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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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Aging01:26

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Aging is a complex biological phenomenon influenced by various processes that affect cellular and systemic functions. Several prominent theories attempt to explain its mechanisms, highlighting cellular limitations, oxidative damage, and hormonal changes as central factors in aging.
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The cellular clock theory posits that the human lifespan is closely tied to the finite capacity of cells to divide, a phenomenon governed by telomeres, which are protective caps at the ends of...
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Drug Dosing: Geriatric Patients01:15

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

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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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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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

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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...
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Orthogeriatrics moving forward.

Darren Aw1, Opinder Sahota

  • 1Orthogeriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.

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Orthogeriatrician care has expanded beyond hip fractures to include complex trauma and pre-operative optimization for elective surgeries. This integrated approach improves patient outcomes and recovery through comprehensive geriatric assessment and innovative treatments.

Keywords:
hip fracturekyphoplastyorthogeriatricspelvic fracturesacroplastyvertebral fracturevertebroplasty

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Area of Science:

  • Geriatric Medicine
  • Orthopedic Surgery
  • Trauma Care

Background:

  • Orthogeriatrics initially focused on fragility hip fractures.
  • The specialty now encompasses a broader range of orthopedic conditions, including spine, pelvis, appendicular fractures, and major trauma.
  • There is a growing role in optimizing pre-operative care for elective joint and spine surgeries.

Purpose of the Study:

  • To highlight the expanding role and scope of orthogeriatric care.
  • To emphasize the integration of comprehensive geriatric assessment in orthopedic patient management.
  • To showcase innovative treatment strategies in fragility fracture care.

Main Methods:

  • Comprehensive geriatric assessment for frail older patients.
  • Research into innovative management strategies for fragility fractures.
  • Application of enhanced recovery after surgery (ERAS) pathways, regional anesthesia, vertebral augmentation, sacral augmentation, and anabolic treatments.

Main Results:

  • Expansion of orthogeriatric services to diverse orthopedic and trauma cases.
  • Increased focus on pre-operative optimization for elective procedures.
  • Implementation of advanced treatment modalities for complex fractures.

Conclusions:

  • Orthogeriatrics plays a vital and expanding role in managing older patients with orthopedic injuries and those undergoing elective surgery.
  • Innovative treatments and comprehensive geriatric assessment significantly reduce post-operative complications.
  • The specialty enhances patient care, leading to improved outcomes and recovery.