An oral talk-Qatar University

1. Aging and Drugs
Dr. Dalia A. Hamdy
Assistant Professor
College of Pharmacy
19 April 2012

2. Aging and Drugs: Outline
• Introduction
• Drug Therapy
• Facts and Recommendations
• Geriatric Pharmacists
2Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)

3. Aging and Drugs: Introduction
3Dr. 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.

4. Aging and Drugs: Introduction
4Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA people >65 years
0
20
40
60
80
100
1900
2000
2026
4
%ofUSApopulation
Year
Data obtained from “The Merck Manual”

5. Aging and Drugs: Introduction
5Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA people >65 years
0
20
40
60
80
100
1900
2000
2026
4 12
%ofUSApopulation
Year
Data obtained from “The Merck Manual”

6. Aging and Drugs: Introduction
6Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA people >65 years
0
20
40
60
80
100
1900
2000
2026
4 12 20
%ofUSApopulation
Year
Number of birth (World War II)
Mortality rate
Overall better health
Data obtained from “The Merck Manual”

7. Aging and Drugs: Introduction
7Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• USA life span statistics
• Gender gap
0
20
40
60
80
100
30
70
%ofUSApopulation
≥ 85 years
Males Females
Data obtained from “Pharmacotherapy”

8. Aging and Drugs: Drug Therapy
8Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
Why do we link Elderly and Pharmaceutical Care?

9. Aging and Drugs: Drug Therapy
9Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
90
0
10
20
30
40
50
60
70
80
90
100
at least 1
drug/week
at least 5
drugs/week
at least 10
drugs/week
%druguseamongpeople>65
• Elderly compose a major group of drug users
Data obtained from “The Merck Manual”

10. Aging and Drugs: Drug Therapy
10Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
90
40
0
10
20
30
40
50
60
70
80
90
100
at least 1
drug/week
at least 5
drugs/week
at least 10
drugs/week
%druguseamongpeople>65
• Elderly compose a major group of drug users
Data obtained from “The Merck Manual”

11. Aging and Drugs: Drug Therapy
11Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
90
40
10
0
10
20
30
40
50
60
70
80
90
100
at least 1
drug/week
at least 5
drugs/week
at least 10
drugs/week
%druguseamongpeople>65
• Elderly compose a major group of drug users
Data obtained from “The Merck Manual”

12. Aging and Drugs: Drug Therapy
12Dr. 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

13. Aging and Drugs:
Facts and Recommendations
13Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
What can a pharmacist do?

14. Aging and Drugs:
Facts and Recommendations
14Dr. 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

15. Aging and Drugs:
Facts and Recommendations
15Dr. 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

16. Aging and Drugs:
Facts and Recommendations
16Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
C. Underuse
Omission of drug therapy that is indicated for the
treatment or prevention of a disease or condition
Inaccessibility to physician
Functional disability
Admission to nursing homes
More cost

17. Aging and Drugs:
Facts and Recommendations
17Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
D. Medication Nonadherence
Prevalence rates 40-80%
When having same number of medications, they show
same adherence to young adults
ADR, dementia,
Hospital admittance
ADR

18. Aging and Drugs:
Facts and Recommendations
18Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
1. Assessing and
Monitoring Drug
Therapy
Medication
appropriateness index
(10 questions)
+
Allergy
Suboptimal medication
choices
Under treatment
Drug interaction

19. Aging and Drugs:
Facts and Recommendations
19Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
2. Problems
Documentation
and Therapeutic
Plan formulation
Document Problem
Develop therapeutic
plans to solve them
Comorbidities
Functional status
Life expectancy

20. Aging and Drugs:
Facts and Recommendations
20Dr. 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

21. Aging and Drugs:
Facts and Recommendations
21Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
4. Counseling and
adherence aids
Document Problem
Develop therapeutic
plans to solve them
Comorbidties
Functional status
Life expectancy

22. Aging and Drugs:
Facts and Recommendations
22Dr. 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

23. Aging and Drugs:
Facts and Recommendations
23Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
6. Targeting high risk
elderly
18 risk Factors
Polypharmacy
High risk drugs
(sedatives,
benzodiazepines,
anticholinerigics)
Patient characteristics
(low weight, >85Y, renal
function)

24. Aging and Drugs:
Facts and Recommendations
24Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
6. Targeting high risk
elderly
18 risk Factors
Narrow therapeutic
range drugs
History of a prior ADR
Six or more illnesses

25. Aging and Drugs: Geriatric Pharmacist
25Dr. Dalia Hamdy (Aging and Health Forum, 04/2012)
• Geriatrics refers to medical care to elderly
Live applications of Geriatric Pharmacists?

26. Aging and Drugs:
Qatar University-College of Pharmacy
26Dr. 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

27. Aging and Drugs:
References
27Dr. 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 geriatrics
http://www.merck.com/mkgr/mmg/sec1/sec1.jsp

28. 28
Dr. Dalia Hamdy (Aging and Health Forum,
04/2012)