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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

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

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

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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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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 Absorption01:22

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

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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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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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Analysis of Population Pharmacokinetic Data01:12

Analysis of Population Pharmacokinetic Data

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Analysis of population pharmacokinetic data involves studying the behavior of drugs within diverse populations to understand their pharmacokinetic parameters. Traditional pharmacokinetic methods typically involve collecting samples from a few individuals and estimating these parameters. While these methods are commonly used, they have limitations in capturing the variability in drug response among individuals or heterogeneous populations. Population pharmacokinetics is employed to address these...
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Related Experiment Video

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Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults
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Using pharmacy dispensing data to predict falls in older individuals.

Marle Gemmeke1, Ellen S Koster1, Romin Pajouheshnia1

  • 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands.

British Journal of Clinical Pharmacology
|August 2, 2020
PubMed
Summary

Medication use is linked to falls in older adults. Pharmacy dispensing data, using the drug burden index and fall risk-increasing drugs, showed associations but were insufficient alone to predict falls in daily practice.

Keywords:
dispensing recordsdrug burden indexelderlyfall risk-increasing drugsfallingrisk prediction

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Area of Science:

  • Gerontology
  • Pharmacoepidemiology
  • Geriatric Medicine

Background:

  • Individual medication use is associated with falls in older adults.
  • A comprehensive medication-based risk score for predicting falls in pharmacy practice is currently lacking.
  • Pharmacy dispensing records offer a potential data source for fall risk assessment.

Purpose of the Study:

  • To determine if pharmacy dispensing records can be utilized to predict falls in older individuals.
  • To investigate the association between cumulative medication exposure and fall risk.
  • To evaluate the predictive performance of medication-based models for fall prediction.

Main Methods:

  • A retrospective cohort study involving 3454 Dutch individuals aged ≥65 years.
  • Classification of medication exposure using the drug burden index (DBI) and fall risk-increasing drugs (FRIDs).
  • Multinomial regression analyses and polytomous discrimination index (PDI) to assess associations and predictive performance.

Main Results:

  • Significant associations were found between a DBI ≥1 and both single (aOR: 1.30) and recurrent falling (aOR: 1.60).
  • The drug burden index model had a PDI of 0.41, and the FRIDs model had a PDI of 0.45.
  • Both medication-based models demonstrated poor discrimination in predicting fallers versus nonfallers.

Conclusions:

  • Medication use is significantly associated with falls in older adults.
  • Current medication-based models derived from pharmacy dispensing data are insufficient for predicting falls.
  • Future fall risk scores for pharmacy practice should incorporate additional factors beyond medication use.