Introduction Flashcards
In 2020, adults 65+ made up ___ but accounted for ___ of healthcare spending
18%, 43.6%
Care must be ___ for aging people
Individualized
What are some other factors affecting health in older age
– Genetics
– Socioeconomic status
– Education
– Social engagement and support
– Lifestyle: Exercise, diet, smoking and alcohol
use
What is life expectancy/
To what proportion of the maximum age a person
may live
WHat is health span?
– Number of years that are spent free from
functional limitations, morbidity, and pain
– Goal of most geriatric models of care -> prolong
the health span
What is ADLs?
Activities of daily living
What are IADLs?
Instrumental activities of daily living
What are some examples of ADLS?
- Dressing, toileting, eating, bathing, walking
What are some examples of IADLs?
Shopping, housekeeping, food preparation, medication
management, financial management
What is an acronym for ADLs?
BATTED
What is an acronum for IADLs?
SCUM
What ins functional reserve?
Body systems generally have capabilities beyond
what is needed for everyday activities
What is impairment in function?
demands exceed
functional capacity
Older adults have ___ functional reserve compared to younger adults
Decreased
What increases risk of decline of functional reserve?
Illness or injury
What is functional decline?
Reduction in ability to perform ADLs and
IADLs due to decreased physical and/or
cognitive function
Higher ____ utilization was reported among
those with more chronic medical conditions,
regardless of age
healthcare
What are tbe absorption changes in older adults? (4)
– ↓ gastric acid secretion
– Slower gastric emptying
– Delayed intestinal transit
– ↓ blood flow
Generally speaking what is decreased in drug absorption?
↓ rate of drug absorption (first-dose, prns)
***No change in extent of drug absorption
____ gastric acid secretion may ___ extent of absorption of some medicaitons… (Which meds)
Decrease, Decrease, Iron, ketoconazole. calcium
How can we combat decreased gastric acid secretion wtih meds?
– Empty stomach with iron supplements
– Use citrate form of calcium
Utilizing percutaneous absorption what is generally the issue?
Aged skin tends to be drier, lower lipid content
___ rate of percutanteous absorption of lipophyllic medications
Decreased
What are examples of lipophyliic medications?
- Fentanyl
- Testosterone
- Estradiol
What occurs with aging and drug distribution/
Changes in body composition
– 25-30% ↑ body fat
– 25-30% ↓ muscle mass/body water
What medications may be more prone to building up in an older perosn?
– Diazepam
– Amiodarone
What happens with highly hydrophilic drugs
Less distribution
Lithium
Aminoglycosides
What decreased over time that affects distribution?
↓ albumin levels in frail/malnourished
older adults ↓ protein-binding of highly-
protein-bound medications:
Over time ___ metabolism and elimination compensates for increased free fraction
increased
- Liver size and blood flow___ significantly with age
decrease
Drugs with high ___ extraction will
have increased bioavailability in older
adults
first-pass
Some___ in Phase I (CYP 450-
mediated) metabolism with aging
reduction
Longer half-lives – _____ or ___
decreased dose requirements
or increase dosing interval
There are ____ in phase II metbaolism
No changes
Medication examples not affected by aging metabolism
– Acetaminophen
– Lorazepam, oxazepam, temazepam
– Zaleplon
– Valproic acid
What happens with elimination?
- ↓renal size, blood flow, glomerular
filtration rate, and tubular secretion with
aging
– ~10% ↓ GFR per decade after age 30
How do we estimate kidney function?
Scr alone not reliable, must take into account muscle mass, and age of kidney/function
____ blood pressure-lowering response to
beta-blockers
↓, decreased
___ response to antiepileptic drugs at a
lower serum concentration
Increased
– _____stiffness of large blood vessels ->
isolated systolic hypertension
– ↑, increased
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