Elderly Clients

Elderly Clients

1. How body reacts

   • -Aging process causes decline in organ function (similar to peds with premature liver/kidneys) -Increased sensitivity to drugs, incidence of side effects -

2. PHYSIOLOGICAL CHANGES

   • -Altered PKs, more sensitive to drugs than younger adults and have wider variation
   • Carciovascular
     • -Decreased absorption and distribution
   • Gastrointestinal
   • Hepatic
     • -Decreased metabolism 
   • Renal
     • -Decreased excretion

3. OTHER PROBLEMS

   • Underlying health problems
   • Taking multiple drugs
   • Impaired memory and cognition
   • Physiological age vs actual age
   • Non-Adherence
     • -Multiple prescriptions/multiple dosing -Can't open bottles/packaging -Cog/phys impairment -Don't understand -Can't pay for it -Don't believe it will work -Side effects
     • Educate family
     • Regimen
       • -Simplify -Tailor according to client's routine -Monitor for response, adverse side effects -Daily reminders -Pill organizers

4. PHARMACOKINETICS

   • Absorption
     • -Most cases: onset of action delayed, not major factor in drug sensitivity -Rate of absorption may be slow
   • Distribution
     • -Increased body fat %; lipid-soluble drugs stored in fat -Decreased total body water  -Reduce [serum albumin]; reduced in malnourished 
   • Metabolism
     • -Hepatic metabolism declines with age -Reduced hepatic blood flow -Half-life may increase, prolong response -Enhance response to oral drug
   • Excretion
     • -Renal function declines  -Drug accumulation secondary to reduced renal exretion  -
     • Creatinine clearance
       • -Creatinine levels may be normal even though kidney function is greatly reduced

5. PHARMACODYNAMIC

   • Receptors
     • -Alterations in receptor properties may underlie sensitivity to drugs -Drugs with more intense effects in elderly -Beta blockers less effective in elderly, even in same concentrations 

6. Adverse drug effects

   • -7x more likely in elderly -Majority are dose-related -Dizziness, cognitive impairment
   • Factors
     • -Drug accumulation secondary to reduced renal function -Polypharmacy -Greater severity of illness and multiple pathologies -Greater use of drugs that have a low therapeutic index (digoxin) -Increased individual variation secondary to altered pharmacokinetics -Inadequate supervision of long-term therapy -Poor patient adherence -Malnourished, lives alone
   • Reduction
     • -Thorough drug history, including OTCs -Consider PK and PD changes due to age -Monitor clinical response/plasma drug levels -Use simplest regimen possible -Monitor drug-to-drug interactions -Periodically review the need for continued drug therapy -Encourage pt to dispose of old meds -Promote adherence and avoid drugs on the Beers List 
     • Beers List
       • -List of meds that should not be used for elders

7. DRUG-RELATED PROBLEMS

   • -Prone to developing overzealous responses to drugs 
   • CNS
     • -Increased sensitivity to CNS depressants and general anesthetics
   • CV
     • -Proneness to hypotension
   • Respiratory
     • Prone to respiratory depression

8. Older adults: Key points