AGING AND DRUGS

AGING AND DRUGS:

OUTLINE
• Introduction

• Drug Therapy

• Facts and Recommendations

• Geriatric Pharmacists

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 2

 AGING AND DRUGS:
INTRODUCTION
• Geriatrics refers to medical care to
elderly

Who are elderly?

 “Older people”
 > 65 is the age often used.

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 3

 AGING AND DRUGS:
INTRODUCTION
• USA people >65
years
100
% of USA population

80
60
40
20 4
0
1900
2000
2026
Yea
r
Data obtained from “The Merck Manual”
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 4
 AGING AND DRUGS:
INTRODUCTION
• USA people >65
years
100
% of USA population

80
60
40
20 4 12
0
1900
2000
2026
Yea
r
Data obtained from “The Merck Manual”
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 5
 AGING AND DRUGS:
INTRODUCTION
• USA people >65 years
Number of birth (World War II)
100
Mortality rate
% of USA population

80
Overall better health
60
40
20 4 12 20

0
1900
2000
2026
Yea
r
Data obtained from “The Merck Manual”
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 6
 AGING AND DRUGS:
INTRODUCTION
• USA life span
• statistics
Gender gap Males Females

100
% of USA population

80 70
60
30
40
20
0

≥ 85 years

Data obtained from “Pharmacotherapy”

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 7
 AGING AND DRUGS:
DRUG THERAPY
• Geriatrics refers to medical care to
elderly

Why do we link Elderly and Pharmaceutical Care?

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 8

 AGING AND DRUGS:
DRUG THERAPY
• Elderly compose a major group of drug users
100
90
% drug use among people > 65

90
80
70
60
50
40
30
20
10
0
at least 1 at least 5 at least 10
drug/week drugs/week drugs/week
Data obtained from “The Merck Manual”
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 9
 AGING AND DRUGS:
DRUG THERAPY
• Elderly compose a major group of drug users
100
90
% drug use among people > 65

90
80
70
60
50
40
40
30
20
10
0
at least 1 at least 5 at least 10
drug/week drugs/week drugs/week
Data obtained from “The Merck Manual”
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 10
 AGING AND DRUGS:
DRUG THERAPY
• Elderly compose a major group of drug users
100
90
% drug use among people > 65

90
80
70
60
50
40
40
30
20
10
10
0
at least 1 at least 5 at least 10
drug/week drugs/week drugs/week
Data obtained from “The Merck Manual”
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012) 11
 AGING AND DRUGS: 12

DRUG THERAPY
• 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

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
• Geriatrics refers to medical care to
elderly
RECOMMENDATIONS

What can a pharmacist do?

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
A. PolyPharmacy RECOMMENDATIONS

 Concomitant use of multiple drugs

 Administration of more drugs than needed

clinically

 Common and increasing among elderly

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
B. Inappropriate prescribing

 Falls outside bounds of accepted medical

standards
(dose, durations, duplication, drug
interaction)

 Their risks outweighs their benefit

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
C. Underuse RECOMMENDATIONS
 Omission of drug therapy that is indicated for
the treatment or prevention
of a disease or condition

 Inaccessibility to physician
 Functional disability
 Admission to nursing homes
 More cost
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
D. Medication Nonadherence
 Prevalence rates 40-80%

 When having same number of medications, they show

same adherence to young adults

 ADR, dementia,
 Hospital admittance
 ADR

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
 Medication
appropriateness index
(10 questions)
1. Assessing
and Monitoring +
Drug
 Allergy
Therapy
 Suboptimal medication
choices
 Under treatment
 Drug interaction

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
 Document Problem
2. Problems
 Develop therapeutic
Documentation plans to solve them
and Therapeutic
Plan formulation  Comorbidities
 Functional status
 Life expectancy

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
 Optimize prescribing for
elderly patients
3. Consulting
Physician
regarding
problems and Followed by
concerns

 Planning for enhancing

patient adherence

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
 Document Problem
 Develop therapeutic
4. Counseling and
plans to solve them
adherence aids  Comorbidties
 Functional status
 Life expectancy

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
 Document
intervention and steps
5. Documenting for application
Intervention and
monitoring  Contact follow
patient progress
up Problem

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
• 18 risk Factors
 Polypharmacy
 High risk drugs (sedatives,
•6. Targeting high risk
elderly benzodiazepines
,
anticholinerigics)
 Patient characteristics
(low weight, >85Y, renal
function)
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
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AGING AND DRUGS:

FACTS AND
RECOMMENDATIONS
18 risk Factors
 Narrow therapeutic
range drugs

6. Targeting high risk

elderly  History of a prior ADR

 Six or more illnesses

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

 AGING AND DRUGS: GERIATRIC 25

PHARMACIST
• Geriatrics refers to medical care to
elderly

Live applications of Geriatric Pharmacists?

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

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AGING AND DRUGS:

QATAR UNIVERSITY-
COLLEGE OF PHARMACY

College of Pharmacy
Class of 2011 BSc. (Pharm)
CPH 1st graduates

A
r
e
Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
w
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AGING AND
DRUGS:
1. REFERENCES
Lindblad Cl et al. Geriatrics (Chapter8) in DiPiro J et al.
Pharmacotherapy: A Pathophysiological Approach

2. The Merk Manual of geriatrics

http://www.merck.com/mkgr/mmg/sec1/sec1.jsp

Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

Dr. Dalia Hamdy (Aging and Health Forum,
28
04/2012)