Pharmacology and Drug Therapy in Critically Ill Elderly Patients

1992 ◽  
Vol 3 (1) ◽  
pp. 137-148 ◽  
Author(s):  
Mary K. Walker

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

2017 ◽  
Vol 13 (7S_Part_16) ◽  
pp. P777-P777
Author(s):  
Brittany C. Schneider ◽  
Dandan Liu ◽  
Francis E. Cambronero ◽  
Katie E. Osborn ◽  
Kimberly R. Pechman ◽  
...  

2020 ◽  
Author(s):  
Nicole D Evangelista ◽  
Andrew O’Shea ◽  
Jessica N Kraft ◽  
Hanna K Hausman ◽  
Emanuel M Boutzoukas ◽  
...  

Abstract Age-related differences in dorsolateral prefrontal cortex (DLPFC) structure and function have each been linked to working memory. However, few studies have integrated multimodal imaging to simultaneously investigate relationships among structure, function, and cognition. We aimed to clarify how specifically DLPFC structure and function contribute to working memory in healthy older adults. In total, 138 participants aged 65–88 underwent 3 T neuroimaging and were divided into higher and lower groups based on a median split of in-scanner n-back task performance. Three a priori spherical DLPFC regions of interest (ROIs) were used to quantify blood-oxygen-level-dependent (BOLD) signal and FreeSurfer-derived surface area, cortical thickness, and white matter volume. Binary logistic regressions adjusting for age, sex, education, and scanner type revealed that greater left and right DLPFC BOLD signal predicted the probability of higher performing group membership (P values<.05). Binary logistic regressions also adjusting for total intracranial volume revealed left DLPFC surface area that significantly predicted the probability of being in the higher performing group (P = 0.017). The left DLPFC BOLD signal and surface area were not significantly associated and did not significantly interact to predict group membership (P values>.05). Importantly, this suggests BOLD signal and surface area may independently contribute to working memory performance in healthy older adults.


2019 ◽  
Vol 35 (11) ◽  
pp. 1332-1337 ◽  
Author(s):  
Pralay Kumar Sarkar ◽  
Michel Boivin ◽  
Paul H. Mayo

Background: Advanced critical care echocardiography (CCE) involves comprehensive assessment of cardiac structure and function for frontline critical care applications. This study reports the effectiveness of a 3-day course in advanced CCE. Methods: We studied the outcome of 5 consecutive advanced CCE courses delivered between 2013 and 2017. A total number of 239 learners were studied. The course included didactic lectures, image interpretation sessions, and hands-on training with normal individuals as models. Training domains included left ventricular structure and function, right ventricular structure and function, valve function using comprehensive 2-dimensional imaging, and Doppler-based measurements for cardiac pressures and flows. Measurements of course outcome included pre- and postcourse assessment of knowledge, image acquisition, and image interpretation skills. Learners rotated between hands-on training and interpretation sessions. The teacher-to-learner ratio was 1:3 during hands-on training. Interpretation sessions consisted of review of normal and abnormal echocardiographic videos with interactive small groups. Learners completed a video-based knowledge assessment examination before and after completion of the course. Hands-on image acquisition skills were tested at the completion of the course during all the years. For years 2016 and 2017, a precourse hands-on skill test was also performed. Results: There was a statistically significant improvement in knowledge and image interpretation skills in the cohort of 239 learners over 5 years of study period. There was improvement in image acquisition skills over the 2-year period when it was measured pre- and postcourse. Conclusions: A 3-day course on advanced CCE resulted in improvement knowledge/image interpretation and hands-on image acquisition skills. Clinical Implications: Advanced CCE has assumed an important place in hemodynamic monitoring of critically ill patients. A course of similar design may facilitate training of frontline clinicians in advanced CCE.


1992 ◽  
Vol 3 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Mickey Stanley

Elderly patients who enter the critical care setting have special nursing care needs based on the physiologic changes of aging. An overview of the changes of aging associated with the immunologic, cardiovascular, integumentary, musculoskeletal, and renal systems provides the basis for care planning to meet the needs of older adults in the intensive care unit


Pain Medicine ◽  
2010 ◽  
Vol 11 (8) ◽  
pp. 1183-1197 ◽  
Author(s):  
Neilly Buckalew ◽  
Marc W. Haut ◽  
Howard Aizenstein ◽  
Lisa Morrow ◽  
Subashan Perera ◽  
...  

2017 ◽  
Vol 122 (4) ◽  
pp. 775-787 ◽  
Author(s):  
Mark S. Miller ◽  
Damien M. Callahan ◽  
Timothy W. Tourville ◽  
James R. Slauterbeck ◽  
Anna Kaplan ◽  
...  

High-intensity resistance exercise (REX) training increases physical capacity, in part, by improving muscle cell size and function. Moderate-intensity REX, which is more feasible for many older adults with disease and/or disability, also increases physical function, but the mechanisms underlying such improvements are not understood. Therefore, we measured skeletal muscle structure and function from the molecular to the tissue level in response to 14 wk of moderate-intensity REX in physically inactive older adults with knee osteoarthritis ( n = 17; 70 ± 1 yr). Although REX training increased quadriceps muscle cross-sectional area (CSA), average single-fiber CSA was unchanged because of reciprocal changes in myosin heavy chain (MHC) I and IIA fibers. Intermyofibrillar mitochondrial content increased with training because of increases in mitochondrial size in men, but not women, with no changes in subsarcolemmal mitochondria in either sex. REX increased whole muscle contractile performance similarly in men and women. In contrast, adaptations in single-muscle fiber force production per CSA (i.e., tension) and contractile velocity varied between men and women in a fiber type-dependent manner, with adaptations being explained at the molecular level by differential changes in myosin-actin cross-bridge kinetics and mechanics and single-fiber MHC protein expression. Our results are notable compared with studies of high-intensity REX because they show that the effects of moderate-intensity REX in older adults on muscle fiber size/structure and myofilament function are absent or modest. Moreover, our data highlight unique sex-specific adaptations due to differential cellular and subcellular structural and functional changes.NEW & NOTEWORTHY Moderate-intensity resistance training causes sex-specific adaptations in skeletal muscle structure and function at the cellular and molecular levels in inactive older adult men and women with knee osteoarthritis. However, these responses were minimal compared with high-intensity resistance training. Thus adjuncts to moderate-intensity training need to be developed to correct underlying cellular and molecular structural and functional deficits that are at the root of impaired physical function in this mobility-limited population.


2014 ◽  
Vol 36 (3) ◽  
pp. 897-910 ◽  
Author(s):  
Tony W. Wilson ◽  
Elizabeth Heinrichs-Graham ◽  
Katherine M. Becker ◽  
Joseph Aloi ◽  
Kevin R. Robertson ◽  
...  

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