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Drug Dosing: Geriatric Patients

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...

Pharmacodynamics in Geriatric Patients: Effects of Age

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...

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Polypharmacy among disabled Taiwanese elderly: a longitudinal observational study.

Ding-Cheng Derrick Chan¹, Yi-Ting Hao, Shwu-Chong Wu

¹Department of Geriatrics, National Taiwan University Hospital, Taipei, Taiwan.

|May 30, 2009

Summary

Polypharmacy is highly prevalent among disabled elderly in Taiwan, affecting 81% of individuals. Visiting multiple healthcare providers significantly increases the risk of polypharmacy in this vulnerable population.

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Area of Science:

Gerontology
Public Health
Pharmacoepidemiology

Background:

Limited data exists on polypharmacy prevalence and correlates among disabled elderly in Taiwan.
Understanding these factors is crucial for developing targeted interventions.

Purpose of the Study:

To determine the prevalence of polypharmacy and major polypharmacy among disabled Taiwanese elderly (aged ≥65 years).
To identify the correlates associated with polypharmacy in this population.

Main Methods:

A longitudinal observational study using data from the Assessment of National Long-Term Care Need in Taiwan (ANLTCNT) study (2001-2002).
Polypharmacy defined as ≥5 medications; major polypharmacy as ≥10 medications.
Multivariate logistic regression analysis of survey and National Health Insurance (NHI) claims data.

Main Results:

The prevalence of polypharmacy was 81% and major polypharmacy was 38% among disabled Taiwanese elderly.
Visiting multiple healthcare providers was a strong correlate (OR 10.24 for high tendency).
Other correlates included younger age (<85), urban living, multiple chronic conditions, poorer physical function, and non-institutionalization.

Conclusions:

Polypharmacy is extremely prevalent in disabled Taiwanese elderly.
Frequent visits to multiple healthcare providers are a key correlate.
Policies promoting primary care relationships and geriatric models are recommended to reduce polypharmacy.