Older Adults

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  • Created by: LBCW0502
  • Created on: 09-04-21 10:11
Why is medicine use in older adults important? (1)
An ageing population – advances in healthcare, living standards, sanitation. Over 85 years – population increasing, will continue to increase. More HIV patients in older adults. More chronic disorders by age group. Patients <65 years (multimorbid but livi
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Why is medicine use in older adults important? (2)
Giblet approach. Appropriate and inappropriate medicines. Life expectancy increases but number of healthy years decreasing. Patients unable to take care of themselves – indication of poor adherence (reduced functional ability and cognitive deficits)
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Why is medicine use in older adults important? (3)
Age doesn’t correlate with frailty – could have a younger person who is more frail compared to an older adult. Some drugs are higher risk in older adults e.g. ibuprofen. Polypharmacy is an issue due to number of drugs and prescribing cascade (one drug to
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What are some of the age-related physiological changes?
Cardiac - reduced organ perfusion – reduced clearance and absorption. Renal function decline starts at the age of 35 years, reduced thirst response (e.g. don’t realise they need to drink more), acute illness (problematic), NSAIDs (inhibiting renal functio
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State features of polypharmacy
Polypharmacy – negative perspective. Appropriate polypharmacy - Improve quality of life, reduce harm. Inappropriate polypharmacy – intended benefit is not realised, harm outweighs benefit, not evidence based
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Describe features of drug-drug and drug-disease interactions
T2DM/depression/HF guidelines, medicines prescribed, mapped against 11 common conditions to find overlap, if guidelines are followed there will be lots of medicines prescribed with lots of interactions. Problematic (multiple conditions/incompatible drugs)
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Describe features of medication-related harm in older adults (1)
Polypharmacy – drug-drug interactions, increased risk of ADRs, drug-disease interactions, reduced QoL, increased risk of errors, reduced compliance. Physiological adaptions – ageing process, diseases older adults are more likely to experience. All drugs h
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Describe features of medication-related harm in older adults (2)
Concept of harm in geriatrics – not a new topic. Five I’s of geriatrics – instability, immobility, iatrogenesis, impaired cognition, incontinence. Geriatric 5 Ms – matters most, mind, mobility, medications, multi-complexity.
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Describe features of medication-related harm in older adults (3)
Medications – polypharmacy, deprescribing, optimal prescribing, adverse medication effects, medication burden.
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Why is frailty important?
A better measure of ageing than chronological age. Associated with medication-related harm. Promotes a different kind of medical management. Relationship between frailty and MRH – PRIME Study. But frailty fails to capture resilience. Lack of evidence for
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What are the strategies proposed by WHO?
‘Medication without Harm’ Challenge: Reduce the level of severe, avoidable harm related to medications by 50% over 5 years, globally. Priorities - high-risk situations, polypharmacy, transitions of care
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Describe features of the multimorbidity guidelines
Optimising care for adults with multiple long-term conditions by reducing treatment burden and unplanned care. Improve quality of life by promoting shared decisions based on what is important to each person in terms of treatment, health priorities, lifest
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What are the steps for delivering care in a patient with multimorbidity? (1)
1. Discuss the purpose of the approach
2. Establish disease and treatment burden
3. Establish patient goals, values, and priorities
4. Review medicines and other treatments – evidence of likely benefits and harms for individual patient and outcomes import
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What are the steps for delivering care in a patient with multimorbidity? (2)
5. Agree individualised management plan with the person
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State other resources used to support older adults
Comprehensive Geriatrics Assessment. Patient resources: Choosing Wisely. Adherence (COM-B framework)
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Describe features of the identification of medicated-related harm
Harm from medicines is the Fifth Frailty syndrome, and so the influence of medicines on any adverse health outcome in frail older adults should not be overlooked.
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What are the triggers for medicines review? (1)
1. Transitions of care. 2. Acute illness, especially involving a hospital admission. 3. Disease progression. 4. Change of medicines (including starting, stopping and dose or formulation change).
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What are the triggers for medicines review? (2)
5. Change in package of care. 6. Bereavement. 7. Patient, carer or HCP reporting medication-related problem
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What are the steps for medicines optimisation? (1)
1. Medicines reconciliation - accurate list of all medicines.
2. Pharmacotherapeutic analysis - screen medicines for underuse, misuse, overuse.
3. Pharmacotherapeutic discussion - possible solutions presented and discussed with relevant parties.
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What are the steps for medicines optimisation? (2)
4. Pharmacotherapeutic plan - explanation, implementation, follow-up
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Describe features of medicines reconciliation (1)
For each medicine record: Name of medicine, Start date, Dose, Frequency, Stop date (if relevant), Administration route, Time(s) of administration (e.g. 9am). Caution with medicines that are not daily (1x/year, 1x/month...) e.g. methotrexate, bisphosphonat
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Describe features of medicines reconciliation (2)
Allergy status, vaccinations. Ask specifically about: Anticoagulants, Inhalers/sprays, Plasters/patches, Ear, eye, nose drops, Creams/ointments, Vitamins, Sleeping pills, Injections (e.g. insulin), Painkillers, Over the counter medicines (from pharmacy or
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Describe features of medicines reconciliation (3)
Medicines information sources: Use a structured approach, Use at least two sources of
information, Where possible the patient or
carer should be asked (check adherence). Medicines review - 7 steps to appropriate polypharmacy
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What are the principles of de-prescribing? (1)
1. Commitment from staff and patient/carer (collaborative partnership) – ‘Friends and Family test’. 2. Review all current medications. 3. Identify medications to be stopped, substituted or reduced. 4. Plan a de-prescribing regimen in partnership with pati
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What are the principles of de-prescribing? (2)
5. Aim for simplified regimen – max od or bd if possible. 6. Frequently review/monitor and support patient/carer. 7. Inform patient/carer re ADRs
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How does STOPIT prevent avoidable harm?
Reducing ‘Pillburden’. Reducing the risk of non-adherence. Reducing the risks of drug interactions and side effects. Providing a sustainable framework for: Structured, measured medication reviews, Opportunities for multi-disciplinary & patient contributio
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Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Practical advice for prescribing in old age
See notes
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Other cards in this set

Card 2

Front

Why is medicine use in older adults important? (2)

Back

Giblet approach. Appropriate and inappropriate medicines. Life expectancy increases but number of healthy years decreasing. Patients unable to take care of themselves – indication of poor adherence (reduced functional ability and cognitive deficits)

Card 3

Front

Why is medicine use in older adults important? (3)

Back

Preview of the front of card 3

Card 4

Front

What are some of the age-related physiological changes?

Back

Preview of the front of card 4

Card 5

Front

State features of polypharmacy

Back

Preview of the front of card 5
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