Geriatrics – Polypharmacy in the Elderly: By Balakrishnan Nair M.D. скачать в хорошем качестве

Geriatrics – Polypharmacy in the Elderly: By Balakrishnan Nair M.D.

medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. Geriatrics – Polypharmacy in the Elderly Whiteboard Animation Transcript with Balakrishnan Nair, MD https://medskl.com/Module/Index/polyp... Polypharmacy is defined as the prescription, administration or the use of more than 5 medications at the same time. Approximately 1/3 of elderly patients take more than 5 drugs, which correlates with the fact that more than 80% of elderly patients have more than 3 chronic conditions. Furthermore, a conservative estimate is that at east 25-50% of older patients have drug side effects. 25% of these Adverse Drug Reactions (ADRs) are preventable. The concern with polypharmacy stems from the increased risk of developing ADRs which cause unnecessary hospital admissions, increasing healthcare cost and most importantly, reducing the patients’ quality of life. The risk factors for polypharmacy in the elderly are numerous, and include poor communication from doctors, cognition issues, deafness and poor eye sight, use of numerous over the counter medications and presence of multiple prescribers. Further, because there is a paucity of pharmacokinetic and pharmacodynamic data from drug trials in the elderly, it is often difficult to foresee drug-drug interactions and subsequent ADRs. Physiologic changes in old age also play a key role. In particular, the reduction of body water content along with concurrent increase in fat content alters the distribution and accumulation of drugs in the system. Further, alterations in the gastrointestinal absorption, hepatic metabolism, and renal excretion all serve to alter the way drugs behave in the body as well as how the body responds to their effects. The way forward is to use every opportunity to review the patient’s medication profile, maintain heightened vigilance for new symptoms possibly cause by medication, and reduce unnecessary drugs known as ‘deprescribing’. What is appropriate at one time, can become inappropriate at a later time, as in the instance of warfarin and its association with falls. Deprescribing is a happiness pill for the doctor and the patient. Swallow it with pride!