Medicine for the elderly

Question 1

What are the current demographics?

Answer 1

18% population pensionable

Fastest growing segment >80 yrs

Question 2

Why is there an economic burden?

Answer 2

Increased cost of social care and home care

Question 3

What are the 4 types of personality?

Answer 3

INTEGRATED - active, satisfied, flexible, functioning
ARMOURED - fights ageing, preoccupied with loss
PASSIVE - dependent, low level of life satisfaction
ANGRY - low activity, low life satisfaction, bitter

Question 4

What physiological changes occur with ageing?

Answer 4

SKIN - wrinklied, dry, cambell de morgan spots, keratosis
MOUTH - less saliva production, impaired muscles of mastication, tooth loss, less taste buds, poorer sense of smell, tongue enlargement
IQ - verbal scores preserved but speed of response decresed
OTHER - reduced hepatic drug metabolism, reduced GFR, prostate enlargement, decreased bladder capacity, bone loss, valve thickening, lens hardens, less lean body mass, increased fat mass, inability to maintain body temp, lower oestrogen levels, increased immune deficiency

Question 5

How can a disease present?

Answer 5

Specifically or non specifically

Question 6

What is specific disease presentation?

Answer 6

Atypical presentation - MI without chest pain
Multiple pathology - immobility leading to DVT
Symptoms attributed to age - hypothyroidism, anaemia
Single illness leads to catastrophic outcome- pneumonia, fractures

Question 7

What is non specific disease presentation?

Answer 7

Intellectual failure, incontinence, immobility, instability

Question 8

What is the link with elderly and pharmacology?

Answer 8

More likely to be on multiple medications, multiple disease, primary and secondary prevention

Question 9

How does age alter pharmacology?

Answer 9

Renal drug clearance is reduced, changes to hepatic drug metabolism

Question 10

How does age affect the volume of distribution of drugs?

Answer 10

Ratio of fat : lean muscle increases so:
Lipid soluble drugs have more volume of distribution leading to more prolonged effect eg diazepam
Water soluble drugs have reduced volume of distribution leading to more rapid peak eg digoxin

Question 11

What % drug - drug interaction result in an adverse effect?

Answer 11

10%

Question 12

How does age affect drug compliance?

Answer 12

Poor compliance with 45- 75% prescriptions
Increased likelihood if on 3+ drugs
Dementia affects compliance