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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the growth pattern of the elderly population.

  2. Discuss age-related pharmacokinetic and pharmacodynamic changes.

  3. Identify drug-related problems and associated morbidities commonly experienced by older adults.

  4. Describe major components of geriatric assessment.

  5. Recognize interprofessional patient care functions in various geriatric practice settings.

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KEY CONCEPTS

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  • Image not available. Population aging is an incontrovertible trend.

  • Image not available. Older Americans use considerably more healthcare services than younger Americans, and their healthcare needs are often complex.

  • Image not available. All four components of pharmacokinetics—absorption, distribution, metabolism, and excretion—are affected by aging; the most clinically important and consistent is the reduction of renal elimination of drugs.

  • Image not available. In general, the pharmacodynamic changes that occur in the elderly tend to increase their sensitivity to drug effects.

  • Image not available. Comorbidities and polypharmacy complicate elderly health status, particularly when polypharmacy includes inappropriate medications that lead to drug-related problems.

  • Image not available. Older adults are at greater risk for medication nonadherence due to the high prevalence of multiple comorbidities, including cognitive deficit, polypharmacy use, and financial barriers.

  • Image not available. The clinical approach to assessing older adults frequently goes beyond a traditional "history and physical" used in general internal medicine practice.

  • Image not available. Consideration of geriatric patients' vision, hearing, swallowing, cognition, motor impairment, and education and literacy levels during counseling and education can lead to enhanced medication adherence.

  • Image not available. Long-term care geriatric practices emphasize the interprofessional team approach.

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The growth of the aging population and increasing lifespan require that healthcare professionals gain knowledge necessary to meeting the needs of this patient group. Despite the availability and benefit of numerous pharmacotherapies to treat their diseases, elderly patients commonly experience drug-related problems resulting in additional morbidities. Therefore, it is essential for clinicians serving older adults across all healthcare settings to understand the epidemiology of aging, age-related physiological changes, drug-related problems prevalent in the elderly, comprehensive geriatric assessment, and interprofessional approaches to geriatric care.

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EPIDEMIOLOGY AND ETIOLOGY

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As humans age, they are at increasingly elevated risk of disease, disability, and death primarily for three reasons: (a) genetic predisposition; (b) reduced immunological surveillance; and (c) the accumulated effects of physical, social, environmental, and behavioral exposures over the life course. Human relationships, social conditions, and networks interact with these accumulating exposures, and differences in time and place influence health outcomes by age cohort. Combined, these factors result in considerable variation by age in health states and healthcare requirements. All elders experience increasing vulnerability and homeostenosis as they age. Although resilient elders are able successfully to maintain high levels of physical and cognitive functioning, avoid chronic conditions, and remain socially engaged, others suffer functional decline, frailty, disability, or death. There is an urgent need for all clinicians to better understand the epidemiology of aging in order that healthcare needs of the elderly can be comprehensively addressed, and so that safe, quality services can be provided efficiently to optimize functioning and health-related quality of life for ...

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