Screening Elderly Syed I. Nabi, MD Resident MHRI Facts on

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Screening Elderly

• Syed I. Nabi, MD
• Resident
• MHRI

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Facts on Elderly Populations

• persons 65 years or older--numbered 34.5 million
  in 1999. 12.7 of the U.S. population, about one
  in every eight Americans
• Since 1900, the percentage of Americans 65 has
  more than tripled (4.1 in 1900 to 12.7)
• older population itself is getting older ) By
  2030, it will double to 70 million older persons,
  

compiled primarily from the U.S. Bureau of the
Census and the National Center for Health
Statistics
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Data source U.S. Census Bureau, Census of
Population and Housing, 2000.
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Commonly screened conditions

• DM
• HTN
• ANEMIA
• CANCERS
• CAS
• LIPID
• DEMENTIA

• DEPRESSION
• HEARING LOSS
• OBESITY
• OSTEOPOROSIS
• THYROID
• VISUAL LOSS

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But I forget..!!!
Dementia Depression
Hearing
Visual Loss /Anemia
HTN
Thyroid/CAS
OBESITY
DM/LIPID
Osteoporosis
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Screening Guideline Trends

• GENERAL TREND ORGANIZATION WITH SPECIALITY ARE
  MORE AGGRESSIVE THAN ORGANIZATION COVERING
  BROADER POPULATIONS E.G. AAFP/ USPSTF

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When and How???
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USPSTF US Preventive Services Task Force, AAFP
American Academy of Family Physicians
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AOA American Optometric Association, AAO
American Academy of Ophthalmology, USPSTF US
Preventive Services Task Force, AGS American
Geriatric Society, AAFP American Academy of
Family Physicians
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USPSTF US Preventive Services Task Force, AGS
American Geriatric Society, AAFP American
Academy of Family Physicians
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AACE American Association of Clinical
Endocrinologists, ATA American Thyroid
Association, USPSTF US Preventive Services Task
Force
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AHA American Heart Association, CNS Canadian
Congress of Neurological Sciences, USPSTF US
Preventive Services Task Force
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• ACAS (Asymptomatic Carotid Atherosclerosis Study)
  JAMA 19955
• 5 year Risk of Ipsilateral Stroke, operative
  stroke, and Death was 5 with CEA (Carotid
  endarterectomy ) vs. 11 in control group
• More benefit in men than women
• Cost-effectiveness of targeted screening and
  surgery for high grade carotid artery stenosis is
  43,000 per QALY (Quality Adjusted Life Year)
• Prevalence of ICAS (Internal Carotid Artery
  Stenosis) of lt70 tends to increase as follows
• Thus lowest in patients with ONLY RISK Factors
• Intermediate in patients with MI and Angina
• Highest in patients with PAD and AAA
• ACST (Asymptomatic Carotid Surgery Trial) LANCET
  2004
• Absolute Risk reduction for stroke or death was
  5.4 at 5 years with significant benefit for
  women
• CARESS Trial (Clopidogrel ASA for Reduction of
  Emboli in Symptomatic Carotid Stenosis)
  Circulation 2005 May
• Clopidogrel ASA more affective than ASA alone
  in reducing asymptomatic embolization in RECENTLY
  SYMPTOMATIC gt50 CAS

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ADA American Diabetic Association, USPSTF US
Preventive Services Task Force
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NCEP III National Cholesterol Education Program
ATP III, USPSTF US Preventive Services Task
Force, AAFP American association of Family
Physician, AACE American Association of Clinical
Endocrinologist
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JNC VII Joint National Commission 7th report
(National Heart, Lung, and Blood Institute),
USPSTF US Preventive Services Task Force, AAFP
American association of Family Physician
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Go laugh _at_ your own MAMA!!!
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NHLBI National Heart, Lung, and Blood Institute,
USPSTF US Preventive Services Task Force, AAFP
American association of Family Physician
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NHLBI National Heart, Lung, and Blood Institute,
USPSTF US Preventive Services Task Force, AAFP
American association of Family Physician
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CANCERS???

• FEMALE
• ORAL
• THYROID
• BREAST
• LUNG
• GASTRIC
• LIVER
• PANCREATIC
• COLORECTAL
• BLADDER
• OVARIAN
• CERIVICAL
• ENDOMETRIAL
• SKIN

• MALE
• ORAL
• THYROID
• LUNG
• GASTRIC
• LIVER
• PANCREATIC
• COLORECTAL
• BLADDER
• PROSTATE
• TESTICULAR
• SKIN

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