Test 1 Special Populations - Geriatrics

Question 1

Current demographics of aging population (long list)

Answer 1

comparing 2004 to 2014

• population age 65 and over = 46.2 million which increased 28%
• population age 60 and over increased 32.5% from 48.9 to 64.8 million
• amount of people aged 45-64 who will reach 65 over the next two decades will increase 17.8%
• 14.5% of population is an older American
• people who reached 65 have 19.3 years left to live
• 72,197 people who were over 100 years
• older women outnumber men by 5.5 million
• 22% of people over 65 were a minority
• older men were more likely to be married than older women
• 34% of older women were widows
• 29% of noninstitutionalized older people lived alone
• 46% of older women over 75 lived alone

Question 2

future demographic changes of the aging population

Answer 2

• Increase in education levels
• Increased life expectancy
• Gender gap in life expectancy is narrowing
• Poverty rates dropping
• Increase of elders in the work force because of non-sustainable pension action plans

Question 3

common health problems of the aging population

Answer 3

• Heart disease
• Hypertension
• Arthritis
• Diabetes
• Any cancer

Question 4

Cardiovascular changes that happens as a result of age

Answer 4

• Cholesterol and triglycerides rise with age
• Systolic BP rise disproportionate with diastolic
• HTN occurs in 45-50% of people over 65

Question 5

Cerebrovascular and Neuropsychiatric changes that happens as a result of age

Answer 5

• Slow progressive loss of brain substance

- Common problems: Parkinson’s, tremors, peripheral neuropathies, stokes, TIA, dementia

Question 6

Renal and urinary changes that happens as a result of age

Answer 6

• Decline of renal function with age
• Leads to HTN, DM, immunological diseases, infections
• Lower urinary tract problems: infections, incontinence, retention due to BPH, cancer

Question 7

Endocrine changes that happens as a result of age

Answer 7

• Hormones secreted from anterior pituitary gland (growth hormone, TSH, ACTH, FSH, LH) decrease with age
• Thyroid function decreases with age
• Adrenal function decreases with age
• DM more common on elderly patient

Question 8

Joint changes that happens as a result of age

Answer 8

• Osteoarthritis increases with aging; RA, gout

- Obesity increases because of burden on joints that impedes movement

Question 9

morbidity and mortality statistics associated with medication related problems in the older patient

Answer 9

• 51% of all deaths and 39% of hospitalizations are due to ADRs occur in the elderly
• 50,000-75,000 older people die each year due to a drug related problem
• One-third of hospital admissions by patients over 75 are linked to drug related problems
• Estimated cost of inappropriate medications and their consequences in older people approaches $200 billion/year
• $32.8 billion associated with DRPs resulting in LTC admissions

Question 10

List factors responsible for “America’s Other Drug Problem”

Answer 10

• Polypharmacy (OTC too)
• Consequences of drug-drug interactions
• Adherence issues
• Pharmacokinetic changes of aging
• Pharmacodynamic changes of aging
• Effects of co-morbidity on kinetics and dynamics

Question 11

Describe changes that predispose older patients to increased morbidity and mortality from medication therapy

Answer 11

• From 1988 to 2010 the median number of prescription medications increased from 2 to 4 among adults > 65
• From 1988 to 2010 the proportion of adults > 65 taking ≥ 5 prescription medications more than tripled from 12.8 % to 39%
• An estimated 30% of all medications for older people are considered unnecessary
• An estimated 25% of all prescribed medications for older people are potentially inappropriately selected or dosed (Beers List)

Question 12

Discuss management considerations to minimize DRPs in the elderly

Answer 12

• Minimize number of medications, attempt gradual dose reduction
• Maximize non-pharmacologic alternatives
• Titrate therapy to the individual patient
• Educate the patient and caregiver
• Review all medications annually
• Improve communication skills
• Use a single pharmacy for all medication needs
• Improve interdisciplinary communication and cooperation
• Use extra caution during transitions between facilities and providers

Question 13

opportunities for pharmacists in the care of the older patient

Answer 13

• Medication therapy management
• Consultant pharmacy
• Medicare Part D Guidance
• Medication safety program for seniors