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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

180
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...
180
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...
150
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

180
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...
180
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

196
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...
196
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

150
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...
150
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

161
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 medicine : Update 2019].

Grégoire Mary Heck1, Sonia Lajoso1, Romain Schneider1

  • 1Service de gériatrie et de réadaptation gériatrique, CHUV, 1011 Lausanne.

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Summary
This summary is machine-generated.

Updated guidelines address inappropriate medications in older adults and type 2 diabetes management. New evidence highlights physical activity benefits for fall prevention, cognitive health, and dementia risk reduction, with intensive blood pressure control showing promise.

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Area of Science:

  • Geriatrics
  • Pharmacology
  • Neurology

Background:

  • Recent 2019 recommendations address inappropriate medication use in older adults and type 2 diabetes management.
  • Emerging evidence supports physical activity's role in secondary fall prevention and mitigating cognitive decline and dementia risk.
  • The SPRINT MIND study investigated the impact of intensive blood pressure management on cognitive function.

Purpose of the Study:

  • To review updated recommendations for medication management in older adults.
  • To synthesize new evidence on physical activity for fall and cognitive decline prevention.
  • To examine the effects of intensive blood pressure treatment on neurocognitive impairment.
  • To evaluate the efficacy of antipsychotics in delirium prevention and treatment.

Main Methods:

  • Review of 2019 updated guidelines and published research.
  • Analysis of studies on physical activity and cognitive health.
  • Reporting of findings from the SPRINT MIND study.
  • Meta-analysis of research on antipsychotic use for delirium.

Main Results:

  • Intensive blood pressure treatment in the SPRINT MIND study showed a 19% reduced risk of minor neurocognitive impairment.
  • Physical activity demonstrates benefits for secondary fall prevention and cognitive health, irrespective of genetic or vascular factors.
  • Antipsychotics showed benefits in delirium prevention only in specific post-operative settings (cardiac, orthopedic).
  • Meta-analysis on delirium treatment found no benefits from antipsychotics.

Conclusions:

  • Updated guidelines and new evidence emphasize optimizing medication and lifestyle interventions for older adults.
  • Physical activity is a key strategy for preventing falls and cognitive decline in the elderly.
  • Intensive blood pressure control may reduce the risk of neurocognitive impairment.
  • Antipsychotics have limited utility in general delirium prevention and treatment, with specific benefits in select surgical populations.