What are the physiological changes/clinical risks in geriatric patients and how does this relate to medicine?
- Baroreceptor (that sensitive to pressure) response decreases
- Decline in renal function (drug excretion)
- Decline in hepatic function (drug metabolism)
- Impaired cognitive and motor function. using the medicine and understanding what it is used for. Memory and mood, particular in Alzheimer’s
- Leaky BBB so more susceptible to CNS drugs
- Vision tends to decline- may not be able to see what the medicine is and risk of falling over
- Muscle mass decreases
- Dexterity - performing tasks especially with hands e.g. opening medicine bottles, popping pills
- Autonomic dysfunction e.g. bladder and bowel function
- Dysphagia- ability to swallow. What is the most appropriate formulation?
- Time-span of their life- is there any benefit continuing on this medication? (particularly the case in end of life patients- ethical issue)
What is a limitation of using Cockcroft and Gault in geriatric patients?
It overestimates renal failure
Medicines have their own inherit risks. True or false?
True
Not everybody who is frail is elderly. True or false?
True
What is the health risk with frail patients?
More likely to get ill and illnesses are generally more serious compared to healthy individuals
What do you need to consider when telling a geriatric patient to have a well balanced healthy diet?
- How realistic is this for them?
- Are they able to do a food shop and cook for themselves?
- Do they have family support?
- Do they live alone?
What are the environmental risks in geriatric patients?
- Do they live alone? What is their household environment?
- Can they access medicines? Do they need pharmacy delivery?
- Can they use the medicine? Impaired vision/dexterity
- Cognitive impairment
- Frequent hospital admissions
- Multiple prescribers
- Reduced independence
What are the 3 areas of evidence based medicine?
- Patient/carer needs and preferences
- Research evidence
- Clinical expertise
What does PIMs stand for?
Potentially inappropriate medications
What is the main way to reduce medication risk?
Deprescribing
What is deprescribing?
Process of withdrawal/tapering of inappropriate medication, supervised by a HCP with the goal of managing polypharmacy and improving outcomes
What are the 4 medication review tools?
- AGS Updated Beer;s Criteria
- STOPP/START - list of medicines that you are thinking could consider stopping if polypharmacy is problematic - however you need to consider how to start the medicine
- ImPE project
- STOP-IT- aid memoir for potentially inappropriate medicines
What is the 7 steps of the deprescribing algorithm?
- Commitment from staff, patient, carers and family. You need to involve them from the start
- Review all current medications
- Identify medications to be stopped/changed/reduced
- Plan a de-prescribing regimen with all involved. If in doubt- reduce and withdraw cautiously
- Aim for simplified regimen (OD or BD)
- Frequently review or monitor and support patient
- Inform patient or carer regarding ADRs
What is beta-histine used for?
Vertigo and hearing loss associated with Menieres disease
What is nicorandil?
Vasodilatory drug for angina
What is the risk of carrying on a bisphosphonate for more than 5 years after a fracture?
Risk of atypical fracture e.g. thigh
What is prochlorperazine used for?
Nausea and vomiting
What is cyclizine used for?
Nausea and vomiting
What are the 4 benefits of STOPIT?
- Reduces pill burden for patients
- Reduces non-adherence risk
- Reducing risk of drug interactions and side effects
- Providing a sustainable framework for:
- Structured medication reviews
- Opportunities for multidisciplinary and patient contributions
- Ongoing monitoring of changes made
What is the main thing you should consider before deprescribing?
Should consult patient and family and explore the reason why they were on the medicine
