Age-Related Physiological Changes and Their Clinical SignificanceTrading Game Pty Ltd
Physiological changes occur with aging in all organ systems. The cardiac output decreases, blood pressure increases and arteriosclerosis develops. The lungs show impaired gas exchange, a decrease in vital capacity and slower
expiratory flow rates. The creatinine clearance decreases with age although the serum creatinine level remains relatively constant due to a proportionate age-related decrease in creatinine production. Functional'changes, largely
related to altered motility patterns, occur in the gastrointestinal system with senescence, and atrophic gastritis and altered hepatic drug metabolism are common in the elderly. Progressive elevation of blood glucose occurs with age on a multifactorial basis and osteoporosis is frequently seen due 'to a linear
decline in bone mass after the fourth decade. The epidermis of the skin atrophies with age and due to changes in collagen and elastin the skin loses its tone and elasticity. Lean body mass declines with ag'e and this is primarily due to loss and atrophy of muscle cells. Degenerative changes occur in many
joints and this, combined with the loss of muscle mass, inhibits elderly patients locomotion. These changes with age have important practical implications for the clinical management of elderly patients: metabolism is altered, changes
in response to commonly used drugs make different drug dosages necessary and there is need for rational preventive programs of diet and exercise in an effort to delay or reverse some of these changes.
PHYSIOLOGY OF AGING PROCESS, CONCEPTS OF AGING PROBLEMS WITH NORMAL AGING, AGEING PROCESS PHYSIOLOGY OF AGING, PROBLEMS IN OLD AGE, USUAL TO SUCCESSFUL AGING
How can we improve the quality of life of an aging person? How can a geriatric physician and a geriatric counselor can work as a team. Who else are the other professionals to be included in the geriatric care team? What are the problems faced by the elderly? These are some of the questions we are trying to find an answer for. Caring for elder persons is getting more and more importance as the number of old people are increasing these days. Relatives alone can't meet the challenges of caring for the old. You need professional who can understand and render proper help in this regard. So geriatric counseling is getting more and more acceptance. Alzheimer's Syndrome, senile dementia, rheumatic pains, feeling of alienation etc are some of the problems counselor have to cope up with.
Age-Related Physiological Changes and Their Clinical SignificanceTrading Game Pty Ltd
Physiological changes occur with aging in all organ systems. The cardiac output decreases, blood pressure increases and arteriosclerosis develops. The lungs show impaired gas exchange, a decrease in vital capacity and slower
expiratory flow rates. The creatinine clearance decreases with age although the serum creatinine level remains relatively constant due to a proportionate age-related decrease in creatinine production. Functional'changes, largely
related to altered motility patterns, occur in the gastrointestinal system with senescence, and atrophic gastritis and altered hepatic drug metabolism are common in the elderly. Progressive elevation of blood glucose occurs with age on a multifactorial basis and osteoporosis is frequently seen due 'to a linear
decline in bone mass after the fourth decade. The epidermis of the skin atrophies with age and due to changes in collagen and elastin the skin loses its tone and elasticity. Lean body mass declines with ag'e and this is primarily due to loss and atrophy of muscle cells. Degenerative changes occur in many
joints and this, combined with the loss of muscle mass, inhibits elderly patients locomotion. These changes with age have important practical implications for the clinical management of elderly patients: metabolism is altered, changes
in response to commonly used drugs make different drug dosages necessary and there is need for rational preventive programs of diet and exercise in an effort to delay or reverse some of these changes.
PHYSIOLOGY OF AGING PROCESS, CONCEPTS OF AGING PROBLEMS WITH NORMAL AGING, AGEING PROCESS PHYSIOLOGY OF AGING, PROBLEMS IN OLD AGE, USUAL TO SUCCESSFUL AGING
How can we improve the quality of life of an aging person? How can a geriatric physician and a geriatric counselor can work as a team. Who else are the other professionals to be included in the geriatric care team? What are the problems faced by the elderly? These are some of the questions we are trying to find an answer for. Caring for elder persons is getting more and more importance as the number of old people are increasing these days. Relatives alone can't meet the challenges of caring for the old. You need professional who can understand and render proper help in this regard. So geriatric counseling is getting more and more acceptance. Alzheimer's Syndrome, senile dementia, rheumatic pains, feeling of alienation etc are some of the problems counselor have to cope up with.
Ch. 2 Comparing Vulnerable Groups
Learning Objectives
After reading this chapter, you should be able to:
Explain the difference between curative and preventive approaches to health care.
Identify common factors among vulnerable populations.
Examine age as it relates to the concept of vulnerability.
Determine the ways in which gender contributes to vulnerability.
Discuss how culture and ethnicity affect vulnerability on both personal and population levels.
Explain the relationship between education and income levels, and vulnerability.
Introduction
The United States boasts one of the most robust health care systems in the world. It is statistically credited with the longer healthy lifetimes enjoyed by a majority of the American population. Advances in medical science and technology certainly improve medical interventions, but a recent change in the philosophy of medical care is credited with improving the population's health on a macro level. As the cost of health care in America soared during the 1990s and 2000s, the health care community's focus shifted from curative care to preventive medicine.
Curative medicine focuses on curing existing diseases and conditions. In contrast, preventive medicine works by educating the community on healthy lifestyle habits, such as regular exercise, nutritious food choices, and abstention from smoking. The idea is to prevent or forestall disease rather than wait until someone falls ill before providing treatment; however, living healthy lifestyles is still a personal choice. Studies indicate that preventive health care reduces morbidity, and that a preventive approach not only thwarts diseases that are associated with unhealthy choices, such as diabetes, heart disease, and cancer, but also creates strong immune systems to fight common illnesses like flu and cold viruses. Furthermore, people who do not get sick are more productive workers because they do not have as many sickness-related absences. This point is particularly important when considering vulnerable populations. For many people, especially those in the most at-risk groups, workdays lost to illness means days without pay. Financial instability detracts from a person's social status, which is a nonmaterial resource that contributes to vulnerability. Less social status means less access to community resources, such as health care and fresh foods. Lack of resource access leads to more illness, and so the cycle continues.
Many individuals have limited access to health care, which includes the inability to access medical clinics for reasons of proximity, the lack of insurance coverage, and financial constraints such as inability to pay for medical treatments. Preventive medicine focuses on educating people before they become ill, but resource accessibility restricts preventive medicine programs and responsive health care programs from reaching the most at-risk populations. Evidence of this is seen in data on topics like bre ...
National Institute on AgingNational Institutes of HealthU..docxvannagoforth
National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services
Global Health and Aging
2 Global Health and AgingPhoto credits front cover, left to right (Dreamstime.com): Djembe; Sergey Galushko; Laurin Rinder; Indianeye;
Magomed Magomedagaev; and Antonella865.
3
Preface
Overview
Humanity’s Aging
Living Longer
New Disease Patterns
Longer Lives and Disability
New Data on Aging and Health
Assessing the Cost of Aging and Health Care
Health and Work
Changing Role of the Family
Suggested Resources
Contents
Rose Maria Li
1
2
4
6
9
12
16
18
20
22
25
4 Global Health and Aging
5
Preface
The world is facing a situation without precedent: We soon will have more older people than
children and more people at extreme old age than ever before. As both the proportion of older
people and the length of life increase throughout the world, key questions arise. Will population
aging be accompanied by a longer period of good health, a sustained sense of well-being, and
extended periods of social engagement and productivity, or will it be associated with more illness,
disability, and dependency? How will aging affect health care and social costs? Are these futures
inevitable, or can we act to establish a physical and social infrastructure that might foster better
health and wellbeing in older age? How will population aging play out differently for low-income
countries that will age faster than their counterparts have, but before they become industrialized
and wealthy?
This brief report attempts to address some of these questions. Above all, it emphasizes the central
role that health will play moving forward. A better understanding of the changing relationship
between health with age is crucial if we are to create a future that takes full advantage of the
powerful resource inherent in older populations. To do so, nations must develop appropriate
data systems and research capacity to monitor and understand these patterns and relationships,
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well-being. And research needs to be better coordinated if we are to discover the most cost-effective
ways to maintain healthful life styles and everyday functioning in countries at different stages of
economic development and with varying resources. Global efforts are required to understand and
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existing knowledge about the prevention and treatment of heart disease, stroke, diabetes, and
cancer.
Managing population aging also requires building needed infrastructure and institutions as soon as
possible. The longer we delay, the more costly and less effective the solutions are likely to be.
Population aging is a powerful and transforming demographic force. We are only just beginning
to comprehend its impact ...
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Electric scooter for handicapped in india side wheel attachment attachment electric scooter 3 wheel handicapped balancing wheel attachment kit retro fitment kit mobility products handicap bike and scooter arai approved attachment for suzuki swish honda cb shine activa5g activa jupiter side wheel bajaj discover 100 cc senior citizen foldable wheelchair trending india
Children with disabilities: concept of disability, definitions, categories, causes, rights, health and community care, prevention, community-based rehabilitation.
This PPT aims to help the learner to give insight about Multiple Disabilities, Types of Multiple Disabilities, Causes of Multiple Disabilities, Treatment for Multiple Disabilities, Teaching Method of Multiple Disabilities.
Dietary Supplements, a Glance at Global TrendsFarhad Zargari
Along with the significant increase in the life expectancy,
almost in every culture people are willing to have a better
quality of life, this in turn has intensely changed the
healthcare environment and created new visions and
frontiers. The convergence of health, wellness and beauty spheres, is creating new service areas and thus fresh opportunities for investors and retailers. Global awareness about weight loss, healthy living, protein intake, fitness, and natural beauty is on the rise particularly among the millennials and Gen Xers. One of the principal areas in the new lifestyle paradigm is
dietary supplementation of various substances such as
vitamins, minerals, amino acids, food stuffs, herbs, roots, oils,
animal extracts, etc. to our daily intake. Dietary factors are
known to play an important role in health and diseases, and
there is convincing evidence that adopting a correct diet
containing the essential nutrients can be more effective than
drug treatment in the maintenance of health and prevention
of diseases, thus improving the quality of your natural life.
Advances and investment in digital health is growing at an incredible rate and Contract Manufacturing Organizations and Contract Development and Manufacturing Organizations are becoming an essential part of the new pharma value chain. From wearables, to apps, to digital platforms, the data and efficiencies generated by these innovations are opening up important avenues across the pharma ecosystem. As pressure on improving drug development heats up, data, digital and technological innovations are critical to delivering the desired business and patient outcomes, promoting significantly more networking and outsourcing strategies. CMOs are evolving from service providers to strategic partners. CMOs now cover the entire value chain of pharma production, including specialized services such as R&D.
تحلیل پنج نیروی رقابتی پورتر، Porter five forces analysisFarhad Zargari
موفقیت کسب و کارها در دنیای امروز در گرو شناسایی رقبا و انتخاب راهبردهای درست در بازار است، مایکل پورتر با ارایه مدل تحلیلی ما را در این حوزه کمک می کند
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
From an Islamic perspective, healthcare is discussed as a universal right for all human being. Numerous codes are cited from Quran and Hadith (words of the Prophet and Imams) to further clarify the subjects. Very lucid classifications are presented in each section to correlate the main course of discussions with modern healthcare basics.
Health literacy is the most important factor in getting the proper health information and health services. Health literacy significantly affects healthcare accessibility, availability, affordability and eventually cost. Health literacy makes it possible for the people to actively participate in the healthcare decision making process.
The Doctor, shows a GP on a home visit. He is watching over a worker’s sick child; the bed is makeshift, two non-matching chairs pushed together. The main figure is the doctor, gazing intently at his patient, while in the background the father stands worried with his hand on the shoulders of his tearful wife.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
5. 1-LONGER LIVES AND DISABILITY
Are we living healthier as well as longer lives, or are our
additional years spent in poor health? There is
considerable debate about this question among
researchers, and the answers have broad implications for
the growing number of older people around the world.
One way to examine the question is to look at changes
in rates of disability, one measure of health and function.
6. 1-LONGER LIVES AND DISABILITY
Disability is part of the human condition. Almost everyone
will be temporarily or permanently impaired at some
point in life, and those who survive to old age will
experience increasing difficulties in functioning.
7. 1-LONGER LIVES AND DISABILITY
Disability is the umbrella term for impairments, activity
limitations and participation restrictions, referring to the
negative aspects of the interaction between an
individual (with a health condition) and that individual’s
contextual factors (environmental and personal factors).
8. 1-LONGER LIVES AND DISABILITY
Disability is “an evolving concept”, also “disability results
from the interaction between persons with impairments
and attitudinal and environmental barriers that hinder
their full and effective participation in society on an
equal basis with others”. Defining disability as an
interaction means that “disability” is not an attribute of
the person.
9. 1-LONGER LIVES AND DISABILITY
Responses to disability have changed since the 1970s,
prompted largely by the self-organization of people with
disabilities, and by the growing tendency to see disability
as a human rights issue. Historically, people with
disabilities have largely been provided for through
solutions that segregate them, such as residential
institutions and special schools. Policy has now shifted
towards community and educational inclusion, and
medically- focused solutions have given way to more
interactive approaches recognizing that people are
disabled by environmental factors as well as by their
bodies.
10. 1-LONGER LIVES AND DISABILITY
Disability encompasses the child born with a congenital
condition such as cerebral palsy or the young soldier
who loses his leg to a land-mine, or the middle-aged
woman with severe arthritis, or the older person with
dementia, among many others.
11. DISABILITY AND HUMAN RIGHTS
Disability is a human rights issue because:
People with disabilities experience inequalities – for example,
when they are denied equal access to health care,
employment, education, or political participation because of
their disability.
People with disabilities are subject to violations of dignity – for
example, when they are subjected to violence, abuse,
prejudice, or disrespect because of their disability.
Some people with disability are denied autonomy – for
example, when they are subjected to involuntary sterilization,
or when they are confined in institutions against their will, or
when they are regarded as legally incompetent because of
their disability.
12. DISABILITY AND DEVELOPMENT
Disability is a development issue, because of its
bidirectional link to poverty: disability may increase the
risk of poverty, and poverty may increase the risk of
disability. A growing body of empirical evidence from
across the world indicates that people with disabilities
and their families are more likely to experience
economic and social disadvantage than those without
disability.
13. 1-LONGER LIVES AND DISABILITY
Some researchers think there will be a decrease in the
prevalence of disability as life expectancy increases,
termed a “compression of morbidity.” Others see an
“expansion of morbidity”—an increase in the prevalence
of disability as life expectancy increases. Yet others
argue that, as advances in medicine slow the
progression from chronic disease to disability, severe
disability will lessen, but milder chronic diseases will
increase.
14. 1-LONGER LIVES AND DISABILITY
In the United States, between 1982 and 2001 severe
disability fell about 25 percent among those aged 65 or
older even as life expectancy increased. This very
positive trend suggests that we can affect not only how
long we live, but also how well we can function with
advancing age. Unfortunately, this trend may not
continue in part because of rising obesity among those
now entering older ages.
15. 1-LONGER LIVES AND DISABILITY
The analysis of the Global Burden of Disease estimates
that 15.3% of the world population (some 978 million
people of the estimated 6.4 billion in 2004 had
“moderate or severe disability”, while 2.9% or about 185
million experienced “severe dis- ability”. Among those
aged 0–14 years, the figures were 5.1% and 0.7%, or 93
million and 13 million children, respectively. Among those
15 years and older, the figures were 19.4% and 3.8%, or
892 million and 175 million, respectively.
16. 1-LONGER LIVES AND DISABILITY
Based on 2010 population estimates – 6.9 billion with 5.04
billion 15 years and over and 1.86 billion under 15 years –
and 2004 disability prevalence estimates (World Health
Survey and Global Burden of Disease) there were around
785 (15.6%) to 975 (19.4%) million persons 15 years and
older living with disability. Of these, around 110 (2.2%) to
190 (3.8%) million experienced significant difficulties in
functioning. Including children, over a billion people (or
about 15% of the world’s population) were estimated to
be living with disability.
17. 1-LONGER LIVES AND DISABILITY
Fig. 2.1. Global disability prevalence estimates from
different sources:
This figure compares the
population-weighted average
prevalence of disability for
high-income, middle- income,
and low-income countries
from multiple sources. The solid
grey bars show the average
prevalence based on
available data, the range lines
indicate the 10th and 90th
percentiles for available
country prevalence within
each income group. The data
used for this figure are not age
standardized and cannot be
directly compared with Table
2.1 and Table 2.3. WHS = World
Health Survey; GBD = the
18. 1-LONGER LIVES AND DISABILITY
Age-specific disability prevalence, derived from multi-
domain functioning levels in 59 countries, by country
income level and sex:
19. 1-LONGER LIVES AND DISABILITY
Age-specific disability prevalence, derived from multi-
domain functioning levels in 59 countries, by country
income level and sex:
21. 1-LONGER LIVES AND DISABILITY
American adults reported worse health than did
European adults as indicated by the presence of chronic
diseases and by measures of disability. At all levels of
wealth, Americans were less healthy than their European
counterparts. Analyses of the same data sources also
showed that cognitive functioning declined further
between ages 55 and 65 in countries where workers left
the labor force at early ages, suggesting that
engagement in work might help preserve cognitive
functioning.
22. 1-LONGER LIVES AND DISABILITY
Prevalence of
Chronic Disease and
Disability among Men
and Women Aged
50-74 Years in the
United States,
England, and Europe:
2004
Source: Adapted from Avendano
M, Glymour MM, Banks J,
Mackenbach JP. Health
disadvantage in US adults aged 50
23. REHABILITATION
Rehabilitation as “a set of measures that assist individuals
who experience, or are likely to experience, disability to
achieve and maintain optimal functioning in interaction
with their environments”. A distinction is sometimes made
between habilitation, which aims to help those who
acquire disabilities con- genitally or early in life to
develop maximal functioning; and rehabilitation, where
those who have experienced a loss in function are
assisted to regain maximal functioning.
25. 2-THE BURDEN OF DEMENTIA
Physicians often define dementia based on the criteria
given in the Diagnostic and Statistical Manual of Mental
Disorders (DSM). In 2013 the American Psychiatric
Association released the fifth edition of the DSM (DSM-5),
which incorporates dementia into the diagnostic
categories of major and mild neurocognitive disorders.
26. 2-THE BURDEN OF DEMENTIA
To meet DSM-5 criteria for major neurocognitive disorder,
an individual must have evidence of significant cognitive
decline (for example, decline in memory, language or
learning), and the cognitive decline must interfere with
independence in everyday activities (for example,
assistance may be needed with complex activities such
as paying bills or managing medications). To meet DSM-5
criteria for mild neurocognitive disorder, an individual
must have evidence of modest cognitive decline, but
the decline does not interfere with everyday activities
(individuals can still perform complex activities such as
paying bills or managing medications, but the activities
require greater effort).
27. 2-THE BURDEN OF DEMENTIA
Dementia is a syndrome due to disease of the brain –
usually of a chronic or progressive nature – in which there
is disturbance of multiple higher cortical functions,
including memory, thinking, orientation, comprehension,
calculation, learning capacity, language, and
judgment. Consciousness is not clouded. The
impairments of cognitive function are commonly
accompanied, and occasionally preceded, by
deterioration in emotional control, social behavior, or
motivation. This syndrome occurs in a large number of
conditions primarily or secondarily affecting the brain.
28. 2-THE BURDEN OF DEMENTIA
The cause of most dementia is unknown, but the final
stages of this disease usually means a loss of memory,
reasoning, speech, and other cognitive functions. The risk
of dementia increases sharply with age and, unless new
strategies for prevention and management are
developed, this syndrome is expected to place growing
demands on health and long term care providers as
population ages.
29. 2-THE BURDEN OF DEMENTIA
The disease is not easy to diagnose, especially in its early
stages. The memory problems, misunderstandings, and
behavior common in the early and intermediate stages
are often attributed to normal effects of aging,
accepted as personality traits, or simply ignored.
30. 2-THE BURDEN OF DEMENTIA
Many cases remain undiagnosed even in the
intermediate, more serious stages. A cross-national
assessment conducted by the Organization for
Economic Cooperation and Development (OECD)
estimated that dementia affected about 10 million
people in OECD member countries around 2000, just
under 7 percent of people aged 65 or older.
37. 2-THE BURDEN OF DEMENTIA
The total number of people with dementia worldwide in
2010 is estimated at 35.6 million and is projected to
nearly double every 20 years, to 65.7 million in 2030 and
115.4 million in 2050. The total number of new cases of
dementia each year worldwide is nearly 7.7 million,
implying one new case every four seconds.
38. 2-THE BURDEN OF DEMENTIA
The total estimated worldwide costs of dementia were
US$ 604 billion in 2010. In high-income countries, informal
care (45%) and formal social care (40%) account for the
majority of costs, while the proportionate contribution of
direct medical costs (15%) is much lower. In low-income
and lower-middle-income countries direct social care
costs are small, and informal care costs (i.e. unpaid care
provided by the family) predominate.
39. 2-THE BURDEN OF DEMENTIA
Alzheimer’s disease(AD) is the most common form of
dementia and accounted for between two-fifth and four
fifth of all dementia cases cited in the OECD report. More
recent analyses have estimated the worldwide number
of people living with AD/dementia at between 27 million
and 36 million. The prevalence of AD and other
dementias is very low at younger ages, then nearly
doubles with every five years of age after age 65.
40. 2-THE BURDEN OF DEMENTIA
In the OECD review, for example, dementia affected
fewer than 3 percent of those aged 65 to 69, but almost
30 percent of those aged 85 to 89. More than one-half of
women aged 90 or older had dementia in France and
Germany, as did about 40 percent in the United States,
and just under 30 percent in Spain.
41. 2-THE BURDEN OF DEMENTIA
The projected costs of caring for the growing numbers of
people with dementia are daunting. The 2010 World
Alzheimer Disease Report estimates that the total
worldwide cost of dementia exceeded US$600 billion in
2010, including informal care provided by family and
others, social care provided by community care
professionals, and direct costs of medical care. Family
members often play a key caregiving role, especially in
the initial stages of what is typically a slow decline. Ten
years ago, U.S. researchers estimated that the annual
cost of informal caregiving for dementia in the United
States was US$18 billion.
42. 2-THE BURDEN OF DEMENTIA
The complexity of the disease and the wide variety of
living arrangements can be difficult for people and
families dealing with dementia, and countries must cope
with the mounting financial and social impact. The
challenge is even greater in the less developed world,
where an estimated two-thirds or more of dementia
sufferers live but where few coping resources are
available.
43. 2-THE BURDEN OF DEMENTIA
Projections by World Alzheimer Disease Report suggest
that 115 million people worldwide will be living with
AD/dementia in 2050, with a markedly increasing
proportion of this total in less developed countries.
44. 2-THE BURDEN OF DEMENTIA
The Growth of
Numbers of People
with Dementia in High-
income Countries and
Low- and Middle-
income Countries:
2010-2050
Source: Alzheimer’s Disease International,
World Alzheimer Report, 2010.
47. 3-GERIATRIC FALLS
Falls are the leading cause of external injuries.
Most common in children less than 5 years old and adults 65
and older.
Trauma is the 5th cause of death in those >65 years
Falls are responsible for 70% of accidental deaths in
people over 75 years old.
1/4 of the elderly people who fracture their hips die
within 6 months of the injury.
35%-40% of people 65+ fall each year. Those who
fall are 2-3 times more likely to fall again.
10%-20% of falls cause serious injuries.
48. 3-GERIATRIC FALLS
Falls are the leading cause of external injuries.
Most common in children less than 5 years old and adults 65
and older.
Trauma is the 5th cause of death in those >65 years.
Falls are responsible for 70% of accidental deaths in
people over 75 years old.
1/4 of the elderly people who fracture their hips die
within 6 months of the injury.
49. 3-GERIATRIC FALLS
Up to 20-30% of falls in older adults result in an injury
requiring medical care
Most fractures in Medicare population are due to falls
Falls in older adults are the leading cause of traumatic
brain injury
Men have a higher rate of fatal falls (due to TBI)
Women are more likely to have non-fatal falls
50. 3-GERIATRIC FALLS
Age Group
First Leading
of Trauma Death
Second Leading
Cause of
Death
35 – 64
Motor Vehicle
36.8%
Falls
29.6%
65+
Falls
43.3%
Motor Vehicle
10.2%
51. 3-GERIATRIC FALLS
Consequences of Geriatric Falls
Death
Injury
Fractures 10-15%
Hip 1-2%
Long Lie
Fear of Falling
Reduced Activity/Independence (25%)
52. 3-GERIATRIC FALLS-HIP FRACTURE
In 1996 more than 250,000 older Americans had
fractured hips.
90% are associated with falls
Excess of $10 billion
Leading fall-related injury that results in hospitalization –
which are often prolonged and costly.
What Happens After the Hip Fracture?
One in four people that have a hip fracture that lived
independently before the fracture had to live in a nursing
home for a year afterward, according to the CDC.
Some never recover their balance and strength.
This can lead to depression and dementia and a downhill
spiral.
Unfortunately 1/4 of the elderly people who fracture their hips
die within 6 months of the injury.
53. 3-GERIATRIC FALLS-BRAIN INJURY
Also a common injury following a fall
Many elderly on “blood thinners”
Symptoms may be subtle and not apparent at the time
of injury.
54. RISK FACTORS FOR FALLS
Increased age
Living alone
Previous falls
Use of a cane or walker
Acute illness
Reduced vision
Glare intolerance
Altered depth perception
Decreased night vision
Decline in peripheral vision
55. RISK FACTORS FOR FALLS
CVA that results in hemiparesis, sensory and/or
motor function deficits.
Decreased range of motion and flexibility in lower
legs and spine.
Weakness
Decreased step length (short shuffling steps)
Alzheimer’s or dementia
Arthritis
Parkinson’s disease
Foot problems
Toenail length, callouses, bunions, deformities
56. RISK FACTORS FOR FALLS
Difficulty rising from a chair
Neurologic changes
Slowed reaction times
Diminished sensory awareness for light touch, vibration,
and temperature
Decline in proprioception
Decreased hearing
Impaired speech discrimination
Excessive cerumen accumulation
Loss of high frequency tones
Risky behaviors
57. RISK FACTORS FOR FALLS
Medications
Some antidepressants
Sedatives
Some antihypertensive and cardiac medications
Hypoglycemic drugs
Alcohol
58. 3-GERIATRIC FALLS
American Geriatrics Society: Most Common Intrinsic Fall
Risk Factors
Muscle weakness: 4.4
History of falls: 3.0
Gait or balance deficit: 2.9
Use of assistive device: 2.6
Visual deficit: 2.5
Arthritis: 2.4
Depression: 2.2
Cognitive impairment: 1.8
Age over 80 years: 1.7
Data from AGS Panel on Falls Prevention. Guideline for the prevention of falls in older
persons. J Am Geriatr Soc 2001;49(5):664–72.
60. POLYPHARMACY-DEFINITION
Polypharmacy means “many drugs.”
In practice, polypharmacy refers to the use of more
medication than is clinically indicated or warranted.
Polypharmacy can result in a gradual accumulation of
side effects and/or adverse drug reactions, which
negatively effects elders’ health and well-being.
61. POLYPHARMACY-DEFINITION
Polypharmacy is the use of four or more medications by
a patient, generally adults aged over 65 years.
Polypharmacy (ie, the use of multiple medications
and/or the administration of more medications than are
clinically indicated, representing unnecessary drug use) is
common among the elderly, affecting about 40% of
older adults living in their own homes.
62. POLYPHARMACY-DEFINITION
Although polypharmacy can be appropriate, it is more
often inappropriate. Concerns about polypharmacy
include increased adverse drug reactions, drug
interactions, prescribing cascade, and higher costs.
Polypharmacy is often associated with a decreased
quality of life, decreased mobility and cognition.
63. POLYPHARMACY-DEFINITION
Patients at greatest risk for negative polypharmacy
consequences include the elderly, psychiatric patients,
patients taking five or more drugs concurrently, those
with multiple physicians and pharmacies, recently
hospitalized patients, individuals with concurrent
comorbidities, low educational level, and those with
impaired vision or dexterity.
65. POLYPHARMACY-DEFINITION
Older adults comprise 12% of the U.S. population, but use
35% of the prescription medications and 50 percent of
the over-the-counter medications.
The average medication usage for persons over 65 is:
2 to 6 prescription drugs, plus …
1 to 3.4 over-the-counter medicines.
In 2011, 58 percent of adults 65 years or older reported
taking 5 or more medications and 18% reported taking
10 or more (Slone Epidemiology Center).
The average American senior spends $870 annually for
pharmaceuticals.
69. POLYPHARMACY-CAUSES
4-Providers – Patients Relationship:
The more the providers and physician visits, the more the
number of medications patients take.
2/3 of all physician visits end with a prescription.
Expectations to receive medication is growing from the patient
side.
Shortage in communicating with PCP about medications
changes.
Self-treatment
70. POLYPHARMACY-COMPLICATIONS
Polypharmacy leads to:
More adverse drug reactions.
Decreased adherence to drug regimens.
Higher rates of disease symptomatology.
(Unnecessary) drug expenses.
All of the above contribute to client distress and poorer
quality of life, which are of great concerns.
71. POLYPHARMACY-COMPLICATIONS
Polypharmacy leads to:
More adverse drug reactions (ADR).
Decreased adherence to drug regimens.
Higher rates of disease symptomatology.
(Unnecessary) drug expenses.
All of the above contribute to client distress and poorer
quality of life, which are of great concerns.
72. ADVERSE DRUG REACTIONS
Side effects: considered minor enough to allow
continuation of therapy.
Adverse Drug Reactions (ADRs): May necessitate
discontinuation of drug and require treatment of adverse
event.
73. ADVERSE DRUG REACTIONS
An adverse drug reaction (ADR) is defined as the
unwanted, negative consequences associated with the
use of a medications or medications.
Over 100,000 deaths a year are attributed to adverse
drug reactions, making ADRs the fourth leading cause of
death in the U.S. (Lazarou, Pomeranz, & Corey, 2009).
Other examples of ADRs include:
Peptic ulcers
Anemia
Deceased white blood cell production (which increases
infection risk)
Liver damage
Kidney damage
Confusion/drowsiness (which can lead to falls and subsequent
injuries)
74. ADVERSE DRUG REACTIONS
About 3 to 7% of all hospital admissions in the United
States are for treatment of adverse drug reactions.
Elderly 7 times more likely to have unwanted side effect
and 2-3 times more likely to have ADRs
Adverse drug reactions occur during 10 to 20% of
hospital admissions, and about 10 to 20% of these
reactions are severe.
The most consistent risk factor for an adverse drug
reactions is:
The number of drugs being taken.
Multiple medications is the factor most strongly
correlated with increased risk of ADRs. Exponential
increase in ADRs with addition of more drugs to a
76. ADVERSE DRUG REACTIONS
Other risk factors for ADRs include:
Having six or more chronic diseases.
Taking twelve or more doses of medication (of any type) per
day.
Taking nine or more medications total.
Having had a prior adverse drug reaction.
Being older than 85 years (this is important because persons 85
and older are the fastest growing segment of the population).
Having decreased kidney function.
77. ADVERSE DRUG REACTIONS
Drugs most frequently associated with adverse reactions
in the elderly:
Psychotropic drugs, especially benzodiazepines (valium,
ativan)
Anti-hypertensive agents (blood pressure medications)
Diuretics
Digoxin (a heart medication)
NSAIDS (Non-steroidal anti-inflammatory drugs, i.e. aspirin,
Aleve, celebrex)
Corticosteroids (i.e. prednisone - often used to treat arthritis)
Warfarin (coumadin - a blood thinner for treating blood clots)
Theophylline (theo-dur - for treating COPD, asthma)
78. PHARMACOKINETICS AND AGING
Pharmacokinetics means “What the body does to the
drug.”
It refers to the following functions by which the body
processes medications:
Absorption
Distribution
Metabolism
Excretion
Normal changes in these processes that occur with
aging increase the risk of adverse medication reactions
among older adults.
79. PHARMACOKINETICS AND AGING
Absorption
Age-related changes in the gastrointestinal tract and skin seem
to have little impact on medication usage.
So fortunately, there is not much to worry about here, however,
this is not the case for other components of medication
metabolism…
80. PHARMACOKINETICS AND AGING
Distribution
Important age-related changes:
Decrease in lean body mass and total body water.
Increased percentage body fat.
Increase in volume of distribution for fat-dissolving drugs, such
as sedatives (I.e. valium, dalmane, librium) that penetrate the
central nervous system.
This means older adults need most lower dosages of such
medications to achieve a therapeutic effect; they are at risk
for toxicity at doses considered normal for younger persons.
Protein-binding changes with aging are of modest significance
for most drugs, especially at steady-state (when the amount of
drug going in is the same as the amount of drug going out).
81. PHARMACOKINETICS AND AGING
Metabolism
Many medications are processed by the liver.
Although liver function is relatively unchanged with age, there
is some overall decline in metabolic capacity.
Plus, many of the chronic conditions common among older
adults do negatively impact liver function.
Decreased liver mass and hepatic blood flow lead to:
High variability with no good estimation algorithms for doctors
to determine appropriate medication dosages for older adults.
Minimal clinical manifestations of actual underlying problems,
so it is difficult for doctors to determine when someone may be
having problems.
82. PHARMACOKINETICS AND AGING
Renal Excretion
Medications are eliminated from the body via the kidneys and
urinary system.
Age-related decreases in renal blood flow and kidney function
(specifically, glomerular filtration rate) impact older adults’
ability to eliminate medications.
In addition, decreased lean body mass leads to decreased
creatinine production (a measure of kidney function, with high
levels being a cause for concern), thus, for older adults serum
creatinine may appear normal even when significant renal
impairment exists!
83. PHARMACODYNAMICS AND AGING
Pharmacodynamics is the opposite of pharmacokinetics;
it refers to “What the drug does to the body.”
Generally, lower drug doses are required to achieve the
same effect with advancing age.
This is because:
Receptor numbers, affinity, or post-receptor cellular effects
may change with age.
Changes in homeostatic mechanisms can increase or
decrease drug sensitivity.
84. PHARMACODYNAMICS AND AGING
Panels of experts in pharmacology and geriatrics have
compiled lists of medications to avoid prescribing for
patients 65 years of age or older.
The most commonly used list is the Beers criteria, which
include 48 "potentially inappropriate medications" (PIMs)
for which there are more effective or safer alternatives
for older patients (Fick, et al, 2003).
85. PHARMACODYNAMICS AND AGING
However in spite of the Beers criteria:
Numerous studies in the last 15 years have found that PIMs
continue to be used in 12% to 40% of older patients in
community and nursing home settings (Raebel, Charles,
Dugan, & et al, 2007).
Administrative data from nearly 400 hospitals across the United
States reveals that nearly half of all older patients hospitalized
for 7 common conditions were prescribed at least 1 PIM
(Rothberg et al, 2008).
86. PHARMACODYNAMICS AND AGING
Such irrational polypharmacy can arise from several
factors:
The prescriber hesitates to discontinue medications the patient
has been taking a long time.
The prescriber may add more drugs to the patient's regimen
without removing any.
The prescriber orders medication to alleviate adverse reactions
to other medications.
he patient may be influenced by anecdotal reports touting the
benefits of certain medications.
87. MEDICATION NON-ADHERENCE
Sometimes being on multiple medications contributes to
patients not taking those medications as the physician
intended.
Not taking medications as prescribed.
Correlates more strongly with number of meds, rather
than age.
It is important to recognize that medication non-
adherence is a two-way street!
Physician factors play a role.
Patient factors play a role.
88. MEDICATION NON-ADHERENCE
Example contributing factors:
Patients
Underreporting symptoms
Use of multiple providers
Use of others’ medications
Physicians
Limited time for discussion, diagnostics
Limited knowledge of geriatric pharmacology
The power of inertia
89. MEDICATION NON-ADHERENCE
Additional contributing factors:
Large number of medications
Cost and other social barriers
Complexity of medication regimen or frequently changing
medication schedule
Adverse reactions (ADRs)
Confusion about brand name/trade name
Difficult-to-open containers
Rectal, vaginal, subcutaneous modes of administration
Lack of insight into illness
Limited patient understanding of medication’s purpose
Cognitive impairment/psych issues
Illiteracy, language/cultural issues
Misunderstanding verbal instructions
90. MEDICATION NON-ADHERENCE
Like polypharmacy itself, the strongest predictor of
medication non-adherence is the number of
medications.
Non-adherence rates are estimated at 25-50 percent of
older adults.
Non-adherence is intentional about 75% of the time.
33-69% of drug-related admissions result from non-
adherence (for all patients)
Patients discharged with 4 or more meds- over 50% error
rate
Changes in medication regimen made by patients to:
Increase convenience
Reduce adverse effects
91. SOLUTIONS TO POLYPHARMACY
Review medication
Anticipate Adverse Drug Events ( ADEs)
Avoid errors- prescribe carefully
Give verbal and written instructions
Simplify
Understand obstacles (cost, memory loss…)
Enlist family/nursing/PCP
Make sure there is good follow up
92. ALWAYS REMEMBER
“Prescribing cascade”- a drug added to treat
(mistakenly) the ADR of another drug.
Clinical Pearl- “Any symptom in an elderly person should
be evaluated as a potential ADR until proven otherwise”.
Many geriatric syndromes can occur as a consequence
of medications: delirium, falls and fractures,
incontinence.
93. ALWAYS REMEMBER
Polypharmacy is a reality of prescribing when patients
have multiple comorbidities.
We must all anticipate and guard against the potential
complications of polypharmacy.
Optimal prescribing is key!