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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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Multi-Modal Home Sleep Monitoring in Older Adults

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Published on: January 26, 2019

Multimorbidity in older adults.

Marcel E Salive

Epidemiologic Reviews

|February 2, 2013

Summary

Multimorbidity, the presence of multiple chronic conditions, affects a majority of older adults. Standardized measurement is crucial for public health surveillance and developing effective interventions.

Area of Science:

Gerontology
Public Health
Epidemiology

Background:

Multimorbidity, defined as the coexistence of two or more chronic conditions, is increasingly prevalent in aging populations.
Declining mortality rates and an aging global population have led to a rise in individuals with multiple chronic diseases.
Understanding the prevalence and impact of multimorbidity is essential for healthcare planning and public health initiatives.

Purpose of the Study:

To determine the prevalence of multimorbidity in a large cohort of Medicare beneficiaries.
To compare findings with existing literature through a systematic review.
To identify methodological challenges in multimorbidity research and advocate for standardization.

Main Methods:

Analysis of population-based administrative claims data for nearly 31 million Medicare fee-for-service beneficiaries.

Keywords:

aged chronic disease comorbidity prevalence

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Inclusion of 15 prevalent chronic conditions in the analysis.

Systematic review of 16 existing prevalence studies in community-based samples of older adults.

Main Results:

A significant prevalence of multimorbidity was observed, with 67% of beneficiaries having two or more chronic conditions.
Multimorbidity prevalence increased with age, reaching 81.5% in those aged 85 years and older.
The systematic review revealed a median prevalence of 63% across other studies, highlighting potential methodological variations.

Conclusions:

Multimorbidity is highly prevalent among older adults, particularly the oldest age groups.
Methodological inconsistencies across studies hinder direct comparisons and reliable public health surveillance.
Standardized methods for defining and measuring multimorbidity are urgently needed to inform prevention and intervention strategies.