Older people medicine Flashcards
What 2 major factors contribute to prescription decisions according to NICE
Co morbidities and short life expectancy
How much of the population is over 65
A. 12%
B. 18%
C. 31%
B. 18%
In 2030 it will be 22%
How many of the 75 - 84yrs age group are living in nursing homes (2011)
A. 3%
B. 11%
C. 17%
A. 3%
In the over 85’s it is 20%
What % of the over 75’s have a visual impairment
A. 25-30%
B. 45- 50%
C. 55- 60%
A. 25-30% patients must be able to read information about their medication
How many people aged 65- 69 years have dementia
2%, 8%, 15%
Same question but in the 84 -89 age group
10%, 18%, 24%
65- 69yrs 2%
84- 89yrs 18%
Psychotropic drugs and benzo diazepam’s need to be prescribed in lower doses, family / carers need to be aware of risks and monitoring needs
what are the 4 top drugs causing admission to hospital in older population? NSAID, Diuretics, Anticoag’s Paracetamol, Antiplatelet’s, Opiods, Beta blockers, Benzo’s Ace inhibitors
NSAIDS, Diuretics Anticoagulants and antiplatelets
What year was the NICE guideline on Multimorbidities
2016 This guideline covers optimising care for adults with multimorbidity by reducing treatment burden It aims to improve quality of life by promoting care that is important to the patient
What are potential cautions in prescribing for older patients
- Lack of social support.
- Poly pharmacy
- Lack of dexterity and poor vision
- Recent discharges and changes in medications (old ones still at home)
- Confusion, Depression leading to non adherence
- Specific meds such as (High risk )
6 biological factors to consider when prescribing for an older adult
Absorption Distribution Metabolism Excretion Organ Reserve Pharmodynamics
Is absorption better or worse in an older adult
Absorption is affected by less acid, less gastric secretions and lower surface area making absorption slower
How is Biochemical distribution of drugs affected in older adults
Older people have generally less water and more fat, drugs that are fat soluble have a longer 1/2 life and water soluble ones may have raised concentrations due to the low water presence
Older people generally have low albumin meaning that there is less binding sites and more free drug leading to more side effects.
Consider corrected levels of albumin when calculating therapeutic levels of drugs (Phenytoin)
What 3 factors do we need to consider in an older adults metabolism
Lower blood flow, lower liver mass and reduced 1st pass, dosing should be started low
How is excretion impaired in the Elderly
Renal function loses 1% function every year after 40. water soluble drugs such as Gent and Digoxin are excreted out of the kidney
What is organ reserve and its relevance to the Older Adult
Organ reserve is the ability of the body to return to homeostasis after an repeated or ongoing insults
I.E. postural drop with meds frusemide’s effect on renal function, opioid’s on G.I. tract etc
Renally cleared drugs are cleared slower as you get older
True or false
True
