scholarly journals Perioperative Drug Therapy in Elderly Patients

2009 ◽  
Vol 110 (5) ◽  
pp. 1176-1181 ◽  
Author(s):  
Richard Rivera ◽  
Joseph F. Antognini ◽  
Bruno Riou
Keyword(s):  
Public Health ◽  
Drug Therapy ◽  
Elderly Patients ◽  
Operating Room ◽  
Surgical Procedures ◽  
Perioperative Period ◽  
Modern Medicine ◽  
Clinical Meaning

Advances in modern medicine and public health have resulted in increased longevity, which in turn has resulted in more elderly patients (arbitrarily defined as aged 65 yr or older) coming to the operating room for a variety of surgical procedures. Even in the absence of comorbidities, these patients, as compared with their younger cohorts, respond differently to various perioperative physiologic trespasses and pharmacologic interventions. In this clinical commentary, we focus on the altered pharmacologic responses elderly patients have during the perioperative period. In many instances, elderly patients are more sensitive to drugs, and for the purposes of this clinical commentary, we use the word sensitivity in its general clinical meaning, i.e., an enhanced response for a given dose of drug that might have a pharmacokinetic or pharmacodynamic explanation.

POLYPHARMACY IN ELDERLY OUT PATIENTS

2019 ◽  
pp. 16-22
Author(s):  
E.A. Panova ◽  
V.A. Serov ◽  
A.M. Shutov ◽  
N.N. Bakumtseva ◽  
M.Yu. Kuzovenkova
Keyword(s):  
Drug Therapy ◽  
Elderly Patients ◽  
Drug Prescription ◽  
Daily Practice ◽  
Drug Prescriptions ◽  
Ulcer Disease ◽  
Start Criteria ◽  
Therapeutic Value ◽  
Elderly Outpatients ◽  
Oncological Diseases

The aim of the work is to study the daily practice of prescribing drugs at the outpatient stage of medical care and to analyze the data obtained based Beers 2012 criteria and STOPP / START version 1. Materials and Methods. The authors analyzed drug prescriptions for 150 outpatients, who were over 65 years old. Results. Cardiovascular diseases, diseases of the osteo-articular system and type 2 diabetes mellitus prevailed in the morbidity structure of patients. Oncological diseases, thyroid diseases, bronchial asthma, cataracts, pancreatitis, anemia, peptic ulcer disease were diagnosed in some patients. All drug prescriptions during the year were taken into account. Simultaneous prescription of more than 4 drugs was considered polypharmacy. All the patients were monitored for a year since drug prescriptions had been made. Death was taken as the end point. The authors considered drug therapy to be irrational according to Beers and STOPP / START criteria. The therapeutic value of drug prescription audit based on restrictive lists was evaluated. Conclusions. Polypharmacy is observed in more than half of elderly outpatients. According to Beers 2012 criteria, irrational drug therapy was detected in 20 % of elderly patients, according to STOPP and START lists – in 43.3 % and 66.6 %, respectively. The lack of drug prescriptions in accordance with START criteria is associated with increased mortality of elderly patients. Keywords: polypharmacy, pharmacotherapy, drug therapy, geriatrics, restrictive lists, Beers criteria, STOPP / START criteria. Цель работы – изучение ежедневной практики назначения лекарственных препаратов на амбулаторном этапе медицинской помощи и анализ полученных данных на основе критериев ограничительных перечней Бирса 2012 г. и STOPP/START версии 1. Материалы и методы. Проанализированы лекарственные назначения 150 пациентам старше 65 лет, находившимся на амбулаторном лечении. Результаты. В структуре заболеваемости пациентов преобладали сердечно-сосудистые заболевания, а также болезни костно-суставной системы и сахарный диабет 2-го типа. Онкологические заболевания, заболевания щитовидной железы, бронхиальная астма, катаракта, панкреатит, анемия, язвенная болезнь диагностированы у единичных больных. Учитывались все лекарственные назначения в течение года. За полипрагмазию принималось одновременное назначение более 4 препаратов. В течение последующего года отслеживалось состояние пациентов, за конечную точку принята смерть. Выявлена нерациональная лекарственная терапия на основе критериев Бирса и STOPP/START. Оценена терапевтическая значимость аудита лекарственных назначений по ограничительным перечням. Выводы. Полипрагмазия наблюдается более чем у половины амбулаторных пациентов пожилого возраста. На основе критериев ограничительных перечней Бирса 2012 г. нерациональная лекарственная терапия выявлена у 20 % пациентов пожилого возраста, на основе критериев STOPP и START – у 43,3 и 66,6 % соответственно. Отсутствие назначений лекарств в соответствии с критериями START ассоциировано с увеличением смертности пациентов пожилого возраста. Ключевые слова: полипрагмазия, фармакотерапия, лекарственная терапия, гериатрия, ограничительные перечни, критерии Бирса, критерии STOPP/START.

Elderly Patients' Understanding of Their Drug Therapy: The Effect of Cognitive Function

1990 ◽  
Vol 19 (4) ◽  
pp. 236-240 ◽  
Author(s):  
E. BURNS ◽  
C. A. AUSTIN ◽  
N. D. S. BAX
Keyword(s):  
Drug Therapy ◽  
Cognitive Function ◽  
Elderly Patients

scholarly journals Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Diana Nordquist ◽  
Thomas M. Halaszynski
Keyword(s):  
Drug Therapy ◽  
Adverse Effects ◽  
Elderly Patients ◽  
Regional Anesthesia ◽  
Pain Control ◽  
The Elderly ◽  
Surgical Patient ◽  
Cochrane Central Register ◽  
Promising Alternative ◽  
Age Related

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

scholarly journals Possibility of oxygen-ozone therapy in the geriatric patient

Ozone Therapy ◽  
2017 ◽  
Vol 1 (3) ◽  
pp. 53
Author(s):  
Marianno Franzini ◽  
Giulia Ionita
Keyword(s):  
Drug Therapy ◽  
Side Effects ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Geriatric Patient ◽  
Multidisciplinary Care ◽  
Invasive Technique ◽  
Ozone Therapy ◽  
Muscular Pain ◽  
Care Of Elderly

In the context of multidisciplinary care of elderly patients, this work will want to consider the presence of osteo-articular and muscular pain, mostly chronic, of these subjects. The treatment has made use of oxygen-ozone therapy, given the absence of side effects of this minimally invasive technique, and the possibility of its use simultaneously with an already established poly-drug therapy, as typically found in the geriatric patient.

Optimizing Antiepileptic Drug Therapy in the Elderly

2005 ◽  
Vol 39 (11) ◽  
pp. 1852-1860 ◽  
Author(s):  
William R Garnett
Keyword(s):  
Drug Therapy ◽  
Elderly Patients ◽  
Antiepileptic Drug ◽  
Age Groups ◽  
The Elderly ◽  
Complex Partial Seizures ◽  
Medline Search ◽  
Age Related ◽  
Epilepsy In The Elderly ◽  
Clonic Seizures

OBJECTIVE To review and evaluate the medical literature concerning antiepileptic drug (AED) therapy in elderly patients. DATA SOURCES A MEDLINE search (1982–December 2004) was conducted. Bibliographies of the articles identified were also reviewed, and an Internet search engine was used to identify additional pertinent references. STUDY SELECTION AND DATA EXTRACTION Clinical studies and reviews were evaluated, and relevant information was included. DATA SYNTHESIS The elderly have the highest incidence of seizures among all age groups. Complex partial seizures are the most common, followed by primary generalized tonic–clonic seizures. An accurate diagnosis may prove difficult because of a low suspicion of epilepsy in the elderly and other diseases that may mimic seizures. Most AEDs are approved for treatment of elderly patients who have partial and tonic–clonic seizures. However, a number of age-related variables should be addressed when selecting an appropriate AED. Age-dependent differences in pharmacokinetics and pharmacodynamics of AEDs must be taken into account. Drug–drug interactions must be considered since elderly people often take multiple medications. The ultimate factor that often determines AED selection is tolerability. CONCLUSIONS Numerous factors must be considered in treating elderly patients for seizures, but maximizing the ability of patients to tolerate drug therapy is often the basis for AED selection. Special consideration should be made along several lines, including elderly patients’ cognitive functioning and their tendency to respond to lower AED concentrations.

scholarly journals The COVID-19 pandemic and the future of public health

2021 ◽  
pp. 209660832110224
Author(s):  
Jinling Tang
Keyword(s):  
Public Health ◽  
Health System ◽  
Clinical Medicine ◽  
Public Health System ◽  
Modern Medicine ◽  
Effective Measure ◽  
Health Measures ◽  
New Ideas ◽  
Rare Opportunity ◽  
Human Death

The COVID-19 pandemic provides us with a rare opportunity to deeply examine the validity of the construction of modern medicine, which is armed by science, and focus more on technologies than on people’s values and more on new ideas than on conventional wisdom. The world’s responses to the COVID-19 emergency have revealed a badly weakened public health system – one of the three pillars of medicine, the other two being basic medicine and clinical medicine. A 100 years ago, public health was the only effective measure for combating infectious diseases, which were then the main cause of human death. It is still a decisive weapon against COVID-19 and other communicable diseases alike, but was barely recognized and trusted at the beginning of the pandemic by the general public and even some international strategists. However, the epidemic has been effectively contained in China by non-pharmacological public health measures, which saved valuable time for the development of vaccines in the country and probably hundreds of thousands of lives as well. Public health aims to improve the health of the entire population by using societal methods. It is not simply a medical issue, and building a strong public health system requires broad participation from various sections of society.

scholarly journals Eye-tunes: role of music in ophthalmology and vision sciences

2021 ◽  
Vol 13 ◽  
pp. 251584142110408
Author(s):  
Shruti Muralidharan ◽  
Parul Ichhpujani ◽  
Shibal Bhartiya ◽  
Rohan Bir Singh
Keyword(s):  
Surgical Procedures ◽  
Diagnostic Procedures ◽  
Well Being ◽  
Modern Medicine ◽  
Holistic Healing ◽  
Operation Theatre ◽  
Healing Effect ◽  
Theatre Staff

Although the healing effect of music has been recognized since time immemorial, there has been a renewed interest in its use in modern medicine. This can be attributed to the increasing focus on holistic healing and on the subjective and objective aspects of well-being. In ophthalmology, this has ranged from using music for patients undergoing diagnostic procedures and surgery, as well as for doctors and the operation theatre staff during surgical procedures. Music has proven to be a potent nonpharmacological sedative and anxiolytic, allaying both the pain and stress of surgery. This review aims to explore the available evidence about the role of music as an adjunct for diagnostic and surgical procedures in current ophthalmic practices.

Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology

2011 ◽  
Vol 120 (11) ◽  
pp. 727-731 ◽  
Author(s):  
Neil Bhattacharyya
Keyword(s):  
United States ◽  
Operating Room ◽  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Secondary Analysis ◽  
The United States ◽  
Tube Placement ◽  
The Mean ◽  
Room Time ◽  
Ambulatory Procedures

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

Pharmacology and Drug Therapy in Critically Ill Elderly Patients

1992 ◽  
Vol 3 (1) ◽  
pp. 137-148 ◽  
Author(s):  
Mary K. Walker
Keyword(s):  
Older Adults ◽  
Critical Care ◽  
Drug Therapy ◽  
Drug Metabolism ◽  
Elderly Patients ◽  
Treatment Modality ◽  
Drug Disposition ◽  
Structure And Function ◽  
Living Things ◽  
And Function

Aging is a complex, normal, and inevitable process affecting all living things. The physiologic changes of aging, by definition, are postmaturational, occurring after adult maturity is achieved. Changes with aging are primary, irreversible, and progressive. While the processes of aging are neither pathology nor disease, they present important changes in structure and function that alter drug disposition, metabolic rate, and excretion. These changes present special challenges to clinicians in critical care settings for whom pharmacotherapy is a common treatment modality. This article explores the physiologic changes associated with aging and the implications of these changes for management of critically compromised elders. Drug metabolism, distribution, utilization, and excretion in older adults are examined

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