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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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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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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 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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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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Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults
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Malnutrition Risk, Rurality, and Falls among Community-Dwelling Older Adults.

C Eckert1, N M Gell, M Wingood

  • 1Nancy Gell PhD, MPH, University of Vermont, 306B Rowell, 106 Carrigan Dr., Burlington, VT, 05405, 802-656-9265, nancy.gell@med.uvm.edu.

The Journal of Nutrition, Health & Aging
|May 5, 2021
PubMed
Summary

High malnutrition risk significantly increases future fall odds in older adults. Rurality was not a significant factor for new falls, suggesting nutrition is key for fall prevention strategies.

Keywords:
Fall risknutritionolder adultrural healthscreening

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Area of Science:

  • Gerontology
  • Public Health
  • Nutrition Science

Background:

  • Falls are a major concern for community-dwelling older adults, impacting independence and healthcare costs.
  • Malnutrition and rural living are potential risk factors for falls, but their independent and combined effects require further investigation.

Purpose of the Study:

  • To assess the association between malnutrition risk, rurality, and the risk of future falls in community-dwelling older adults.
  • To determine if malnutrition and rurality independently predict fall risk and future falls.

Main Methods:

  • Prospective cohort study of 3,300 community-dwelling older adults receiving home support services.
  • Utilized the DETERMINE Nutrition Risk Questionnaire and Fall Risk Questionnaire to assess malnutrition and fall risk.
  • Follow-up analysis included a subset of 2,043 participants with two years of health assessment data.

Main Results:

  • High malnutrition risk was independently associated with increased fall risk (p<0.001) and also associated with rurality (p<0.001).
  • After adjusting for covariates, individuals with high nutrition risk had a 66% increased odds of falling within the next year.
  • Rurality was not significantly associated with an increased risk of future falls after adjustment.

Conclusions:

  • Malnutrition risk is a significant predictor of future falls in older adults, independent of other factors.
  • The association between rurality and future falls is less clear, suggesting that nutritional status is a more critical factor.
  • Further research should focus on interventions to mitigate malnutrition risk and identify specific nutritional aspects protective against falls in the elderly.