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Related Concept Videos

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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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

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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

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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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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

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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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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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[Physicians and advance directives in geriatric setting].

Hoby Razafimbelo1, Kenza Laloui1, Sadia Lassouane1

  • 1Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France.

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Summary

Advance directives are underutilized in geriatric care. This study assessed geriatricians' knowledge and practices regarding patient information and collection of advance directives.

Keywords:
advance directivesdirectives anticipéeselderlyimplicationinformationinvolvementmedicsmédecinsujet âgé

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Area of Science:

  • Gerontology
  • Medical Law
  • Bioethics

Background:

  • Advance directives (AD) are legal documents outlining patient preferences for future medical treatment.
  • Despite legal frameworks like the Claeys-Leonetti law, AD application in geriatric settings remains suboptimal.
  • Understanding healthcare professionals' perspectives is crucial for improving AD implementation.

Purpose of the Study:

  • To evaluate geriatricians' comprehension of advance directives.
  • To assess geriatricians' current practices in informing patients about AD.
  • To examine the process of collecting AD in geriatric care.

Main Methods:

  • A survey-based study was conducted among geriatricians.
  • The survey assessed knowledge regarding AD concepts and legal requirements.
  • Practices related to patient counseling and AD documentation were investigated.

Main Results:

  • Geriatricians demonstrated varying levels of knowledge regarding AD.
  • Significant gaps were identified in routine patient information processes concerning AD.
  • Inconsistent practices were observed in the collection and integration of AD into patient records.

Conclusions:

  • Enhancing geriatricians' knowledge and standardizing AD information protocols are necessary.
  • Improved training and systemic support are required to increase AD utilization in geriatric care.
  • Addressing these factors can lead to better adherence to patient wishes in end-of-life care.