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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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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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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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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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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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Development and Validation of a Geriatrics Knowledge Test to Evaluate Geriatrics Fellowship Programs.

Alia T Tuqan1, Ming Lee2, Nancy T Weintraub2,3

  • 1University of Nevada, Reno School of Medicine, Reno, Nevada.

Journal of the American Geriatrics Society
|August 29, 2017
PubMed
Summary

A new 31-item geriatrics knowledge test was developed and validated. This reliable and valid instrument is suitable for evaluating geriatrics fellowship programs and assessing trainee knowledge progression.

Keywords:
evaluation of geriatrics fellowship programsgeriatrics educationgeriatrics knowledge test

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Area of Science:

  • Geriatric Medicine
  • Medical Education
  • Assessment and Evaluation

Background:

  • Accreditation Council for Graduate Medical Education mandates evaluation of geriatrics fellowship programs.
  • Existing evaluation instruments are insufficient, posing challenges for program assessment.
  • Development of a validated knowledge test is crucial for effective geriatrics fellowship evaluation.

Purpose of the Study:

  • To develop and validate a geriatrics knowledge test.
  • To create a reliable instrument for assessing geriatrics fellowship program effectiveness.
  • To provide a tool for measuring knowledge acquisition in geriatrics trainees.

Main Methods:

  • Cross-sectional validation studies (initial and replication) were conducted.
  • A 31-item multiple-choice question (MCQ) test was developed from a 54-item pool.
  • Selection of MCQs was based on content, item correlation, discrimination, and difficulty.

Main Results:

  • The 31-item test demonstrated high reliability (Cronbach alpha = 0.83) and known-group validity.
  • Scores increased progressively with higher levels of geriatrics training (P < .001).
  • Replication studies confirmed score progression, with no floor or ceiling effects observed.

Conclusions:

  • A 31-item geriatrics knowledge test is reliable and valid.
  • The developed test is appropriate for evaluating geriatrics fellowship programs.
  • This instrument can effectively assess the knowledge base of geriatrics trainees.