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Related Concept Videos

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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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

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

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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

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

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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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Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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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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The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture.

Kilian Rapp1, Clemens Becker, Chris Todd

  • 1Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart; School of Health Sciences, University of Manchester, and Manchester Academic Health Sciences Centre, and Manchester University NHS Foundation Trust, Manchester, UK; Institute of Epidemiology and Medical Biom etry, Ulm University, Ulm; Center for Trauma Research, Ulm University, Ulm; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart; Department of Orthopedics and Trauma Surgery, Diakonissen Hospital Karlsruhe-Rüppurr, Karlsruhe.

Deutsches Arzteblatt International
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Summary

Orthogeriatric co-management significantly reduces 30-day mortality for older patients with hip fractures. This collaborative approach also led to longer hospital stays, improving care for elderly individuals with fragility fractures.

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Area of Science:

  • Geriatrics
  • Orthopedics
  • Public Health

Background:

  • Specialized care models, known as orthogeriatric co-management, have been developed for older patients with fragility fractures.
  • Hip fractures in the elderly are a significant health concern, necessitating effective care strategies.

Purpose of the Study:

  • To investigate the association between orthogeriatric co-management and mortality rates in older patients following hip fractures in Germany.

Main Methods:

  • Observational study utilizing health insurance claims data from 58,001 patients aged 80 years and above with hip fractures.
  • Comparison of mortality outcomes in German hospitals with and without orthogeriatric co-management between January 2014 and March 2016.

Main Results:

  • Hospitals with orthogeriatric co-management showed a crude 30-day mortality of 10.3% versus 13.4% without it.
  • Adjusted 30-day mortality was 22% lower in the co-management group (RR 0.78; 95% CI [0.74; 0.82]).
  • Patients in co-management had a longer mean index hospital stay (19.8 days vs. 14.4 days).

Conclusions:

  • A multidisciplinary orthogeriatric approach is linked to reduced mortality after hip fracture in older adults.
  • Orthogeriatric co-management also correlates with extended hospital stays, suggesting improved patient management.