Lecture 19 - Geriatrics Flashcards
what is the comprehensive geriatric assessment (CGA)?
the comprehensive geriatric assessment is a multidimensional, multidisciplinary diagnostic and therapeutic process. it determines the medical psychological and functional capabilities of an older person.
it develops a coordinated and integrated plan for treatment and follow u
what are the biomolecular changes - the hallmarks of ageing in geriatrics?
genomic instability
telomere attrition
epigenetic alterations
loss of prosteostasis
deregulated neutron sensing
mitochondrial dysfunction
cellular senescente
stemcell exhaustion
altered intercellular communication
what are Physiological changes that occur as we age?
neurodegeneration with dementia is indicated by degenerating neurons, eye diseases with cataracts, hearing loss with damaged hair cells, cardiovascular diseases including a heart attack and arteriosclerosis, chronic obstructive pulmonary disease with obstructed airflow, and a weak immune system which is vulnerable to pathogens.
what are geriatrics syndrome ?
Geriatric syndromes are common problems that affect older adults.
Many of the most common conditions cared for by geriatricians, including:
delirium, falls, frailty, dizziness, syncope and urinary incontinence.
While heterogeneous, geriatric syndromes share many common features. They are highly prevalent in older adults, especially the frail elderly. Their impact on quality of life and disability is substantial. Multiple underlying factors, involving multiple organ systems, tend to contribute to, and define, geriatric syndromes
what is fragility defined as ?
Frailty is defined as a clinically recognizable state of increased vulnerability resulting from age associated decline in reserve and function across multiple physiological systems such that the ability to cope with everyday or acute stressors is comprised.
different frailty measures used in clinical practice that can help:
The Frailty Phenotype
and
The Frailty Index
describe the friend phenotype
The phenotype defines frailty as the presence of at least three criteria including exhaustion, weakness, unintentional weight loss, slow walking, low physical activity.
describe the rockwood once as a measurement of fragility
This measure of frailty is based on the measurement of deficit accumulation and leads to the development of a frailty index score for an individual.
Why is frailty an important consideration in pharmacy?
There is significant association between an increased number of medications and frailty.
Polypharmacy is an area of concern for the elderly for several reasons:
Adverse Drug Reactions
Higher risk of drug-drug interactions
Can lead to decreased medication compliance, poor quality of life, and unnecessary drug expenses
Some symptoms of polypharmacy are the same as the normal signs of ageing!
what are the main absorption change sin elderly people ?
Slowed gastric motility and reduced hepatic metabolism.
Delayed absorption and reduced bioavailability of drugs administered orally.
Distribution - Sarcopenia and relative adiposity
what are main distribution changes in elderly ?
Distribution - Sarcopenia and relative adiposity.
Reduced plasma albumin - Reduced volume of distribution of water-soluble drugs and increased volume of distribution of fat-soluble drugs.
Decreased protein binding of acidic drugs.
what are main metabolism changes in elderly?
Reduced hepatic volume and blood flow.
No consistent effects on phase I clearance but evidence on reduced phase II clearance.
what are main excretion changes in elderly patients ?
Excretion - Glomerular filtration rate reduced, reduced renal drug clearance.
Pharmacodynamics - Reduced resilience to external stressors.
May be some reduced receptor function in presence of chronic inflammation
Exaggerated or reduced drug effects
