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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 Excretion01:18

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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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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

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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 Metabolism01:18

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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 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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Inappropriate medications and physical function: a systematic review.

Elizabeth Manias1, Md Zunayed Kabir2, Andrea B Maier3

  • 1School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC 3125, Australia.

Therapeutic Advances in Drug Safety
|August 5, 2021
PubMed
Summary
This summary is machine-generated.

Potentially inappropriate medications (PIMs) and prescribing omissions in older adults are linked to reduced physical function, increasing risks of falls and fractures. Interventions to reduce PIMs and prevent omissions are crucial for maintaining older adults' physical health.

Keywords:
activities of daily livingagedfunctional independenceindependent livingmedication therapy managementphysical function

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Area of Science:

  • Gerontology
  • Pharmacology
  • Public Health

Background:

  • Inappropriate medication prescription is prevalent in older adults.
  • This practice is associated with adverse health outcomes and impaired physical function.

Purpose of the Study:

  • To examine associations between potentially inappropriate medications (PIMs) and prescribing omissions with physical function in older adults.
  • To investigate these associations across diverse environmental settings.

Main Methods:

  • A systematic literature search was conducted across multiple databases (MEDLINE, CINAHL, PsycINFO, EMBASE, COCHRANE).
  • Data from 55 studies involving 2,767,594 older adults were extracted and analyzed.

Main Results:

  • PIMs were significantly associated with higher risks of falls, fractures, and impaired activities of daily living (ADL) and instrumental ADL (IADL).
  • PIMs were linked to poorer physical performance, including gait speed and grip strength.
  • Specific medication classes like antipsychotics, sedatives, and anticholinergics were implicated. Prescribing omissions also increased fall and fracture risks.

Conclusions:

  • Inappropriate medication prescriptions are demonstrably linked to impaired physical function in older adults.
  • Reducing PIMs and addressing prescribing omissions are essential for supporting older adults' physical well-being.