Aging and Drugs

Dr. Dalia A. HamdyAssistant Professor

College of Pharmacy19 April 2012

2

Aging and Drugs: Outline

• Introduction

• Drug Therapy

• Facts and Recommendations

• Geriatric Pharmacists

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

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Aging and Drugs: Introduction

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

• Geriatrics refers to medical care to elderly

Who are elderly?

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

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Aging and Drugs: Introduction

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

• USA people >65 years

19002000

2026

0102030405060708090

100

4

Year

% o

f USA

pop

ulati

on

Data obtained from “The Merck Manual”

5

Aging and Drugs: Introduction

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

• USA people >65 years

19002000

2026

0102030405060708090

100

4 12

Year

% o

f USA

pop

ulati

on

Data obtained from “The Merck Manual”

6

Aging and Drugs: Introduction

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

• USA people >65 years

19002000

2026

0102030405060708090

100

4 12 20

Year

% o

f USA

pop

ulati

onNumber of birth (World War II)

Mortality rate

Overall better health

Data obtained from “The Merck Manual”

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Aging and Drugs: Introduction

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

• USA life span statistics• Gender gap

Series1

0

20

40

60

80

100

30

70

Males Females

≥ 85 years

% o

f USA

pop

ulati

on

Data obtained from “Pharmacotherapy”

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Aging and Drugs: Drug Therapy

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

• Geriatrics refers to medical care to elderly

Why do we link Elderly and Pharmaceutical Care?

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Aging and Drugs: Drug Therapy

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

at least 1 drug/week

at least 5 drugs/week

at least 10 drugs/week

0102030405060708090

10090

% d

rug

use

amon

g p

eopl

e >

65

• Elderly compose a major group of drug users

Data obtained from “The Merck Manual”

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Aging and Drugs: Drug Therapy

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

at least 1 drug/week

at least 5 drugs/week

at least 10 drugs/week

0102030405060708090

10090

40

% d

rug

use

amon

g p

eopl

e >

65

• Elderly compose a major group of drug users

Data obtained from “The Merck Manual”

11

Aging and Drugs: Drug Therapy

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

at least 1 drug/week

at least 5 drugs/week

at least 10 drugs/week

0102030405060708090

10090

40

10

% d

rug

use

amon

g p

eopl

e >

65

• Elderly compose a major group of drug users

Data obtained from “The Merck Manual”

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Aging and Drugs: Drug Therapy

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

• 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

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Aging and Drugs: Facts and Recommendations

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

• Geriatrics refers to medical care to elderly

What can a pharmacist do?

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Aging and Drugs: Facts and Recommendations

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

A. PolyPharmacy

Concomitant use of multiple drugs

Administration of more drugs than needed clinically

Common and increasing among elderly

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Aging and Drugs: Facts and Recommendations

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

B. Inappropriate prescribing

Falls outside bounds of accepted medical standards

(dose, durations, duplication, drug interaction)

Their risks outweighs their benefit

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Aging and Drugs: Facts and Recommendations

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

C. UnderuseOmission of drug therapy that is indicated for the

treatment or prevention of a disease or condition

Inaccessibility to physicianFunctional disabilityAdmission to nursing homesMore cost

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Aging and Drugs: Facts and Recommendations

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

D. Medication NonadherencePrevalence rates 40-80%

When having same number of medications, they show same adherence to young adults

ADR, dementia, Hospital admittanceADR

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Aging and Drugs: Facts and Recommendations

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

1. Assessing and Monitoring Drug

Therapy

Medication appropriateness index (10 questions)

+AllergySuboptimal medication

choicesUnder treatmentDrug interaction

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Aging and Drugs: Facts and Recommendations

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

2. Problems Documentation and Therapeutic Plan formulation

Document ProblemDevelop therapeutic

plans to solve themComorbiditiesFunctional statusLife expectancy

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Aging and Drugs: Facts and Recommendations

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

3. Consulting Physician regarding

problems and concerns

Optimize prescribing for elderly patients

Followed by

Planning for enhancing patient adherence

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Aging and Drugs: Facts and Recommendations

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

4. Counseling and adherence aids

Document ProblemDevelop therapeutic

plans to solve themComorbidtiesFunctional statusLife expectancy

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Aging and Drugs: Facts and Recommendations

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

5. Documenting Intervention and

monitoring patient progress

Document intervention and steps for application

Contact follow up Problem

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Aging and Drugs: Facts and Recommendations

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

6. Targeting high riskelderly

18 risk FactorsPolypharmacyHigh risk drugs

(sedatives, benzodiazepines, anticholinerigics)

Patient characteristics (low weight, >85Y, renal function)

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Aging and Drugs: Facts and Recommendations

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

6. Targeting high riskelderly

18 risk FactorsNarrow therapeutic

range drugs

History of a prior ADR

Six or more illnesses

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Aging and Drugs: Geriatric Pharmacist

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

• Geriatrics refers to medical care to elderly

Live applications of Geriatric Pharmacists?

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Aging and Drugs: Qatar University-College of Pharmacy

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

Are we ready for the bright future?!

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

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Aging and Drugs: References

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

1. Lindblad Cl et al. Geriatrics (Chapter8) in DiPiro J et al. Pharmacotherapy: A Pathophysiological Approach

2. The Merk Manual of geriatricshttp://www.merck.com/mkgr/mmg/sec1/sec1.jsp

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

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