Elderly and elderly care Flashcards
what are the consequences of the ageing population?
- annual costs of health and social care are greater for old people
- admissions have increased rapidly
- older people living on their own more so require formal care more
What are the consequences of ageing population in regards to health?
- focus on shifts to chronic diseases
- increasing disability so long-term care services are needed
- need to integrate medical services
- ongoing management of multiple diseases and medication
definition of polypharmacy?
a situation where someone, a patient, is taking multiple medication for any sort of multiple conditions
why is polypharmacy so common
due to multiple comorbidities
- increased risk of ADR and DDI
- most OTC is purchased by older people
- most older adults are on repeat prescriptions
what is the steps for management of patients that have multiple chronic conditions?
- generalist skills are needed
- patients goals/priorities need to be discussed
- specialist skills needed for guidelines
- guidelines needed to be applied
- generalist skills needed
- either judgment about lifestyle and lifestyle advice should be given or judgement about whether treatment should be de-intensified or intensified
- treatment plan is made with patient
how does polypharmacy affect risk of ADR?
for older adults it increases the risk of ADRs
What are the changes elderly experience with absorption?
- reduced saliva
- increased gastric pH
- decreased GI motility
- decreased GI and regional blood supply
What are the changes elderly experience relating to first pass metabolism?
First pass metabolism can result in extensive metabolism of lipid-soluble drugs
- there can be a reduced hepatic blood flow so therefore reduced FPM and greater drug effect
- minor decrease in FPM can lead to increase in drug bioavailability
How is factors like distribution affected by a patient being elderly?
- body fat and water distribution is altered
- increased proportion of fat so increase Vd of lipid soluble drugs so they accumulate
- decrease in total body water and so decrease Vd for water soluble drugs so lower doses of these drugs needed
- reduced plasma conc.
- reduced P-P binding cause increase risk of ‘free’ drug
- increase in toxicity risk
how is the metabolism factor affected in the elderly?
- hepatic metabolism of many drugs through P-450 drugs are reduced
- reduced metabolic clearance so increased levels or duration of drug action
- pro-drugs may be less effective
how is pharmacokinetic factor of elimination affected in elderly?
- decreased renal elimination of drugs
- GFR falls with age
so renal tubular function falls also with age - dose adjustment is required for renal excreted drugs e.g. digoxin, gentamicin, opiates
what changes occur to the heart, skeletal muscle, bones and joints, CNS and endocrine with ageing?
Heart - less compliance in cardiac - loss of pacemaker cells - calcification of conduction system - less response to catecholamines Skeletal muscles - atrophy Bones/Joints - Osteoporosis, osteoarthritis CNS - vision and hearing Endocrine changes - reduction in hormone production and target sensitivity increases e.g. oestrogen, testosterone
What pharmacodynamic factors change with ageing?
- changes in receptor sensitivity
- reduction in receptor number
- increases sensitivity to several drugs
If baroreceptor function is reduced how does this increase risk of falls in elderly?
this leads to increased hypotension with antihypertensive drugs so more falls and this increases with age due to extra sensitivity in elderly
Name some important drug classes used in the elderly?
- analgesics
- digoxin
- ACE inhibitors
- beta blockers
- warfarin and anticoagulants
- Benzodiazepines
How is frailty affected by ageing?
there is progressive physiological decline in multiple organ systems
- loss of function, loss of physiological reserve and increased vulnerability to death
What are the five frailty syndromes?
- falls
- immobility- increases with age and susceptibility to immobilisation and inactivity
- delirium
- incontinence
- Susceptibility
What are some common reason/mechanism that cause a fall?
- sedation
- hypotension
- cardiovascular medications
- psychotropic medications
Name and explain the three types of urinary incontinence
- Stress- due to urethral sphincter incompetence; pelvic musculature weakness
- Overflow- constant involuntary loss of urine; prostatic hypertrophy
- Urge- strong desire to pass urine and involuntary loss of urine; neurological lesions
what is the STOPP/START criteria used for?
used to check potentially inappropriate prescribing in older people
how is STOPP/START used?
STOPP- prescriptions which are potentially inappropriate to patients over 65 years
START- unless status is end-of-life these criteria are drug therapies to be considered where omitted for no valid clinical reasons
explain the term ‘deprescribing’
the process of withdrawal of an inappropriate medication, supervised by health care professional in order to manage polypharmacy and to improve outcomes
- dose reduction
- switch to safer medication
- care with withdrawals of neuroactive drugs due to withdrawal symptoms
How can you tackle inappropriate polypharmacy?
by doing structured medication reviews and using STOPP/START criteria and other tools
What are some example of STOPP criteria?
- a drug prescribed without clinical indication
- a duplicate drug class prescription
- verapamil or dilitiazem with IV heart failure
- loop diuretic for treatment of hypertension with concurrent urinary incontinence
