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Top Geriatric Papers of 2012 [email protected] May 1, 2013

27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

Speaker Disclosure Form Financial Disclosure • $6000 in non-direct honorariums/speaker fees in 2012 • No current grants or research support

27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

Speaker Disclosure Form Dr. Chris Brymer “I have not in the past 2 years, had a financial interest, arrangement or affiliation with one or more organizations that could be perceived as a direct/indirect conflict of interest in the content of the subject of this or any other program.”

27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

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Learning Objectives to critically appraise recent literature regarding diabetes in the elderly, pills, probiotics, pain, dementia care, falls and comprehensive assessment. • to discuss how this literature may inform and alter your care of elderly patients •

27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

Treating diabetes beyond age 70 • HbA1c q3months; “No” fingerpick glucoses (Farmer AJ et al, BMJ 2012;344:e486). • Only treat HbA1c down to .08 if old and frail, to preserve function- Yau CK, et al, J Am Geriatr Soc 2012;60:12151221) • Bariatric surgery for high BMI is safe, and highly effective at either preventing (72%) or curing (40%) type 2 diabetes in men and women aged 50 to 70 (Schauer PR, et al, N Eng J Med 2012;366:1567; Carlsson LM, et al, N Eng J Med 2012;367;695) 27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

No need for fasting for either lipid or HbA1c blood work • Total and HDL cholesterol varied 20% reduction in MI/stroke/CV death. •Olive oil, mixed nuts, or a combo, with fruits/veggies/fish/red wine/whole grains •Estruch R, et al, N Engl J Med 2013 PMID 23432189 •Hubbard BP, et al, Science 2013 (1231097)- Resveratrol (red wine) really does activate SIRT-1, and reduce Alzheimer’s, inflammation, etc.

27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

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…but skip the omega-3 pills • 900 mg n-3 fatty acid supplements , vs. 2 ml olive oil a day, made no difference in rates of anything over 6 years in 12,611 adults generally in their 60’s and 70’s. (The Origin trial, N Eng J Med 2012;367:309)

27th Annual Geriatric Medicine Refresher Day May 1, 2013 • London Convention Centre, London, Ontario

Vitamin B12 supplementation prevents cognitive decline in the elderly • Vitamin B12 .1 mg/day prevented cognitive decline over 2 yrs. in 900 Australian seniors (Walker JH, et al Am J Clin Nutr 2012;95:194-203) • Framingham study of 549 75 year olds over 8 years found cognitive decline with ‘low-ish’ (