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HSM330 lec 7

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Health Services Management
HSM 330
Daolun Chen

HealthandAgingLecture#7 • front page of toronto star: seniors die hungry • residents of a retirement home • danny henderson died in hospital last winter • they were told initially there were no problems, but someone died in july • cause of death was starvation in a RETIREMENT HOME!! • in 2005, one geriatrician for every 5000 americans 65 and older • of 145 medical schools in U.S., only 9 have departments of geriatrics • very few schools in canada and US require geriatric courses for med students • med schools don’t put much emphasis on geriatrics • there are certain specialities such as cardiology or oncology that are in demand • there is a high satisfaction among geriatricians • few med schools require rotations in geriatrics • doctors are managing chronic conditions such as diabetes, osteoporosis and dementia • there is risk-benefit analysis that they engage in trying to manage symptoms • problem is that we don’t have the specialists we need doctors do not get much money in geriatrics • • orthopedic surgeon 400 grand, whereas a geriatrician is 150 grand • emergency room workers don’t really know how to address geriatric-related problems • other doctors as well don’t have sufficient training in dealing with the elderly • we need to know how to respond humanly to others’ problems • MRI services • major canadian hospitals are servicing people to get MRI or CT scans through private health care • there is a loop hole: third parties can purchase the rights for CT or MRI scans • one toronto man turned over 150 dollars to get an MRI: he paid 850 to an insurance company that was the third party • he got a scan within 2 days as opposed to 2 months • according to news released this week • creation of medicare in canada, was second most significant event in history • the most important key event in canadian history was confederation in 1867 • in third place, was charter of rights and freedoms in 1982 (constitution) • association of canadian studies • canadian patient survey week: healthcare organizations have made significant progress in minimizing risk and improving patient safety; we are successful in being able to have safe cultures in the way healthcare is being provided, communication is doing well, medication use • highest compliant scores (we’re doing better): hand hygiene education and training, infection control guidelines, standardizing and limiting the medication concentrations • one of the highest levels of improvement: falls prevention strategy • TELUS company launched personal health record • involves 2000 members and what they are doing is working in partnership with cardiovascular health heart and stroke foundation and telus support and family assistance provider • and they are launching start of personal health records through telus • canadian resonant matching service released report about canadians that are studying abroad • looked at data from students: they think there is 3500 students enrolled in medical schools abroad and majority have desire to return back canada to practice medicine and unfortunately majority will not be able to secure post-graduate medical training in canada • people here are suspicious as to why they didn’t get into med school to begin with • age of 65 and over accounts for 13.7% of all canadians • 3.7% of canadians are between 55-64 elderly pop is growing • • and medical advances are allowing us to live longer • we are facing a unprecedented challenge in how to deal with this age group • cognitive impairment is an early manifestation of aging and precursor to physical decline • our current medical system requires that the patient is just a number and just a recipient of care • sensory systems: touch, taste, smell, hearing and vision • basic concept: allows our nervous system • lets us get info about external environment • we know if a surface is cold, with age, receptors become less able to become sensitive to touch • if sense of touch becomes affected with age, we have a problem to discern external environment • as we age there is a 10% decline in sense of smell • olfactory bulb in brain is situated close to hippocampus and we have reason to believe that if someone has altered sense of smell, they should be checked out for alzheimer’s disease • if person loses sense of smell, they can’t taste food, and appetite becomes impaired and they enter cycle where they cant get enough nutrients • taste: bitter, salty, sweet receptors • as we age, there is a change in the ability to taste food • gradual losses: pariodontal disease • sudden loss of taste, doctor will send to a neurologists as well as loss of smell • auditory system: affects what we hear in environment, sense of balance (ability to stand and walk) • balance: ataxia (neurological term); someone has a lack of balance: ataxic • prebicursis: on average 30% of women lose their hearing , 80% of men • hearing a a ringing noise in ear non-stop (disease?): tininis...something • william shattner and some other dude in star trek suffered from tininis due to a blast from something on set • years ago, you’d be considered disabled if you needed glasses • lens loses elasticity with age, makes it harder to zero in on objects • presbiopia (happens to people in 40s maybe 30s) • muscles in iris decrease in number and strength with age • collagen stiffens and affects ability of pupil to enlarge • happens to people in 20s • changes in iris decrease the speed in which you can respond to light • age wave: ken talked about fluroescent lights • if yuo can’t adjust to lights, working after age of 20 becomes difficult if you have to contend with fluorescent light • tear gland: less lubrication people complain about dry eyes • vitruous humor becomes more fluid • “floater in the eye” one day you look out and see a bug infront of your eye • retina undergoes changes: cones and rods lose sensitivity as a result our night vision becomes affected • 4 most common diseases of eye: cataracts, glycoma (leading cause of blindness), diabetic , macular degeneration (losing central part for ability to see) (accounts for 40% of vision impairment for people over age of 80): atrophic type, and another type • smoking is known to be linked to sensory changes: taste buds don’t work as well • wear earplugs at work, and wear safety goggles and protective gear to protect your eyes (avoid strain), use proper lighting, get enough sleep • CNS consists of brain and spinal cord: parkinson’s disease, tumors, other neurological conditions • “MRI of brain and spine” by Scott • communication in brain occurs through neurons and synapse • different kinds of neuronal cells: each has axon, dendrite and soma • problem in communication across brain and spinal cord • disarthria (difficulty speaking): CVA (cerebral vascular accide
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