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Geriatric Considerations
Margarita Blajeva
(Group 35, 2010)
Objectives
1. Describe the main physiological changes that occur with
aging
2. Identify factors affecting absorption and distribution with
the geriatric client
3. Describe how drugs are metabolized and excreted in the
elderly
4. Examine the issues related to drug compliance in the
elderly population
Demographics
Geriatric population
largest consumers of Rx medications
the higher the age, the higher the number of Rx drugs a person takes
average usage ~ 3-4 drugs per senior (not uncommon to have 10+
Rx)
nature and frequency of adverse drug reactions increase with age
Aging
Estimated that after 25-30 years of age, CO by 1% a
year
Most body organs in size with age fewer cells to carry
out organ functions
Changes the way in which body will cope with metabolic
processes particularly important for pharmacology
Pharmacological changes:
Drug absorption
Drug distribution
Drug metabolism
Drug excretion
Drug Absorption
Changes to intestinal tract:
Result:
SLOWED rate of drug absorption
SLOWED rate of drug action
Drug Distribution
Changes in body composition:
Lean body mass (muscle) % decreases
Body water % decreases
Body fat increases
Organs with greater fat (adipose tissue/muscle) will get more than younger adults
Organs with lower fat content (liver/kidney) will get less than younger adults
liver & kidney do most of the metabolism and excretion so
= SLOWED elimination
= GREATER half life
= GREATER duration of action
Drug Distribution
Body water change = more drug in less fluid
GREATER concentration of drug
HIGHER concentration of drug in elderly patient
Drug Metabolism
In general
RATE of drug metabolism decreases with age
but there is much variability
Why?
Decreased blood flow to liver (less coming in/fewer resources
available)
Decreased production of liver enzymes
Drug Excretion
Main routes of elimination:
Renal & Gastrointestinal
Enterohepatic cycling
Some drugs also are eliminated by travelling through the liver,
biliary tract, then intestinal tract
Some of these drugs, which undergo enterohepatic cycling, will not
be eliminated at a final step but will re-enter circulation
increased half-life & duration
Drug Excretion
Renal excretion
One of the most greatly impacted systems by aging process
Renal function decreases across the board:
glomerular filtration rate (GFR)
creatine clearance
Drug Compliance
Extremely important issue in elderly
Challenges with elderly compliance
Complicated dosing regimens
Confusion
Drug Compliance
Other considerations:
Helping compliance:
Drug Compliance
BLISTER PACK!!!
Summary
Demographics & Aging
Drug Absorption
Drug Distribution
Drug Metabolism
Drug Excretion
Compliance
THE END