Kathy Sykes Senior Advisor, US EPA Aging InitiativeOctober 31, 2007

Improving Patient Safety Through Informed Medication Prescribing and Disposal Practices

Why Should Aging and the Environment Be a Research Priority?

The Demographic Imperative

By 2030, the 65+ population will double to 70 million

The population 85+ is the frailest and most rapidly increasing cohort

4 million today; 19 million by 2050

These increases are projected to be long-lasting features of American demographics

Why Focus on Older Adults?

Demographics

Decrease in organ function & reserves

Impaired chemical clearance and detoxification

Vulnerable to medication-environment adverse interactions (example - heat/psychotropic drugs)

Legacy of past occupational and environmental cumulative exposures to persistent agents.

Interactions with Environmental Agents: Concern about Polypharmacy

The body uses the same biological processes to “clear” medications as it does environmental toxicants.

Older persons take multiple medications.

Could be at increased risk of adverse reactions due to unknown interactions between medications and concurrent environmental exposures.

Indicator 30 - Prescription Drugs

Indicator 27 - Air Quality

Indicator 27 - Air Quality

The public health concern

WHO estimates 4% of all deaths and 5% of health loss to disability is caused by diarrhea. It is most commonly

caused by gastrointestinal infections which kill around 2.2 million people globally. Contaminated water is an

important cause of diarrhea.

Burden of Gastrointestinal Illness in the United States

CDC estimates 211 million episodes of acute gastrointestinal (GI) illness occur each year in the US resulting in over 900,000 hospitalizations and 6,000 deaths.

Many of these cases may be of infectious origin due to food or waterborne transmission—teasing apart this difference is a key reason for doing trials.

Source: Mead 1999

Older adults at increased risk for GI illness

Decline in immunity, changes in GI functions, and dehydration associated with aging lead to an increased susceptibility of enteric infections

Older adults may be at increased risk for infectious GI illness, severe diarrhea, or dying from diarrheal illness (Peterson 2003, Mounts 1999, Gerba 1996, Lew 1991)

Older adults are recognized by the USEPA as a sensitive subpopulation for waterborne diseases (USEPA 2000)

Burden of Waterborne Disease

Studies by Payment found that 1/3 of GI illness cases are related to drinking water, suggesting that up to 70 million cases of GI illness may be caused by waterborne pathogens.

Source: Payment 1991 & 1997

Gastroenteritis Costs

In the US, infectious gastroenteritis costs are estimated to exceed $20 billion annually.

Source: Peterson 2003

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Age Categories

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Bacterial and Viral Enteric Diseases as Contributing Causes of Death by Age, 1989 - 1996

Viral

’89-90 ’91-’92

’93-’94 ’95-’96

Bacteria

’89-90 ’91-’92

’93-’94 ’95-’96

GI Hospitalizations

Older adults are at the highest risk of dying during an gastroenteritis-related hospitalization, even when compared to infants

65-74: 14.4 deaths/1000 discharges; 75+: 24.9 deaths/ 1000 discharges)

Source: Mounts 1999

GI Hospitalizations 65+ Population

Persons over 65+ years of age account for over 75% of hospitalizations due to gastroenteritis

Source: Mounts 1999

Deaths Due to Enteric Disease

Highest rates of death related to enteric disease: 75+ years

Deaths related to bacterial enteric disease in older adults are increasing at a greater rate than in any other age category

Source: Peterson 2003

Major GI Pathogens

Morbidity Parasites- Cryptosporidium, Cyclospora, Giardia,

Microsporidia

Morbidity and Mortality Bacteria- Salmonella, Pseudomonas, Clostridium

difficile, Campylobacter, Mycobacterium avium complex, E.Coli

Viruses- Norwalk and Norwalk-like viruses, enteroviruses, rotavirus, adenovirus

Cryptosporidium spores

Susceptible populations include those with:

Advanced age

Immune suppression due to disease Immune suppression due to taking

pharmaceuticals

Intervention: Identify & Educate People at Risk

Building Healthy Communities for Active Aging

Building Healthy Communities for Active Aging

Can improve air & water quality in the community and improve the health of older adults and all citizens through intentional community design and systematic programming for active aging.

Change Behavior at the Community Level

Aging Initiative Fact Sheets and Posters

Age Healthier, Breathe Easier Fact sheet and poster Effective Control of Household Pests It’s Too Darn Hot--Planning for Excessive Heat

Events Environmental Hazards Weigh Heavy on the Heart Water Works Diabetes and Environmental Hazards

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Low Vision Large font Purple Series: for persons with limited reading ability

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