Pharmacologic Considerations in the Elderly Surgical Patient

2017 ◽  
Author(s):  
Linda Sohn ◽  
Joe C. Hong ◽  
Michael W. Yeh ◽  
Tara A. Russell ◽  
Marcia M. Russell
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Postoperative Delirium ◽  
Medication Management ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Age Related ◽  
The Impact ◽  
Preoperative Medication

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.   This review contains 2 highly rendered figures, 9 tables, and 61 references

Pharmacologic Considerations in the Elderly Surgical Patient

2016 ◽  
Author(s):  
Linda Sohn ◽  
Joe C. Hong ◽  
Michael W. Yeh ◽  
Tara A. Russell ◽  
Marcia M. Russell
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Postoperative Delirium ◽  
Medication Management ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Age Related ◽  
The Impact ◽  
Preoperative Medication

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.   This review contains 2 highly rendered figures, 9 tables, and 61 references

Conclusion

2016 ◽  
Author(s):  
Maria A. Sullivan
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
The Elderly ◽  
Social Consequences ◽  
Individual Therapy ◽  
Older Individuals ◽  
Prescribing Practices ◽  
Elderly Age ◽  
Age Related ◽  
The Impact

Addiction in older adults very often goes unrecognized, for several reasons: social biases about the elderly, age-related metabolic changes, and the inappropriate use of prescription benzodiazepines and opioids to address untreated anxiety and mood conditions. Alcohol or substance-use disorders (SUDs) in older individuals may present in subtle and atypical ways. Strategies to overcome such difficulties include systematic screening using validated instruments, patient education regarding the impact of psychoactive substances on health, and cautious prescribing practices. Relying on standard DSM criteria may result in a failure to detect an SUD that presents with cognitive symptoms or physical injury, as well as the absence of work or social consequences. Older individuals can benefit from the application of risk-stratification measures, and they can be referred, e.g., to age-appropriate group therapy and non-confrontational individual therapy focusing on late-life issues of loss and sources of social support, as well as be offered medication management for alcohol or substance use disorder. Although research has been limited in this population, treatment outcomes have been found to be superior in older adults than younger adults.

Substance Abuse among the Elderly Population: Overview and Management

2015 ◽  
Vol 46 (4) ◽  
pp. 11-17 ◽  
Author(s):  
Amani A. Kettaneh
Keyword(s):  
Older Adults ◽  
Substance Abuse ◽  
Elderly Population ◽  
The Elderly ◽  
The United States ◽  
Addictive Disorders ◽  
Addiction Risk ◽  
Health Services Need ◽  
The Impact ◽  
The Relationship

The number of older adults in the United States is increasing dramatically. Increased life expectancy worldwide has led to greater populations of older adults and greater populations of older adults with alcohol use disorders. Hence, professionals in the health services need to have increased awareness about appropriate screening and treatment methods and services for working with older people with these conditions. A review of the literature was conducted to identify the impact of substance abuse on older adults. This paper provides an overview of the addictive disorders among older adults, with details about the impact of addiction, risk and protective factors, the relationship between addiction and demographics variables, and finally, the rehabilitation counselor's role in helping older adults with alcohol and substance use disorders.

Catalyst to Connection: When Technical Difficulties Lead to Social Support for Older Adults

2018 ◽  
Vol 62 (9) ◽  
pp. 1167-1185 ◽  
Author(s):  
Jessica Francis ◽  
Travis Kadylak ◽  
Taj. W. Makki ◽  
R. V. Rikard ◽  
Shelia R. Cotten
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Social Ties ◽  
Negative Impact ◽  
Well Being ◽  
The United States ◽  
Daily Lives ◽  
Ict Use ◽  
Age Related ◽  
The Impact

Information and communication technology (ICT) use can mitigate the negative impact of various age-related threats, such as isolation and loneliness, by facilitating connection with social ties and access to social support. Although research regarding various uses and benefits of ICTs among older adults has increased, there is limited research regarding the impact of technical difficulties on older adults’ well-being. Our study explores technical difficulties encountered, how older adults cope with ICT failure, and the various forms of social support that may result as a consequence of accessing technical support. We use data from nine semistructured focus groups conducted with older adults in the Midwest region of the United States. Results show that older adults may adapt new strategies for coping with the technical difficulties that arise from regular ICT use. Furthermore, as older adults incorporate ICTs into their daily lives and seek assistance from social ties and experts, they may also be indirectly combating the threat of isolation and loneliness.

The Looming Geriatrician Shortage: Ramifications and Solutions

2019 ◽  
Vol 32 (9) ◽  
pp. 1052-1062 ◽  
Author(s):  
Paula E. Lester ◽  
T. S. Dharmarajan ◽  
Eleanor Weinstein
Keyword(s):  
Adverse Drug Events ◽  
Medication Management ◽  
Geriatric Medicine ◽  
Historical Context ◽  
The Elderly ◽  
The United States ◽  
Training System ◽  
Atypical Presentations ◽  
The Impact ◽  
Number Of Individuals

Objective: Geriatricians are skilled in the recognition of asymptomatic and atypical presentations that occur in the elderly and provide comprehensive medication management including recognizing adverse drug events, reducing polypharmacy, and de-prescribing. However, despite the increasing average age of the U.S. population, with the number of individuals above 65 years old predicted to increase 55% by 2030, the geriatric workforce capacity in the United States has actually decreased from 10,270 in 2000 to 8,502 in 2010. Method: We describe physiologic changes in older adults, historical trends in geriatric training, and propose solutions for this looming crisis. Results: Many factors are responsible for the shortage of skilled geriatric providers. Discussion: We discuss the historical context of the lack of geriatricians including changes to the training system, describe the impact of expert geriatric care on patient care and health system outcomes, and propose methods to improve recruitment and retention for geriatric medicine.

scholarly journals Aging in Place with Age-Related Cognitive Changes: The Impact of Caregiving Support and Finances

Societies ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 31
Author(s):  
Alexandra Wagner
Keyword(s):  
Older Adults ◽  
Qualitative Interviews ◽  
Aging In Place ◽  
The United States ◽  
Cognitive Changes ◽  
Age In Place ◽  
Age Related ◽  
Personal Finances ◽  
The Impact ◽  
At Home

In the United States, aging in place is a common concept that refers to older adults’ desire to remain in their homes as they age. However, this ability to age in place is a complex process that is not only impacted by the home’s accessibility or individual functional abilities. This paper aims to examine different factors, such as home environment and home modification, caregivers, finances, and other supports present in the participants’ lives, that impact older adults with age-related cognitive changes (ARCC) (in)ability to age in place. Qualitative interviews with older adults with ARCC (n = 5) and their caregivers (n = 5) were conducted. The participants’ experiences while aging in place indicate that finances and caregiving support greatly impacted their lives at home and ability to age in place. Personal finances dictated where some of the participants could age and the support, they could afford from home health aides. Additionally, informal and formal caregivers were an important source of support that aided in the older adults’ ability to remain home. As researchers, we need to continue to address personal finances and the support that the individual has in their lives to most effectively promote aging in place and their life at home.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

scholarly journals The Geriatric Medication Game to Raise Community Pharmacists’ Awareness on Older Adults’ Day-to-Day Challenges

2021 ◽  
pp. 1-6
Author(s):  
Aisha F. Badr
Keyword(s):  
Older Adults ◽  
Saudi Arabia ◽  
Learning Process ◽  
Community Pharmacists ◽  
The Elderly ◽  
Learning Activity ◽  
Simulation Games ◽  
Self Reflection ◽  
Satisfaction Rate ◽  
The Impact

<b><i>Introduction:</i></b> In Saudi Arabia; it is estimated that the elderly (aged 60 and above) would reach up to (22.9%) by 2050, compared to (5.6%) in 2017. Simulation games have proven to be a useful and effective method of education in pharmacy schools, as it actively involves participants in the learning process. The objective of this study was to examine the impact of the modified geriatric medication game on community pharmacists’ awareness and attitudes toward older adults with common disabilities. <b><i>Methods:</i></b> A modified geriatric medication game was adopted to stimulate both physical and sensory disabilities in older adults. A total of 9 community pharmacists were gathered in 1 room and were asked to play 2 scenarios each. Self-reflection was assessed and ground theories were analyzed. <b><i>Results:</i></b> All pharmacists felt frustration and anger playing the game (100%), followed by becoming more aware of the extra time and guidance needed with older adults and realized how disabling chronic diseases could be, and felt they needed to improve common perceived attitude towards the elderly (88.89%). Pharmacists also felt empathy, sympathy, and compassion towards this population, needed improvement of common perceived attitude towards older adults, and felt the need to double check with older adults if they have any disabilities before counseling (77.78%). Finally, over half pharmacists (55.5%) wished they had more training on geriatrics during pharmacy school and the need for further review of Beer’s criteria. All pharmacists were satisfied with the game and recommended it to all community pharmacists. <b><i>Conclusion:</i></b> Simulation games are a great way to strengthen awareness and change practice accordingly. Pharmacists improved their awareness and attitude towards the elderly and reported a positive perceived value of this learning activity; with a 100% satisfaction rate. Adding a geriatric course with simulation component is recommended for better geriatric care.

scholarly journals The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America

2021 ◽  
Vol 35 ◽  
pp. 100848
Author(s):  
Ganesh M. Babulal ◽  
Valeria L. Torres ◽  
Daisy Acosta ◽  
Cinthya Agüero ◽  
Sara Aguilar-Navarro ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Latin America ◽  
Well Being ◽  
The United States ◽  
The Impact

scholarly journals Considerations for a Respiratory Syncytial Virus Vaccine Targeting an Elderly Population

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 624
Author(s):  
Laura M. Stephens ◽  
Steven M. Varga
Keyword(s):  
Respiratory Syncytial Virus ◽  
Disease Burden ◽  
Elderly Population ◽  
Vaccine Development ◽  
The Elderly ◽  
The United States ◽  
Susceptible Population ◽  
Age Related ◽  
Syncytial Virus ◽  
Tract Infections

Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.

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