approval of thefinal
draft of themanuscript.
www.pediatrics.org/cgi/doi/10.1542/peds.2011-0046
doi:10.1542/peds.2011-0046
Accepted for publication Apr 4, 2011
Address correspondence to FredM. Henretig, MD, Division of
Emergency Medicine,Children’s Hospital of Philadelphia, 3400
Civic Center Blvd, Philadelphia, PA19104. E-mail: henretig@email.
chop.edu
PEDIATRICS(ISSNNumbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2011bytheAmerican Academy of Pediatrics
FINANCIALDISCLOSURE: Theauthors have indicated theyhaveno personal financial relationships relevant to this article todisclose.
ARTICLES
PEDIATRICSVolume128, Number 2, August 2011 289 at Trinity Health Sciences Centre on March 21, 2012pediatrics.aappublications.orgDownloaded from
DOI: 10.1542/peds.2011-0046; originally published online July 18, 2011; 2011;128;289Pediatrics
Fred M. Henretig, Dennis R. Durbin, Michael J. Kallan and Flaura K. Winstonand Injuries
Grandparents Driving Grandchildren: An Evaluation of Child Passenger Safety
http://pediatrics.aappublications.org/content/128/2/289.full.html
located on the World Wide Web at: The online version of this article, along with updated information and services, is
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy published, and trademarked by the American Academy of Pediatrics, 141 Northwest Pointpublication, it has been published continuously since 1948. PEDIATRICS is owned, PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
at Trinity Health Sciences Centre on March 21, 2012pediatrics.aappublications.orgDownloaded from
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• Broaden debate
• Ageism in access to full spectrum of care
• Embracing the complexity of frailty
• Gerontological competence no longer discretionary
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Reduces death and disability by 25%
Comprehensive geriatric assessment for older adults
admitted to hospital (Review)
EllisG, Whitehead MA, O’Neill D, LanghorneP, Robinson D
Thisisareprint of aCochranereview, prepared and maintained byTheCochraneCollaboration and published in TheCochraneLibrary
2011, Issue7
http://www.thecochranelibrary.com
Comprehensive geriatric assessment for older adults admitted to hospital (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ComprehensiveGeriatricAssessment
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Medical• Co-morbidity and
disease severity• Neurobiological
basis Dx• Medication review• Nutritional status
• Frailty*• Problem list
Social• Informal
support• Social network
Function• PADL
• Gait/balance*• Activity/exercise
• DADL/IADL
Mental Health• Cognition*
• Mood*• Fears
• + Collateral Hx
Environment• Home
• ?Telehealth• Transport
• Local resources
Elements of CGA
BGS 2015
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Expertise
Diligence
Time
The desire to do it!
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• Fried
• Phenotype
– Weight loss
– Weakness
– Fatigue
– Slowness
– Low activity
• Rockwood*
• Cumulative deficit
*asserting copyright!
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..nobody is quite sure what they are for, but they add a touch of class
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Key Question
• Threshold for stepping back
• Trigger for CGA approach
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Successful or Optimal Ageing
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• Older people do not primarily define themselves in terms of an overall state of ‘frailty’
• Older people do, however, recognise the experience of living with frailty
!
Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society
June 2015
!
Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society
June 2015
!
Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society
June 2015
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• Older people unaware of CGA• Name CGA disliked• Feel that it is a good idea in principle, despite
reservations about the time, effort and what it would entail in practice!
!
Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society
June 2015
!
Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society
June 2015
!
Frailty: Language and Perceptions A report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society
June 2015
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Single Assessment ToolMeasures needsFacilitates communicationPrompts careCommunity, hospital and nursing homeElectronicInternational comparison
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…terms older Europeans deemed unacceptable: “elderly,” “aged,” and “old,” with a particularly forceful rejection of “elderly”.
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Carer Burden
or
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The film succeeds
brilliantly in the
evocation of the wider
themes of ageing:
wisdom, altruism,
negotiation, and that
combination of “tough
but frail” that
increasingly
characterises older
people in the 21st
centuryBMJ 2009;339:b4215
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