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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

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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...
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

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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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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

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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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

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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...
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Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Inappropriate prescribing as a predictor for long-term mortality after hip fracture.

M Gosch1, M Wörtz, J A Nicholas

  • 1Department of Geriatrics and Internal Medicine, Hospital Hochzirl, Zirl, Austria.

Gerontology
|November 20, 2013
PubMed
Summary

Inappropriate medication prescribing significantly increases long-term mortality risk in older hip fracture patients. This study found a 28% higher relative risk of death associated with suboptimal drug use.

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacology
  • Epidemiology

Background:

  • Hip fracture patients face elevated mortality rates compared to controls.
  • Medical comorbidities and polypharmacy contribute to adverse drug events and outcomes in this population.
  • Optimizing medication regimens is crucial for improving survival in elderly hip fracture patients.

Purpose of the Study:

  • To evaluate the impact of inappropriate medication prescribing on long-term mortality in elderly patients who have sustained a hip fracture.
  • To identify specific medication prescribing issues that correlate with adverse outcomes.

Main Methods:

  • Retrospective cohort study of 457 hip fracture patients (2000-2004).
  • Utilized Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria to assess prescribing appropriateness.
  • Correlated 'positive items' (inappropriate prescriptions) with mortality data from the national death registry.

Main Results:

  • A mean of 2 inappropriate medication items per patient was identified; only 9.6% had no issues.
  • Higher numbers of positive STOPP/START items were significantly associated with increased mortality.
  • Inappropriate prescribing was an independent risk factor for mortality (OR 1.28, 95% CI 1.07-1.52) after adjustments.

Conclusions:

  • Inappropriate medication prescribing is a significant, independent predictor of long-term mortality in older hip fracture patients.
  • Suboptimal drug management increases the relative risk of mortality by 28% in this vulnerable group.
  • Clinical interventions targeting medication appropriateness may improve outcomes for hip fracture survivors.