1 aging outside the box stanford continuing studies bio 59 james f. fries, md december 5, 2007...
Post on 20-Dec-2015
215 views
TRANSCRIPT
![Page 1: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/1.jpg)
1
Aging Outside the Box
Stanford Continuing StudiesBio 59
James F. Fries, MDDecember 5, 2007
Slides Available at ARAMIS.Stanford.edu
![Page 2: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/2.jpg)
2
Class Schedule
General Themes
• October 17 – Longevity
• October 24 – Compression of Morbidity
• October 31 – Declining Disability
• November 7 – Aging and Health Policy
• December 5 – Questions and Application
• _ Evaluations
![Page 3: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/3.jpg)
3
For a Letter Grade
• Pick an article, any article, from the course reader.• Write a page, double-spaced, bullets allowed, on
”Why you should believe this paper”• Write a second page on “Why you should not
believe this paper.”• Email to [email protected] or mail to J. F. Fries,
1000 Welch Road, Suite 203, Stanford, CA 94304• Be ready to say a few words about your arguments
at the last class meeting December 5
![Page 4: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/4.jpg)
4
A General Theory of Morbidity and Mortality
• Perturbations to the individual health may be classified quantitatively as increasing or decreasing morbidity and as increasing or decreasing mortality
• The individual is subject to many perturbations and it is usual for some to have positive and some negative effects on morbidity and/or mortality
• Consider, for example, the perturbations of ‘suicide’ and ‘osteoarthritis’, which have opposite effects on mortality and morbidity
• Population morbidity and population mortality are the integrated sums of the positive or negative effects of different perturbations on individuals in the population
![Page 5: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/5.jpg)
Health Improvement Programs: Randomized Trials in Seniors
n time
health risk
score cost per person
savings per
person ROI
Bank of America 4,712
12 months -12% $29 $179 6.1
CALPers 57,268 12
months -10% $59 $300 5.1
Arthritis 809 6
months -7% $50 $260 5.2
Parkinson’s 290 6
months -10% $100 $570 5.7
Take Care of Yourself 2,833
12 months -17% $6 $20 3.5
Fries et al, Health Affairs, 1998
![Page 6: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/6.jpg)
6
Health Improvement and Cost Reduction Programs in Senior Populations: Goals
• Improved Self-Efficacy
• Reduction in Health Risks
• Increased Self-Management
• Targeting High-Risk Persons
• Targeting Chronic Disease
• Advance Directives: Humanizing the Last Year
![Page 7: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/7.jpg)
7
Parameters of Programs that Improve Health and Save Money
• Program cost $100/year or less (medical costs per senior per year = $6,000). Design ROI 5:1
• Multiple interventions in one• Multiple contacts through the year• Tailored interventions - to each his or her own health
improvement program• Not doctor/hospital/one-on-one based: too
expensive• Computer-driven, mail (and increasingly Web)
delivered• Focus on big, modifiable health and cost issues
![Page 8: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/8.jpg)
8
Senior Risk Reduction Program• Medicare Demonstration Program 2007-2010• Tailored health improvement and cost
reduction programs (‘HRA based’)• Potential established by RAND; randomized
trial design by MedSTAT• Five interventions ‘best in class’, two control
groups, three years, 85,000 subjects, independent assessment of results
• Goals:health up, risks down, costs neutral or down = a new Medicare benefit
![Page 9: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/9.jpg)
9
ConclusionsTheory, Longitudinal Studies, Population
Surveys, and Randomized Trials document that:• Disability has been decreasing by 2% or more per year in the
U.S.for at least 10 years. Mortality rates are decreasing at
only 1% a year, documenting Compression of Morbidity
• Health enhancement programs can improve health and
reduce costs in mature adult populations
• The Senior Risk Reduction Demonstration is a randomized
controlled trial which could lead to better senior health and
lower medical costs
• Further Compression of Morbidity is feasible but not
inevitable.
![Page 10: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/10.jpg)
10
![Page 11: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/11.jpg)
11
QUESTIONS?
![Page 12: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/12.jpg)
12
HOW CAN BETTER SENIOR HEALTH BE ACHIEVED?
• Self-Efficacy
• Health Policies
• Targeted Postponement of Morbidity
• Behavioral Health Risk Reduction
• Medical Primary Prevention
• Medical Secondary Prevention
• Social and Environmental Policies
![Page 13: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/13.jpg)
13
PRIMARY PREVENTION
• Smoking• Passive Smoking• Inactivity• Obesity• Lipids• Inflammation• Salt• Fiber• Screenings:mam, col, pap,
bp, eye, bmd
• Alcohol
• Caffeine
• Sun
• Seat Belts
• Vehicles
• Highways
• Aspirin
• Pollution
• Vaccines
![Page 14: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/14.jpg)
14
SECONDARY PREVENTION
• Aspirin• Hypertensive control• Lipid control• Diabetes control• Beta blockers
• Bone strengthening• Fall Prevention• Self-management• Medical errors• Plus: Primary
prevention approaches
![Page 15: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/15.jpg)
15
![Page 16: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/16.jpg)
16
FRAILTY, ORGAN RESERVE, AND RESILIENCE
The Frail Elder
The Resilient Senior
![Page 17: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/17.jpg)
17
Abundant Benefits of Exercise
• Increased Longevity
• Postponed Disability
• Heart Disease Down
• Brain Function Up
• Lung Disease Down
• Muscle Strength Up
• Endurance Up
• Osteoporosis Down
• Blood Clots Down
• Better Appearance
• Better Sleep
• Less Stress
• Better Self-Efficacy
• Better Sex
• Increased Reserves
• Endorphans
• The Overweight Dividend: Fit but Fat
![Page 18: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/18.jpg)
18
CREDENTIALS OF AN AGING EXERCISE GURU
• Boston Marathon age 40 (3:09)
• Grand Teton ages 40,50,60
• Nevada Pisco age 46
• Everest, almost, age 54
• Six Summits, age 50 +
• Twenty 14ers, age 60 +
• Pike’s Peak Marathon age 65
![Page 19: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/19.jpg)
19
BEING A WEEKEND WARRIOR IS NOT GOOD
• Insufficient Conditioning
• Prone to Injuries
• Sporadic and more Sporadic
• Too Easy a Habit to Break
![Page 20: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/20.jpg)
20
THE PROBLEM OF TIME
• A Matter of Habit• Put the Time In first, Intensity Later• 2-3 Endurance Hours a Week for 90 %
Effect• Breaking a Sweat on a cool day• Plateau occurs at 8 hours/week
![Page 21: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/21.jpg)
21
THE PROBLEM OF BOREDOM
• There is an Activity for Everyone• It Must Be A Happy Habit• Scenery or Television or Meditation• Cross-Training• Dogs and Aerobic Gardening• No Excuses Please• Exercise is its Own Reward• Feeling Good All Day Long
![Page 22: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/22.jpg)
22
WHEN YOU HURT• Reduce or discontinue activity• Increase alternative activity – most
frequently bicycling (moving or stationary), swimming, brisk walking, cross-country ski machine
• Usually smooth and gradable is best• When resuming an activity, take as long to
get back to baseline as you took away from the activity
![Page 23: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/23.jpg)
23
WHERE YOU HURT:Listening to the Pain MessageThe Six-Week Re-Injury Rule
• Back - favor• Ribs - tape• Ankles - brace• Achilles Tendon - lift
• Knees - brace• Plantar Fascia - strap• Elbow - strap• Neck - collar
![Page 24: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/24.jpg)
24
![Page 25: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/25.jpg)
25
![Page 26: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/26.jpg)
26
![Page 27: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/27.jpg)
27
![Page 28: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/28.jpg)
28
![Page 29: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/29.jpg)
29
![Page 30: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/30.jpg)
30
![Page 31: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/31.jpg)
31
![Page 32: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/32.jpg)
32
![Page 33: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/33.jpg)
33
![Page 34: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/34.jpg)
34
![Page 35: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/35.jpg)
35
![Page 36: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/36.jpg)
36
![Page 37: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/37.jpg)
37
Scenarios for Future Morbidity and Longevity
Morbidity Death
Present Morbidity
I. Life Extension
II. Shift to the Right
III. Compression of Morbidity
56
7765
8060
8056
76
![Page 38: 1 Aging Outside the Box Stanford Continuing Studies Bio 59 James F. Fries, MD December 5, 2007 Slides Available at ARAMIS.Stanford.edu](https://reader031.vdocuments.us/reader031/viewer/2022032201/56649d415503460f94a1c591/html5/thumbnails/38.jpg)
38