Older people Flashcards
(18 cards)
what fraction of older people have a disability or long term illness?
two thirds
what is frailty?
a state of increased vulnerability resulting from ageing and associated with a decline in the bodies physical and psychological reserves
what are the 5 frailty syndromes?
- Falls
- Immobility
- Delerium
- Incontinence
- Side effect susceptibility of meds
what changes may an older person experience?
swallow issues
hearing issues
visual issues
manual dexterity decline
cognitive impairment
mobility decline
What are the PK changes in older people?
Absorption- slower
Distribution- increased fat so increased VD of lipophilic drugs. Decreased serum albumin so decreased protein binding and free fraction of drug
Metabolism- decreased metabolism due to decreased blood flow to liver, so decreased FPM and increased bioavailability (mindful of propranolol, warfarin and morphine)
Excretion- decreased renal excretion due to decreased blood flow so increased drug accumulation (mindful of NSAIDs, DOACs and lithium
what are the PD for elderly people?
increased sensitivity to drugs and altered homeostatic mechanisms due to impaired hypothalamus (decreased binding receptor numbers so decreased receptor-initiated cellular responses leading to biochemical reactions
- decreased thermoregulation
-decreased bp regulation
-altered bladder and bowel control
-altered blood sugar levels- hypo risk so avoid long acting hypoglycs
-altered fluid and electrolyte balance (drug induced hyponatreamia risk)
what is polypharmacy?
patient on 5 plus meds
(36% on greater than 4. 50% on unneccesary meds)
What are good prescribing principles in older people?
use familiar meds
use lowest effective dose
anticipate for interactcions
be alert for ADRs
Monitor
Avoid prescribing cascade
promote concordance
involve carers when neccessary
what is inappropriate prescribing?
-PIM- Potentially inappropriate meds- have increased ADR risk, interact or are contraindicated
-Overprescribing- no clear indication of meds
what is PPO?
Potential prescribing omission- should be on rx
what are poorly tolerated drugs in older people?
digoxin at doses greater than 187.5 mcg
Benzos and Z drugs
Antipsychotics and TCAs
Anticholinergics (ssris, oxybutinin, carbemazepine, opiates, loperamide) cause G1 SE’s- peripheral- constipation, dry mouth and eyes. G2-CNS- confusion, delerium, falls
combo analgesics
What are the advantages of using the Medication Appropriateness Index (MAI) for prescribing in older people?
- can be used for any drug, disease or setting
what are the disadvantages of MAI?
-doesnt address underprescribing and is time consuming (10 mins per med)
what is Beers’ criteria and what are its advantages?
outlines 34 meds or drug classes to avoid, meds to avoid in 14 diseases and 5 meds to use with caution in older people.
adv- good explanation as to why, gives severity rating of ADR’s, can be used by computers
what are the disadvantages of Beer’s Criteria?
doesnt tell us drug interactions, doesnt consider under prescribing or duplication, poor structure
What is the STOPP/START toolkit and what are its advantages?
STOPP- inappropriate meds in 65+. 130 explicit criteria, 3 implicit
START- can be started in 65+- 57 explicit criteria,1 implicit
adv- organsied by physiological condition, considers drug interactions and drug disease interactions and under prescribing
what are disadvantages of STOPP/START toolkit?
doesnt offer alternative, doesnt tell us the bases for the appropriateness ie cost, indication?
what is deprescribing?
the process of withdrawing an inappropriate medication under HCP supervision with the goal of managing polypharmacy and improving outcomes
