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Related Concept Videos

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

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

213
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...
213
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

221
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...
221
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

180
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...
180
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...
188
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...
226

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The Pharmacist's Role in Age-Friendly Mobility.

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This case study demonstrates how a collaborative, Age-Friendly approach using the 4Ms (What Matters, Medication, Mobility, and Mentation) improved functional outcomes for a frail, elderly patient with a hip fracture. Pharmacist-led medication optimization and interdisciplinary rehabilitation significantly enhanced mobility, cognition, and fall risk reduction.

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacy
  • Rehabilitation Therapy

Background:

  • An 85-year-old skilled nursing facility resident experienced a hip fracture, necessitating surgery and rehabilitation.
  • The patient had a history of hypertension, type 2 diabetes mellitus, osteoporosis, and depression.
  • Admission assessment identified frailty and high fall risk, impacting functional abilities and mobility.

Purpose of the Study:

  • To assess and develop a comprehensive care plan for a geriatric patient post-hip fracture.
  • To evaluate the impact of interdisciplinary collaboration and Age-Friendly care principles on rehabilitation outcomes.
  • To optimize medication regimens, specifically reducing anticholinergic burden, to improve mentation and mitigate cognitive decline.

Main Methods:

  • A multidisciplinary team including a pharmacist, physical therapist (PT), occupational therapist (OT), and speech-language pathologist (SLP) conducted a comprehensive assessment.
  • Age-Friendly care principles and the 4Ms (What Matters, Medication, Mobility, Mentation) guided the assessment and care planning.
  • Pharmacist applied Beers Criteria to identify and recommend deprescribing of anticholinergic medications, transitioning to safer alternatives like escitalopram.

Main Results:

  • The patient demonstrated significant improvements in strength, stability, cognitive alertness, and participation in rehabilitation.
  • Rehabilitation exercises enhanced gait, endurance, and stability during transitions, leading to a reduced fall risk.
  • Deprescribing anticholinergic medications improved mentation, reduced confusion, and stabilized mood without compromising pain or sleep.

Conclusions:

  • Comprehensive assessment utilizing the 4Ms is crucial for managing elderly patients with impaired function and mobility.
  • Interdisciplinary collaboration between pharmacists and other healthcare providers leads to coordinated and successful patient outcomes.
  • Optimizing medication and addressing mentation are vital components of geriatric rehabilitation, even when mobility is the primary concern.