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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

107
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...
107
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

72
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...
72
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

87
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...
87
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

100
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...
100
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

97
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...
97
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

147
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...
147

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Semi-Targeted Ultra-High-Performance Chromatography Coupled to Mass Spectrometry Analysis of Phenolic Metabolites in Plasma of Elderly Adults
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Polypharmacy Management in Older Patients.

Robert William Hoel1, Ryan M Giddings Connolly2, Paul Y Takahashi2

  • 1Division of Medication Therapy Management, Pharmacy Services, Mayo Clinic, Rochester, MN.

Mayo Clinic Proceedings
|January 8, 2021
PubMed
Summary
This summary is machine-generated.

Polypharmacy, the use of multiple medications, poses risks for older adults, including falls and hospitalizations. A systematic approach to medication reduction, or deprescribing, can improve patient safety and quality of life.

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacology
  • Health Services Research

Background:

  • Polypharmacy, defined as using five or more medications, is common in older adults.
  • It frequently leads to adverse drug events, including drug interactions, toxicity, falls, delirium, and nonadherence.
  • Polypharmacy is associated with increased hospitalizations and healthcare costs.

Purpose of the Study:

  • To present a systematic, consultative approach for identifying and reducing high-risk medications in older adults.
  • To outline strategies for deprescribing in various care settings, including palliative, long-term, and ambulatory care.
  • To emphasize aligning medication management with patient goals, focusing on quality of life and comfort.

Main Methods:

  • A systematic, consultative process to identify high-risk medications and drug-therapy problems.
  • Strategic medication reduction (deprescribing) in palliative, long-term, and ambulatory older adult populations.
  • Incorporation of patient and family education regarding medication risks and benefits.

Main Results:

  • Deprescribing high-risk medications like opioids and benzodiazepines, with patient/family agreement, improves outcomes.
  • A team-based approach is optimal for managing polypharmacy in long-term care settings.
  • Medication adjustments aligned with patient goals enhance comfort and quality of life.

Conclusions:

  • A systematic deprescribing strategy is essential for managing polypharmacy in older adults.
  • Addressing polypharmacy requires a patient-centered approach, prioritizing quality of life and comfort.
  • Reducing high-risk medications can mitigate adverse events and healthcare costs.