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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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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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According to statistical moment theory, mean residence time (MRT) is an important measure in pharmacokinetics. MRT can be defined as the expected mean of a probability density function distribution. It provides valuable insights into drug disposition in the body.
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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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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

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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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Geriatric Psychiatry Inpatient Primer for Residents.

Nishina A Thomas1, Erin Van Enkevort2, Robert K Garrett3

  • 1Stanford University, Palo Alto, CA, USA. nishina.thomas@gmail.com.

Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
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PubMed
Summary

A brief educational intervention significantly improved psychiatry residents' geriatric psychiatry knowledge, enhancing their preparedness for overnight calls with older adult patients. Residents made better medication choices for common scenarios in the elderly.

Keywords:
Curriculum developmentEducationGeriatric psychiatry

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Area of Science:

  • Geriatric Psychiatry
  • Medical Education
  • Psychiatry Residency Training

Background:

  • Geriatric psychiatry knowledge is crucial for psychiatry residents, especially when managing overnight calls.
  • Effective educational strategies are needed to enhance residents' competence in treating older adults.

Purpose of the Study:

  • To assess the impact of a novel curricular intervention on first- and second-year psychiatry residents' geriatric psychiatry knowledge.
  • To improve residents' preparedness for managing clinical scenarios in older adults during overnight calls.

Main Methods:

  • A four-page educational document on geriatric clinical scenarios and pharmacologic interventions was distributed.
  • Residents completed pre- and post-intervention surveys assessing comfort and knowledge of evidence-based interventions.
  • Statistical analysis included Wilcoxon-signed rank test, paired T test, and Mann-Whitney U test.

Main Results:

  • Statistically significant improvements were observed in residents' first-line medication choices for scenarios like non-aggressive agitation and insomnia.
  • Residents were less likely to select medications contraindicated in the elderly, aligning with expert recommendations.

Conclusions:

  • Educational interventions are vital for equipping residents with geriatric psychiatry skills for on-call duties.
  • This brief intervention effectively improved residents' clinical knowledge regarding geriatric patient care.