WeighingTheRisksandBenefitsofTreatmentinOlder…：权衡收益与风险的治疗中老年….pptVIP

Weighing The Risks and Benefits of Treatment in Older Adults Do our scales need recalibration? Debra L. Bynum, MD Division of Geriatric Medicine University of North Carolina ?????? What do you think of when you think of “Geriatrics”…… Quips… Benjamen Franklin: “All would live long, but none would be old” Abraham Lincoln: “And in the end, its not the years in your life that count. It’s the life in your years.” Geriatric “Domains” Palliative Care Dementia Incontinence Falls Delirium Frailty Constipation Geriatric “Catch Phrases” Start low and go slow… The Dying Patient…. “?Moriatrics…” Life expectancy… Quality of Life…. Falls Risk…. Polypharmacy Geriatric “Realities” “Graying” of America… Increasing population of oldest of the old (number of people over age 80 will increase form 6.9 million in 1990 to 25 million by year 2050) Geriatric “Realities” With an increase in older adults comes an increase in chronic diseases Many older adults are not “dying” but are living healthy, active lives with several chronic diseases… New Geriatric Domains Myocardial Infarction Congestive Heart Failure Atrial Fibrillation Stroke Hypertension Hyperlipidemia Osteoporosis Aortic Stenosis Do we “undertreat” older adults with chronic conditions? Probably Yes…. Outline Why we might undertreat older patients Problems with clinical trials New perspectives on life expectency Examples Importance of Absolute Risk reduction and determination of baseline risk Objectives Appreciate the need to individualize care of older patients with complex medical problems Understand the importance of Baseline Risk in determining the overall impact, or absolute risk reduction, that any certain therapy may have– patients at highest risk for a bad outcome stand to gain the most from a treatment that has even modest benefit! Why would we undertreat? Ageism Exclusion of older adults from clinical trials Assumption that the older adult may not want “aggressive” treatment Ideas based upon Life Expectanc