geriatrics and drugs
TRANSCRIPT
Aging and Drugs
Dr. Dalia A. HamdyAssistant Professor
College of Pharmacy19 April 2012
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Aging and Drugs: Outline
• Introduction
• Drug Therapy
• Facts and Recommendations
• Geriatric Pharmacists
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
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Aging and Drugs: Introduction
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
Who are elderly?
“Older people” > 65 is the age often used.
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Aging and Drugs: Introduction
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA people >65 years
19002000
2026
0102030405060708090
100
4
Year
% o
f USA
pop
ulati
on
Data obtained from “The Merck Manual”
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Aging and Drugs: Introduction
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA people >65 years
19002000
2026
0102030405060708090
100
4 12
Year
% o
f USA
pop
ulati
on
Data obtained from “The Merck Manual”
6
Aging and Drugs: Introduction
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA people >65 years
19002000
2026
0102030405060708090
100
4 12 20
Year
% o
f USA
pop
ulati
onNumber of birth (World War II)
Mortality rate
Overall better health
Data obtained from “The Merck Manual”
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Aging and Drugs: Introduction
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA life span statistics• Gender gap
Series1
0
20
40
60
80
100
30
70
Males Females
≥ 85 years
% o
f USA
pop
ulati
on
Data obtained from “Pharmacotherapy”
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Aging and Drugs: Drug Therapy
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
Why do we link Elderly and Pharmaceutical Care?
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Aging and Drugs: Drug Therapy
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
at least 1 drug/week
at least 5 drugs/week
at least 10 drugs/week
0102030405060708090
10090
% d
rug
use
amon
g p
eopl
e >
65
• Elderly compose a major group of drug users
Data obtained from “The Merck Manual”
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Aging and Drugs: Drug Therapy
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
at least 1 drug/week
at least 5 drugs/week
at least 10 drugs/week
0102030405060708090
10090
40
% d
rug
use
amon
g p
eopl
e >
65
• Elderly compose a major group of drug users
Data obtained from “The Merck Manual”
11
Aging and Drugs: Drug Therapy
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
at least 1 drug/week
at least 5 drugs/week
at least 10 drugs/week
0102030405060708090
10090
40
10
% d
rug
use
amon
g p
eopl
e >
65
• Elderly compose a major group of drug users
Data obtained from “The Merck Manual”
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Aging and Drugs: Drug Therapy
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• However, providing safe and effective drug therapy for the elderly is challenging:
Most of clinical studies done for adults less than 55 years old Usually have chronic diseases that alter the behavior of drugs Consume a lot of medications concurrently and have complicated
drug dosage schedules (polypharmacy) Change in cognitive and physiologic functions with age Alteration in quality and quantity of target receptors
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
What can a pharmacist do?
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
A. PolyPharmacy
Concomitant use of multiple drugs
Administration of more drugs than needed clinically
Common and increasing among elderly
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
B. Inappropriate prescribing
Falls outside bounds of accepted medical standards
(dose, durations, duplication, drug interaction)
Their risks outweighs their benefit
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
C. UnderuseOmission of drug therapy that is indicated for the
treatment or prevention of a disease or condition
Inaccessibility to physicianFunctional disabilityAdmission to nursing homesMore cost
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
D. Medication NonadherencePrevalence rates 40-80%
When having same number of medications, they show same adherence to young adults
ADR, dementia, Hospital admittanceADR
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
1. Assessing and Monitoring Drug
Therapy
Medication appropriateness index (10 questions)
+AllergySuboptimal medication
choicesUnder treatmentDrug interaction
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
2. Problems Documentation and Therapeutic Plan formulation
Document ProblemDevelop therapeutic
plans to solve themComorbiditiesFunctional statusLife expectancy
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
3. Consulting Physician regarding
problems and concerns
Optimize prescribing for elderly patients
Followed by
Planning for enhancing patient adherence
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
4. Counseling and adherence aids
Document ProblemDevelop therapeutic
plans to solve themComorbidtiesFunctional statusLife expectancy
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
5. Documenting Intervention and
monitoring patient progress
Document intervention and steps for application
Contact follow up Problem
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
6. Targeting high riskelderly
18 risk FactorsPolypharmacyHigh risk drugs
(sedatives, benzodiazepines, anticholinerigics)
Patient characteristics (low weight, >85Y, renal function)
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Aging and Drugs: Facts and Recommendations
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
6. Targeting high riskelderly
18 risk FactorsNarrow therapeutic
range drugs
History of a prior ADR
Six or more illnesses
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Aging and Drugs: Geriatric Pharmacist
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
Live applications of Geriatric Pharmacists?
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Aging and Drugs: Qatar University-College of Pharmacy
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
Are we ready for the bright future?!
College of Pharmacy Class of 2011 BSc. (Pharm)CPH 1st graduates
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Aging and Drugs: References
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
1. Lindblad Cl et al. Geriatrics (Chapter8) in DiPiro J et al. Pharmacotherapy: A Pathophysiological Approach
2. The Merk Manual of geriatricshttp://www.merck.com/mkgr/mmg/sec1/sec1.jsp
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
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