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Marlon Maus MD, DrPH, FACS UC Berkeley School of Public Health email@example.com
PH 217C, Tuesday March 5th, 2013
• Background • Common roots of Public Health and Built Environment • Health problems in the 21st Century: effects on older adults • Vision in older adults • Conclusion
Common Roots of PH and Planning Schilling. “ The public health roots of zoning: In search of active living ’s legal genealogy . 2005. Am J of Prev Med.
S. Population 1900 .U.
Leading Causes Of Death United States: 1900 .
“…Of the 30 years of increased life expectancy 1890 1990… 5 years can be attributed to medical care.” The rest has come from: Infrastructure (including housing. immunization) Bunker cited in Prescription for a Healthy Nation Farley and Cohn 2004 . clean water) Public Health (esp.
• The real Leading causes of death United States: 2000 .
Obese People Worldwide People with Diabetes Worldwide • Worldwide: – 25% Obese – 7% Diabetic .
Obesity: US Adults .
Diabetes: US Adults .
qualys by 22 years.gov/nr/ne/yr11/yr11rel95.cde. http://www.Childhood obesity • Rates of overweight and obesity have quadrupled among 6-11 year olds in the last three decades • Over 9 million American children over the age of 6 are considered obese • Cuts life expectancy by 15 years. UCLA Center for Health Policy Research. . et al.ca.asp#tab1 . pushups and body mass index measurements… Babey SH. • In CA only 25% of 5th graders met state fitness standards: one mile run.) Bubbling Over: Soda Consumption and Its Link to Obesity in California. (2009.
heart disease. hypertension and reduced quality of life • 5 million blind.1% • Human cost: increased deaths.Costs of Diabesity • Diabetes consumes $226 billion or 14% of US healthcare expenditures (2% of GNP) • Obesity consumes $147 billion or 9. leading cause • 82.000 amputations per year . strokes. cancers.
Diabesity…the causes .
1 hours of walking! .49--- 7.Hardee's introduces new Mega-Calorie “Monster Thickburger” 1410 calories! 107 grams of fat! ---All for $5.
One 20 Ounce Soda Per Day • • • • 17 teaspoons of SUGAR 250 calories 50 gallons per person per year Children and teens 2 cans per day (25% 4 or more!) • No. 1 source of calories in our diets • Soda portion sizes have increased dramatically. .
High Fructose Corn syrup (HFCS) • HFCS: 63 pounds consumed per capita • Most common sweetener in processed foods • $$$$$ Corn subsidies make it cheap! .
• Fast food industry spent $4.$6.2 billion in advertisement • $294 million targeting children • Federal “5 A Day Campaign” $9.55 million • Center for Nutrition Policy and Promotion.5 million .
Carek. Charleston 29406. . PJ et al Department of Family Medicine. 2011. • Depression and anxiety most common psychiatric conditions • 10% of American adults • Leading cause of disability • Physical activity as effective as medication for depression International Journal of Psychiatry and Medicine. Medical University of South Carolina. USA.Exercise for the treatment of depression and anxiety.41(1):15-28.
Welton and Beckett Building ) . (1959.Building Design UC Berkeley School of Public Health.
Stairs Inspired by??? .
Florida .Walkable Neighborhoods • Celebration.
our finances. and our communities. our health. mixed use – Parks and public space – Pedestrian design – Schools and workplaces Paris. France . • Key elements: – A center – People – Mixed income. time in community activities falls 10%. • Benefits to the environment.Walkable Neighborhoods • Residents weigh 7 pounds less than in suburbs • For every 10 minutes a person spends in a daily car commute.
” • Health problems in the 21st Century: Diabesity and depression epidemics • Common roots of Public Health and Built Environment • Collaborations between PH and Planners Winston Churchill • What is the relation to vision???? .“First we shape our buildings. they shape us. thereafter.
healthypeople.gov/document/html/volume2/28vision. Healthy People 2010 http://www. Three fourths of all blindness and vision impairment is either preventable or treatable Two-thirds of all blind individuals in the world are female Most are older than 50 years 90% of blind people live in poverty • • • British Columbia Centre for Epidemiologic & International Ophthalmology (BCEIO).htm .3 million Americans 40 years and older Economic impact: >50 billion dollars in 2002 for health care for individuals with visual disorders (both direct and indirect costs) Estimate: by 2030 the number of visually impaired and legally blind individuals in the US may double Ranks behind arthritis and CVD as the third most common chronic cause of impaired function in persons older than 70 years.Statistics • • • • • • >80 million people have potentially blinding diseases Blindness or low vision affects 3. 2000.
Statistics BRFSS • Behavioral Risk Factor Surveillance System (BRFSS) • Since 1984 survey of civilian.S.000 people surveyed • State-based telephone surveillance system. health status. • Summarizes the prevalence of vision loss and eye diseases reported by people aged 65 or older . adults aged 18 years or older • 350. • Vision data collected from 19 states that used the supplemental Vision Impairment and Access to Eye Care Module (Vision Module) • Provides information about access to eye care. noninstitutionalized U. comorbid conditions among older adults.
1 million to 17. • Cases of early age-related macular degeneration are expected to double by 2050. particularly among people older than 75 years.9 million .5 million to 9. from 9. from 2.Statistics BRFSS • Findings: • Prevalence of blindness and vision impairment increases rapidly with age among all racial and ethnic groups.8 million for those aged 50 years or older • Cases of diabetic retinopathy among people aged 65 or older are expected to quadruple by 2050.
Statistics BRFSS .
MA. Epidemiol. Untreated poor vision: a contributing factor to late-life dementia. Am.Visual Loss is Associated With……. J. • • • • • • Decreased quality of life Changes in independent living Increased injury and falls Increased depression Increased isolation Untreated poor vision is associated with cognitive decline and onset of dementia • Death Rogers. Langa KM. 2010 171:728 .
2010. 57:1825. J Am Geriatr Soc.Visual Impairment and Falls • Falls in older adults – Occur in 35-40% of individuals – Responsible for 90% of fractures in the elderly – Clinical risk factors include vision impairment. gait abnormality and muscle weakness • Fractures associated with – – – – Poor visual acuity in older women Poor contrast sensitivity Decreased depth perception Binocular visual field loss Coleman AL. Patino CM el al. 2009. Ophthalmology. . 117:199. el al.
4% believe mostly under 40 y/o need eyes checked • 30% of people surveyed listed blindness as their greatest fear second to cancer (43%) (Vision 2020 Australia) .Misconceptions Among Elderly • 23% ignorant that early eye disease has no noticeable symptoms • 27% believe must wait until symptoms before eyes tested • 51.
Normal Changes of Aging • Physical changes related to “Normal” aging ARE NOT disease • Changes occur in most body systems to include: Sensory System Brain and Central Nervous System Muscles and Bones Digestion Heart/Circulatory System Respiratory System .
– Vitreous Humor Haziness Flashing Lights Moving Spots – Color • Lens of eye yellows making it more difficult to see red and green colors • Discrimination as cones • Visual Field Size 1 to 3 degrees per decade .Vision • Not all older people have impaired vision! • Normal visual changes that occur with aging: – Presbyopia: loss of ability to see items that are close up begins in the 40’s – Decreased contrast sensitivity caused by retinal changes – Decreased dark/light adaptation – Night vision not as acute – Delayed glare recovery.
S..3 million • Cataracts: 20.Common Eye Diseases in the United States Associated with Vision Loss • In the U.2 million diagnosed. most prevalent eye disease in older persons and are the leading cause of blindness worldwide • Glaucoma: 2.5 million age >65. 2 million NOT diagnosed “Vision Problems in the USA” NEI/PBA Report: Eye Diseases .6 million age >60 • Diabetic Retinopathy: 5. the most prevalent etiologies of vision loss in persons 40 years and older are: • AMD (Age-Related Macular Degeneration): 1.
Age-Related Macular Degeneration (AMD)
• ARMD: leading cause of legal blindness in the USA • 9 million people have some form of ARMD • 1.6 million have advanced disease • accounts for 54 % of all blindness
• Age is the greatest risk factor • 55-64: one percent are affected • 65-74: four percent are affected • >75: thirty percent are affected
• Other risk factors • Smoking. • Family history. • Obesity. • Race. Caucasians are more likely to lose vision from AMD. • Women tend to live longer than men, F:M lifetime risk 2:1 • 6% for females • 3% for males
– Asymptomatic initially
– No pain. – Blurred vision. – Loss of central vision (reduced visual acuity causing difficulties with detail discrimination) – Metamorphopsia (i.e., distortion of objects) – Central scotomas – Increased glare sensitivity – Contrast sensitivity – Decreased color vision. – Key: Peripheral vision remains intact, and the patient does not progress to total blindness
AMD Normal vision Same scene as viewed by a person with AMD .
or macula • Two types – Nonexudative (DRY ) drusen (hyaline deposits) and areas of alternating bands of depigmentation/ hyperpigmentation in the retinal pigmented epithelium – Exudative (WET) neovascularization .AGE-RELATED MACULAR DEGENERATION • Damage of the central retina.
beta carotene.AMD • • Treatment options: Age-related eye disease study (AREDS): high-dose regimen of vitamin C. vitamin E. Laser surgery. and zinc shown to decrease risk of developing vision loss caused by advanced AMD in patients with intermediate AMD or advanced AMD in one eye. Photodynamic therapy and intravitreal injections of antivascular endothelial growth factor and corticosteroids have shown promise in treating subsets of patients with macular degeneration. Control of vascular disease risk factors Exercise to increase circulation Sunglasses for UV light protection • • • • • • . Patients without AMD and those with early AMD did not benefit from supplementation.
or stop smoking Maintain normal blood pressure Maintain a healthy weight Exercise .AMD What can you do? Eat a healthy diet Don’t smoke.
• Primary open-angle glaucoma is the most common .Glaucoma • Increased ocular pressure that can damage the optic nerve in the eye. • Symptoms: • Loss of peripheral vision that can lead to decreased central acuity • Difficulty functioning in dim light • Decreased contrast sensitivity • Glare disability • Decreased dark/light adaptation • Glaucoma can develop in one or both eyes.
Glaucoma Normal vision Same scene as viewed by a person with glaucoma .
Glaucoma • Risk factors: age > 40. beta blockers. eye injury. myopia. chronic steroids • Treatment: • Topical prostaglandins. HTN. hispanic. african american. adrenergics. family history. carbonic anhydrase inhibitors • Oral medications • Laser therapy • Filtering surgery • About 50% of individuals with glaucoma are not diagnosed . diabetes.
.Glaucoma • What can you do? • People at higher risk should get a comprehensive dilated eye exam every one to two years or as instructed by your eye care professional.
2009. 116:2327. Ophthalmology. .6% in the age range 60-69 • 17% in individuals > 80 • Females 20% more likely than males • 1/3 of patients with cataract had an unmet need for surgery • Surgery for cataract accounts for 60% of Medicare expenses for vision Richter.Cataract • Cataract prevalence increases with increasing age • 2. CM et al.
• Income <$20. • Ocular UV-B light exposure • Bmi >35 • Lack of health insurance • Low education.Cataract • Risk factors and associations: • Age • Female sex • Corticosteroid use • Diabetes • Smoking • Myopia.000 per year • Self-reported barriers to care • Last eye exam > 5 years ago .
decreased contrast sensitivity. and glare disability • Cloudy or blurred vision • Colors that may not appear as bright as they once did.Cataract • Opacifications of the crystalline lens of the eye • Symptoms: • Decreased visual acuity. decreased color perception. • Glare • Poor night vision .
Cataract Normal vision Same scene as viewed by a person with cataract .
• Surgical extraction • What can you do? • Eat a healthy diet. John Taylor. • Don’t smoke.Cataract • Treatment: • Alter prescriptions for eyeglasses or contacts. the flamboyant 18th-century British oculist . • Wear sunglasses and a brimmed hat when outdoors.
Diabetic Retinopathy • Leading cause of new blindness in U.S. • Rapid increase in chance if diabetic for 15+ years • Retinal vessels weakened by sorbitol aneurysms leakage retinal damage • Other complications: • Secondary glaucoma • Retinal detachment . In adults 20 to 74 years of age.
distortion. color perception. glare disability. • Laser photocoagulation • Surgery .Diabetic Retinopathy • Symptoms • No early warning signs or symptoms • Decreased visual acuity. contrast sensitivity. and scotomas • Treatment options • Early detection and timely treatment can reduce the risk of vision loss. and dark/light adaptation.
Diabetic Retinopathy Normal vision Same scene as viewed by a person with diabetic retinopathy .
• Maintain a healthy weight. • Don’t smoke. and cholesterol.A1C. • Have a dilated eye exam at least once a year. • Take your medications as directed. blood pressure. .Diabetic Retinopathy • What can you do? • Control your ABCs . • Exercise.
For diabetics – Normal examination or minimal nonproliferative retinopathy– annually – Mild to moderate nonproliferative retinopathy without macular edema .Screening • The American Academy of Ophthalmology (AAO) suggests comprehensive medical eye evaluations: For non-diabetics – Every 2-4 yrs for patients 40 to 54 years of age – Every 1-3 years for patients 55 to 64 years of age – 1 or 2 years for patients older than 65 years.every 6 to 12 months – Severe nonproliferative diabetic retinopathy – every 2 to 4 months • • .
Evaluation • Check visual acuity using standard Snellen chart • An impairment of 20/50 or worse or a one-line difference between the eyes should warrant referral • Visual fields • Fundoscopic exam • Amsler Grid .