Pharmacotherapy considerations in elderly adults

ABSTRACT: Life expectancy for Americans has increased dramatically since 1900, as have the available pharmacotherapeutic options. Unfortunately, pharmacotherapy mishaps occur commonly in the older adult population. This problem greatly affects the morbidity and mortality of elderly patients and greatly increases healthcare costs. To improve patient care among elderly adults, healthcare practitioners must consider several issues when developing a pharmacotherapy plan. A thorough understanding of pharmacokinetics, pharmacodynamics, adverse drug reactions, drug interactions, and several other factors is necessary for practitioners to develop a safe and effective drug therapy plan for older adults. This review provides a general but comprehensive review of the issues pertaining to pharmacotherapy in elderly people and offers several suggestions for improving their pharmaceutical care.     

Surgical considerations in the management of the immunocompromised patient

We have attempted to give a broad overview of issues of importance to the surgeon that may arise in the management of the immunocompromised patient. These include airway obstruction, diffuse and focal pulmonary lesions, vascular access problems, gastrointestinal bleeding, perforation, obstruction, and soft tissue infections. Principles of perioperative management in this patient group are discussed in detail. Often they will require broad metabolic and hemodynamic support. The spectrum of pathology ranges from common problems found in the general patient population that present with only subtle clinical findings, making diagnosis difficult, to conditions unique to the patient with a deficient immune system. The importance of early consultation with the surgeon for the indications that have been described cannot be overemphasized. One should attempt to identify certain surgeons who have a particular interest in dealing with these complex problems. It is of the utmost importance for the surgeon to have the guidance of the primary physician with regard to aggressiveness of therapy. This decision must take into account the basic underlying disorder as well as the wishes of the patient and family. Many of these patients can be salvaged despite the seemingly endless problems that may arise along the way.     

Methodological considerations in the study of frail elderly people

The purpose of this paper is to increase the awareness of gerontological nurse researchers about methodological, theoretical and ethical issues that are unique and critical to the study of frail elderly people Discussion focuses on (a) sampling, recruitment, informed consent and retention of subjects, (b) selection and adaptation of measurement instruments, (c) implementation of treatment modalities and data collection protocols, (d) theoretical shortcomings, and (e) ethical concerns Such issues must be resolved if answers are to be found for multiple health problems that pose such a heavy burden for many frail elderly people As the number in this highly vulnerable group increases, gerontological nurse scientists, like all health care researchers, must better understand their needs and discover their strengths We must design innovative research protocols to capture that information     

Clinical considerations. Tube feeding in the elderly.

1. The major indication for tube feeding is the inability to ingest sufficient nutrients by mouth in the presence of a functioning gastrointestinal tract. 2. Diarrhea, a frequent complaint, may be due to a variety of factors, including medication side effects, bacterial contamination of formula, viral infection, low albumin, high osmolality of the formula, too rapid infusion rate, and fecal impaction. 3. Aspiration of the tube feeding resulting in pneumonia is a serious and potentially life-threatening complication seen more frequently in patients with altered mental status or the inability to protect their airway. 4. Key items in the nutritional assessment include body weight; weight loss; visceral protein estimation, eg, albumin; exercise tolerance; and muscle strength.     

Surgical considerations for tremor and dystonia

Deep brain stimulation (DBS) is among the most effective approaches for the treatment of patients with advanced movement disorders. In patients with essential tremor, stimulation typically targets the ventral intermediate nucleus of the thalamus. Results of several studies have shown that over a follow-up period of 1 to 5 years, the severity of tremor decreases by an average of approximately 50% from baseline. Ongoing research continues to define the optimal stimulation parameters for patients with tremor, including frequency, voltage, and pulse width. In patients with dystonia, DBS typically targets the globus pallidus internus or the subthalamic nucleus. Long-term prospective clinical trials demonstrated reductions in motor severity rating scale scores of approximately 50% to 80% over follow-up periods of 2 to 3 years. Serious adverse events were uncommon, and included lead failures and infections. Appropriate candidates for DBS treatment of dystonia include patients with an unequivocal diagnosis of dystonia and significant disability. Several issues in the use of DBS for movement disorders remain unresolved, including the intensity of appropriate medical management before undergoing DBS, the importance of intraoperative mapping, optimal stimulator programming, and the time course of the beneficial effects of treatment.     

Digoxin therapy in the elderly: pharmacokinetic considerations in nursing

Digoxin is effective in controlling ventricular rhythm in atrial fibrillation and is used in heart failure when angiotensin converting enzyme inhibitors and diuretics are ineffective. Because use of more than 1 drug is often required with these conditions, pharmacokinetic considerations, including those related to complementary medicine, are important. Increased awareness of drug action in the elderly is important because there is often an increase in body fat and leaner muscle mass as well as changes in organ function, such as that of the kidney, which alters drug activity. Nurses have an important role to play in the safe administration of digoxin.     

老年胆囊穿孔外科治疗27例分析

目的 分析老年胆囊穿孔诊治特点,提高围手术期处理经验.方法 对我院普外科2000年1月至2006年12月间共收治老年急性胆囊穿孔27例临床资料进行回顾性分析.结果 本组27例病例中,有慢性囊炎或胆囊结石病史25例,并存内科疾病19例(70.04%),术后并发症11例(40.74%),1例因多器官功能衰竭死亡.结论 由于老年人的生理及病理特点,其胆囊穿孔临床表现不典型,加之内科合并症较多见,术后并发症发生率高.应选择合适的手术时机、麻醉和手术方式,并加强围手术期处理.     

Treatment considerations for the elderly person with cancer

In an aging population, the number of patients with cancer continues to rise. Little research has focused on the treatment of cancer in the elderly. Therefore, the treatment for various cancers differs across the healthcare system. A uniform approach in assessing the elderly person with cancer is lacking. This article describes two case studies in the elderly population, focusing on two common cancers: acute myelogenous leukemia and breast cancer. Common side effects of treatment and determinants of treatment options are discussed. It is important that the elderly receive appropriate screening, early detection, treatment, and management of comorbidities.     

Diagnostic criteria and diagnostic considerations for hypertension in the elderly

Hypertension in the elderly consists mostly of essential hypertension, and its pathophysiology differs in many ways from that of essential hypertension in the young or middle-aged. No special diagnostic criteria for hypertension in the elderly were stated in ESH/ESC JNC 7 guidelines, that is, the criteria is systolic pressure of 140 mmHg and greater or diastolic pressure of 90mmHg and greater as in general adults. As the diagnostic considerations for hypertension in the elderly, we should pay much attention to medical history taking, measurement of blood pressure, discrepancy on auscultation, pseudohypertension, fluctuation of blood pressure, and diagnosis of secondary hypertension.     

Complexities of pain assessment in the elderly. Clinical considerations

Establishing a trusting, caring relationship that acknowledges suffering and demonstrates caring is an important first step toward pain management in the elderly. The content of assessing pain in the elderly is similar to that for younger individuals. However, the source of information, manner and timing of assessment, method, and amount of data collected must be adapted to meet the special needs of the elderly individual. Strategies for assessing pain in the elderly must be adapted for those with sensory, cognitive, or psychomotor deficits. Many tools currently available for assessing pain may be effective when adapted to accommodate these changes. Interpreting reports of pain and pain-related behaviors in the elderly is complicated by myths and misunderstandings commonly held by the elderly and many health professionals. Careful consideration must be given to the meaning of pain or lack of pain report, as well as personal biases, which may influence the interpretation of pain behaviors.     

Surgical treatment of lumbar spinal stenosis in the elderly

Unrelenting sciatica or intermittent neurogenic claudication in the elderly may be caused by degenerative lumbar spinal stenosis. This rather common condition is produced by advanced multilevel disc degeneration leading to facet hypertrophy, infolding of ligamentum flavum, descent of the pedicles, and occasional disc herniation. The symptoms of lumbar spinal stenosis usually do not improve with time. Despite the advanced age of some patients, surgical decompression may offer significant relief. Of 19 patients who underwent lumbar decompressive laminectomy, 18 showed sufficient improvement to return to normal daily activities.     

Pain and analgesia: considerations for the elderly in critical care

A large percentage of patients in critical care are older than 65 years old. Pain is a problem common to the elderly receiving critical care. Effective management of pain is accomplished through collaboration between nursing and medicine. Understanding physiologic changes experienced with aging and anticipated changes in functional abilities is necessary to the development of a pain-management plan and to providing comprehensive nursing care. Pharmacologic analgesia will be a part of the pain-management plan, with consideration given to the effects on the elderly.     

Treating diabetes in the elderly. What are the special considerations?

Management of diabetes in elderly patients generally follows the same lines as in younger patients; that is, improvement of blood glucose status with diet, oral hypoglycemic, and insulin therapy as required. Older patients are more fragile, however, and more caution must be used with therapeutic interventions.