This 58-year-old businessman is generally healthy but feels more sluggish than in the past. He has controlled hypertension and engages in occasional exercise and a healthy diet, but does not feel as physically active as 20-30 years ago. He sees aging as catching up to him and wants to improve his wellness.
Exercise is a subcategory of physical activity that is planned, structured, repetitive and purposeful with the objective of improving or maintaining one or more components of physical fitness.
Frailty as a Long Term Condition?
Monday 10 November 2014
12noon – 12.45pm
Professor John Young
National Clinical Director for Integration & Frail Elderly, NHS England
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
Scott Letendre, MD, of the UC San Diego HIV Neurobehavioral Research Program, presents "Overview of HIV & Aging" for AIDS Clinical Rounds at UC San Diego
Exercising During the Pandemic
Presentation by Dr Goh Ping Ping
Cardiologist, Echocardiologist
Clinical Exercise Specialist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Frailty applications in clinical practice. Assessing level of frailty can help identify underlying risks to contextualize conversations with patients and their caregivers.
Cardiorespiratory Fitness, Health Outcomes, and Health Care Costs: The Case f...Matti Salakka 🐠
Physical inactivity is becoming a world-wide epidemic – and the consequences can be both costly and deadly. This was outlined by Dr. Jonathan Myers who, citing a range of studies and recent research results, was able to show hard-hitting data related to the correlation between fitness (or lack thereof) and poor health. Myers argues fitness may well be a better marker than traditional risk factors for CVD and all-cause mortality. Amongst the eye-opening findings presented to the audience was that, for the first time, global deaths-per-year due to physical inactivity are higher than for smoking.
Studies have shown that older women receive less aggressive screening and treatment for breast cancer. Geriatric Oncologist, Meghan Karuturi, of MD Anderson Cancer Center joins us in this webinar to discuss age bias and how it affects older patients.
Exercise is a subcategory of physical activity that is planned, structured, repetitive and purposeful with the objective of improving or maintaining one or more components of physical fitness.
Frailty as a Long Term Condition?
Monday 10 November 2014
12noon – 12.45pm
Professor John Young
National Clinical Director for Integration & Frail Elderly, NHS England
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
Scott Letendre, MD, of the UC San Diego HIV Neurobehavioral Research Program, presents "Overview of HIV & Aging" for AIDS Clinical Rounds at UC San Diego
Exercising During the Pandemic
Presentation by Dr Goh Ping Ping
Cardiologist, Echocardiologist
Clinical Exercise Specialist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Frailty applications in clinical practice. Assessing level of frailty can help identify underlying risks to contextualize conversations with patients and their caregivers.
Cardiorespiratory Fitness, Health Outcomes, and Health Care Costs: The Case f...Matti Salakka 🐠
Physical inactivity is becoming a world-wide epidemic – and the consequences can be both costly and deadly. This was outlined by Dr. Jonathan Myers who, citing a range of studies and recent research results, was able to show hard-hitting data related to the correlation between fitness (or lack thereof) and poor health. Myers argues fitness may well be a better marker than traditional risk factors for CVD and all-cause mortality. Amongst the eye-opening findings presented to the audience was that, for the first time, global deaths-per-year due to physical inactivity are higher than for smoking.
Studies have shown that older women receive less aggressive screening and treatment for breast cancer. Geriatric Oncologist, Meghan Karuturi, of MD Anderson Cancer Center joins us in this webinar to discuss age bias and how it affects older patients.
I need a response for the 2 peers belowMany disorders, eskarinorchard1
I need a response for the 2 peers below:
Many disorders, especially malignancies, are asymptomatic in their early stages. Consequently, it is imperative that health care providers provide routine screenings so that diseases can be detected early on and prevention and treatment can be implemented if necessary. Screening is in no way a cure for diseases, but it provides a means to detect diseases before symptoms start. Screenings include Pap smear to detect cervical cancer, mammograms to detect breast cancer, colonoscopy to detect colorectal cancer, and low dose CT scan to detect lung cancer (Centers for Disease Control and Prevention (CDC), 2020).
Enacted in 1984, the U. S. Preventive Task Force (USPTF) is an independent group of experts from several specialties, such as pediatrics, primary care, behavioral health, and nursing, that strive to provide knowledge and advice on various interventions and preventive services for diseases based on evidence-based research (D’Andrea, Ahnen, Sussman, & Najafzadeh, 2019). The USPTF helps shape medicine by assisting health care professionals and patients to prevent and treat diseases. Patients and clinicians collectively decide what treatment is best for the patient based on the recommendation of “best practice” disseminated by the USPTF (D’ Andrea et al., 2019). The ultimate goal of USPFT is to promote and improve the health of Americans by enacting clinical preventive measures based on scientific research.
Colorectal Cancer Screening Recommendation
The USPFT has several recommendations in place regarding screening for colorectal cancer, which is a collective group of cancers that affects the large intestine (the colon) and/or the rectum. This type of cancer usually starts in the colon, preliminary as polyps in many cases, and then metastasize as cancerous cells to proximal areas of the gastrointestinal system or reproductive organs (American Cancer Society, 2020). According to the American Cancer Society, the recommendation for individuals of average risk of colorectal cancer is screening starting at age 45, with either a stool-based test that detects cancer cells in the stool or an imaging exam that visualizes the structures of the colon and rectum.
The American Cancer Society (2020) recommends that individuals who are in “good health and a life expectancy of at least 10 years” should continue to be screened for colorectal cancer until they are 75 years of age. For individuals 76 to 85 years of age, the choice to continue to be screened should be based on the preference of the patient, their life expectancy, overall health status, and outcome of prior screenings (American Cancer Society, 2020). Screening is not recommended for individuals over the age of 85 due to their decreased life expectancy with or without the disease (American Cancer Society, 2020).
The American Cancer Society (2020) reports that testing for colorectal is separated by stool-based testing or visualization of images. The ...
Dr. Fox: http://drmurrayfoxmd.com | 972-379-2416
Dr Murray Fox, M.D. of Women's Specialists of Plano presents on a variety of preventative health care topics specific to women.
This is the updated slideshow for the 2011 NFMBR presentation of Geriatrics. We apologize sincerely for the error in the manual, you can both view the slideshow online or download it to your computer and view with PowerPoint.
Critical Appraisal of a Diagnostic Test Article.pptxMarc Evans Abat
How to critically appraise a journal article on accuracy of a diagnostic test. This presentation spans issues regarding directness, validity, applicability and individualization. Also included are how to process information on sensitivity, specificity, likelihood ratios, predictive values and decision thresholds
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Abat wellness in elderly--pims 2020 version 2 -trimmed down
1. • 58 year old successful businessman
• (+)Hypertension, controlled by
medications
• Plays golf 1-2x a month
• Healthy eater
• Does not smoke
• Occasional drinker
• Feels sluggish
• Not as physically active as he was
20-30 years ago
• Feels like “age is catching up on
him”
I need
something more…
2. MARC EVANS M. ABAT, MD, FPCP, FPCGM
Internal Medicine-Geriatric Medicine
Division of Adult Medicine, Department of Medicine, PGH
“I wanna be forever
young”
(Wellness in the Elderly)
3. Outline
• Concept of Wellness in the Elderly
• Approaching Wellness Evaluation in the Elderly
• Indicators of Health and Wellness in the Elderly
• Multidisciplinary Approach to Good Health and Wellness in the
Elderly
5. Aging
• accumulation of changes responsible for the sequential
alterations that accompany advancing age and the associated
progressive increases in the chance of disease and death
Harman D, Proc National Academy of Science USA, 1991
6. Wellness in the Elderly
“The antonym of
ILLNESS”
“Something
much MORE”
7. Wellness in the Elderly
• a purposeful process of
individual growth, integration of
experience, and meaningful
connection with others,
reflecting personally valued
goals and strengths, and
resulting in being well and
living values
Nurs Forum. 2012 Jan-Mar; 47(1): 39–51.
8. Healthy Aging
• The process of
developing and
maintaining the
functional ability that
enables well-being in
older age
WHO. 2015. World report on ageing and
health
11. Goal of the Diagnostics
Screening
Case
Finding
12. ..difference between screening, i.e., testing large numbers
of apparently healthy people to detect unrecognized disease at
an earlier stage……
………and case-finding, i.e., evaluating subgroups of
people at increased risk of having a disease to make a diagnosis
earlier than would occur by waiting for them to present with
symptoms or signs.
http://jamanetwork.com/journals/jama/fullarticle/2510889
13. The Core
• multidimensional, interdisciplinary
diagnostic process
• develop a coordinated and integrated
plan for treatment and long-term
follow-up.
• emphasizes quality of life and
functional status, prognosis, and
outcome
• employment of interdisciplinary
teams and the use of any number of
standardized instruments
• both a diagnostic and therapeutic
process
Comprehensive
Geriatric
Assessment
Medical
History
Physical
Functional
Behavioral
Emotional
Environmental
Spiritual
Social
http://journals.sagepub.com/doi/pdf/10.1177/107327480301000603
https://www.uptodate.com/contents/comprehensive-geriatric-assessment
https://www.bmj.com/content/343/bmj.d6553
14. Guidance on Preventive Services
US Preventive Services Task Force (USPSTF)
Independent panel of experts in primary care and prevention who
systematically reviews the evidence of effectiveness and develops
recommendations for clinical preventive services. These reviews are
published as U.S. Preventive Services Task Force recommendations
on the Task Force Website and/or in a peer-reviewed journal.
https://www.uspreventiveservicestaskforce.org/Page/Name/recommendation
s
15.
16. Grade A
women aged 30 to 65 years, screening every 3 years with
cervical cytology alone, every 5 years with high-risk human
papillomavirus (hrHPV) testing alone, or every 5 years with
hrHPV testing in combination with cytology (co-testing).
2018
Screening for colorectal cancer starting at age 50 years and
continuing until age 75 years.
2016 (being
updated)
Screening syphilis infection in persons who are at increased risk
for infection.
2016
screening for high blood pressure in adults aged 18 years or
older
2015 (being
updated)
17. Grade B
Unhealthy Drug Use Screening 2020
Hepatitis C Infection Screening 2020
1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men
aged 65 to 75 years who have ever smoked.
2019
assess women with a personal or family history of breast, ovarian, tubal, or
peritoneal cancer or who have an ancestry associated with breast cancer
susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial
risk assessment tool; a positive result on the risk assessment tool should receive
genetic counseling and, if indicated after counseling, genetic testing.
2019
unhealthy alcohol use in primary care settings, and providing persons engaged in
risky or hazardous drinking with brief behavioral counseling interventions to reduce
unhealthy alcohol use.
2018
18. screening for osteoporosis with bone measurement testing to prevent
osteoporotic fractures in women 65 years and older
2018
screening for osteoporosis with bone measurement testing to prevent
osteoporotic fractures in postmenopausal women younger than 65 years who
are at increased risk of osteoporosis, as determined by a formal clinical risk
assessment tool
2018
screening for latent tuberculosis infection (LTBI) in populations at increased
risk.
2016
screening for depression in the general adult population, 2016 (being
updated)
biennial screening mammography for women aged 50 to 74 years. 2016
19. screening for abnormal blood glucose as part of cardiovascular risk
assessment in adults aged 40 to 70 years who are overweight or obese
2015
screening for chlamydia and gonorrhea in sexually active women age 24
years and younger and in older women who are at increased risk for infection
2014 (being
updated)
screening for hepatitis B virus (HBV) infection in persons at high risk for
infection
2014 (being
updated)
annual screening for lung cancer with low-dose computed tomography
(LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking
history and currently smoke or have quit within the past 15 years; screening
should be discontinued once a person has not smoked for 15 years or
develops a health problem that substantially limits life expectancy
2013 (being
updated)
20. Grade C
selectively offer screening for AAA with ultrasonography in men aged 65
to 75 years who have never smoked
2019
men aged 55 to 69 years, the decision to undergo periodic prostate-
specific antigen (PSA)-based screening for prostate cancer should be an
individual one
2018
screen for colorectal cancer in adults aged 76 to 85 years should be an
individual one, taking into account the patient's overall health and prior
screening history
2016 (being
updated)
21. Grade D
asymptomatic bacteriuria in nonpregnant adults 2019
routine risk assessment, genetic counseling, or genetic testing for women whose personal or family
history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations.
2019
screening for pancreatic cancer in asymptomatic adults. 2019
screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do
not have a history of a high-grade precancerous lesion (ie, cervical intraepithelial neoplasia [CIN] grade
2 or 3) or cervical cancer.
2018
screening for cervical cancer in women older than 65 years who have had adequate prior screening and
are not otherwise at high risk for cervical cancer
2018
screening with resting or exercise electrocardiography (ECG) to prevent cardiovascular disease (CVD)
events in asymptomatic adults at low risk of CVD events
2018
screening for ovarian cancer in asymptomatic women. 2018
screening for thyroid cancer in asymptomatic adults 2017
against screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults. 2016 (being
updated)
against screening for asymptomatic carotid artery stenosis in the general adult population. 2014 (being
updated)
against screening for testicular cancer in adolescent or adult men 2011
22. Grade I
Cognitive Impairment in Older Adults 2020
Screening for abuse and neglect in all older or vulnerable adults 2018
screening for atrial fibrillation with electrocardiography (ECG). 2018 (being
updated)
screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk with the
ankle-brachial index (ABI) in asymptomatic adults
2018
adding the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, or
coronary artery calcium (CAC) score to traditional risk assessment for cardiovascular disease
(CVD) in asymptomatic adults to prevent CVD events.
2018
screening for osteoporosis to prevent osteoporotic fractures in men 2018
screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at
intermediate or high risk of CVD events
2018
celiac disease in asymptomatic persons. 2017
screening pelvic examinations in asymptomatic women for the early detection and treatment of a
range of gynecologic conditions.
2017
23. visual skin examination by a clinician to screen for skin cancer in adults. 2016
screening for impaired visual acuity in older adults. 2016 (being
updated)
digital breast tomosynthesis (DBT) as a primary screening method for breast cancer. 2016
adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or
other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
2016
screening mammography in women aged 75 years or older 2016
screening for thyroid dysfunction in nonpregnant, asymptomatic adults. 2015
screening for vitamin D deficiency in asymptomatic adults. 2014 (being
updated)
screening for chlamydia and gonorrhea in men. 2014 (being
updated)
screening for suicide risk in adolescents, adults, and older adults in primary care 2013 (being
updated)
screening for oral cancer in asymptomatic adults. 2013
screening for primary open-angle glaucoma (POAG) in adults. 2013 (being
updated)
screening for hearing loss in asymptomatic adults aged 50 years or older 2012 (being
updated)
screening for bladder cancer in asymptomatic adults. 2011
26. •International Journal of Environmental Research and
Public Health 10(12):6630-44
Healthy
Ageing
Good quality
of life
Survivial to
specific age
in good
health
Autonomy in
ADLs
No or few
chronic
diseases
Little or no
disability
No/mild
cognitive or
function
impairment
High social
participation
Health
behavior
Culture
Gender
29. What if at the end of the Wellness Check-Up there is really
nothing wrong with the older person?
Re-evaluate
goals
Modify
plans
Revise
management
Reassure
Good day. Let me start of by presenting this case. He is a 58 year old successful businessman. Hypertensive, but, controlled by medications. He Plays golf 1-2x a month.
He is a Healthy eater, Non-smoker and Occasional drinker
However, he Feels sluggish and Not as physically active as he was 20-30 years ago. He Feels like “age is catching up on him”
He needs something more
In the next few minutes we will be discussing some concepts on Wellness in the Older Person. I am Dr. Marc Abat, and thank you for being with us.
WE will discuss the concept of Wellness in the Elderly, How to approach wellness evaluation for this age group, the indicators of health and wellness in the elderly and briefly touch on the multidisciplinary approach to good health and wellness for the elderly
We will start with the concept of wellness in the elderly
Aging is accumulation of changes responsible for the sequential alterations that accompany advancing age and the associated progressive increases in the chance of disease and death
Changes happen from the molecular level, in our DNA and genes, up to larger biochemical processes, up to our organs, leading to changes in how we function. All of these contribute to us getting more sick and dying.
Being well was earlier thought of as just having no disease and not being sick. But throughout the years, this definition has considerably expanded.
We now acknowledge wellness in the elderly as a purposeful process of individual growth, integration of experience, and meaningful connection with others, reflecting personally valued goals and strengths, and resulting in being well and living values
Wellness may thus be different concept and process from person to person, and at each stage of their lives
There is considerable similarity and overlap with the WHO concept of healthy aging, defined as The process of developing and maintaining the functional ability that enables well-being in older age
The intrincic capacity of the older person emanates from his genetics, health characteristics (like age-related traits, health related behaviors, risks factors, diseases and geriatric syndromes), and personal characteristics. The intrinsic capacity interacts with his environment in both directions, leading to his overall functional ability that enables wellbeing.
So how do we approach wellness evaluation in the elderly?
We should always recognize that there is a reason for them to undergo these wellness evaluations. It may start out just like any preventive or general exam, but there may more deep-seated concerns like psychosocial concerns, or concerns for particular diseases
Selection of diagnostics may boil down to whether you are doing the test for screening or case finding
Screening involves testing large numbers of apparently healthy people to detect unrecognized disease at an earlier stage……versus
Case-finding involves evaluating subgroups of people at increased risk of having a disease to make a diagnosis earlier than would occur by waiting for them to present with symptoms or signs.
The core of doing a wellness evaluation in the elderly still involves doing the Comprehensive Geriatric Assessment. This is a multidimensional, interdisciplinary diagnostic process to develop a coordinated and integrated plan for treatment and long-term follow-up. It employs interdisciplinary teams and the use of any number of standardized instruments. There is emphasizes on quality of life and functional status, prognosis, and outcome. It is both a diagnostic and therapeutic process
We will base our choices of diagnostics mainly and primarily on evidence-based recommendations. It can be from health authorities or societies involved in these policies. For this talk, we will use the Guidance on Preventive Services of the US Preventive Services Task Force (USPSTF)
These are the explanations for the grading. Grades A and B should be offered or provided. Grade C services should only be offered for select patients depending on individual circumstances. Grade D services are discouraged. Grade I services have insufficient current evidences, and as such patients should be aware of the uncertainty in harms and benefit
Grade A recommendations are for cervical cancer screening for women aged 30 to 65 years, Screening for colorectal cancer starting at age 50 years and continuing until age 75 years, Screening syphilis infection in persons who are at increased risk for infection, screening for high blood pressure in adults aged 18 years or older
Grade B recommendations are for Unhealthy Drug Use Screening, Hepatitis C Infection Screening, 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked, unhealthy alcohol use in primary care settings, women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or with an ancestry associated with (BRCA1/2) gene mutations with an appropriate familial risk assessment tool
screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older, or in those younger and increased risk of osteoporosis, as determined by a formal clinical risk assessment tool
screening for latent tuberculosis infection (LTBI) in populations at increased risk
screening for depression
biennial screening mammography for women aged 50 to 74 years
screening for abnormal blood glucose in adults aged 40 to 70 years who are overweight or obese
screening for chlamydia and gonorrhea in older women who are at increased risk for infection
screening for hepatitis B virus (HBV) infection in persons at high risk for infection
annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked
men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one
screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history
Notable Grade D recommendations against screening for asymptomatic bateriuria, routine BRCA ½ testings, pancreatic CA testing, cervical Ca screening in those post-hysterectomy and with no high-grade cervical lesions and in those older than 65 but low risk and with adequate previous screening
ECG in asymptomatic adults at low risk for CVD
Ovarian and thyroid Ca
Asymptomatic adults for COPD
Asymptomatic carotid artery stenosis
Grade I is given to screening for cognitive impairment, abuse and neglect, AF with ECG, PAD and CVD risk with ankle brachial index in asymptomatic adults, adding parameters like ABI or hsCRP to traditional CVD risk assessment, osteoporosis in men, resting or exercise ECG in asymptomatic but intermediate to high risk adults, celiac disease, screening pelvic examinations in asymptomatic women
others
Shared decision making should be done in cases wherein there are no clear recommendations for a particular procedure, especially if the patient is requesting it. The pros and cons, including possible adverse events should be balanced with perceived benefits
Indicators of healthy ageing would be a perceived good quality of life, survival to a specific age in good health, autonomy in activities of daily living, none or few chronic diseases, little or no disability, none or mild cognitive impairment, high social participation, good health behavior
All of these happen in the context of biology/genetics, gender, social services, physical environment, culture and economic determinants, that help promote healthy ageing
Let’s briefly discuss a multidisciplinary approach to wellness in the elderly
Given the data set we obtained for the older person, we formulate a management plan with the health care team, including the primary attending doctor, other specialists, nursing team, the rehabilitation team, possibly the fitness coach, social worker and other professionals needed to help address the concerns identified in the entire evaluation processes. This may be a continuing or evolving process, that also needs prioritization.
If the person is really “well” or there is nothing clearly amiss at the start, the cycle of reassurance, reevaluation of goals, modification of all plans, and revision of management should be done. There may be other important issues that where not initially identified or new ones that develop or revealed over time