Quality use of medicines in the elderly (ES-8065)
We are all aware that a large proportion of our elderly patients are taking one or more (in some cases many more) medicines. In this unit, Dr Geraldine Moses discusses how pharmacokinetics and pharmacodynamics change with ageing, how this influences prescribing and some of the important 'red flag' drugs to keep in mind when prescribing for the elderly. Polypharmacy and adverse drug reactions are also addressed by Dr Moses, and she explains the importance of the Home Medicines Review. This unit should take approximately 90 minutes to complete and consists of a voice over powerpoint pesentation by Dr Moses.
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Learning Objectives:
- Be able to demonstrate knowledge of issues relating to quality use of medicines in the elderly, including pharmacodynamics, polypharmacy, interactions and dose adjustment, and to apply this knowledge in clinical practice
- Be aware of primary care initiatives to assist GPs and their patients e.g. the Home Medicines Review
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This education program is developed and delivered for The University of Queensland, by The University of Queensland (UQ) Health Insitu. UQ Health Insitu is the lifelong learning arm of The University of Queensland Faculty of Health Sciences.
Expert presenter:
Dr Geraldine Moses
Dr Geraldine Moses is a doctor of clinical pharmacy who specialises in drug information. Based at Mater Health Services in South Brisbane, Geraldine manages the Adverse Medicine Events Line, a national consumer service for adverse drug reaction reporting funded by the Pharmacy Guild. Her areas of special interest include geriatrics, pharmacovigilance and the consumer perspective on medicines.
Geraldine is frequently involved in health professional education. She provides pharmacy-based lectures to undergraduate and postgraduate students of pharmacy, dentistry, medicine, podiatry, nursing and optometry at the University of Queensland, QUT and Bond University. In addition, she is an accredited pharmacist and provides training for students wishing to become accredited for conducting Home Medicines Reviews.
Suggested further reading:
Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade . BMJ 1997;315:1096-1099 (available at http://www.bmj.com/cgi/content/full/315/7115/1096)
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med.2003;163:2716-2724. (available at http://archinte.ama-assn.org/cgi/content/full/163/22/2716)
References:
[1] Australian Bureau of Statistics. 2001 National Health Survey. Category no: 4364. ACT: Commonwealth of Australia; 2007.
[2] Australian Government Department of Health and Ageing. National Medicines Policy. Commonwealth of Australia. Viewed on 30/05/2007, at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/National%20Medicines%20Policy-2
[3] McLean AJ, Le Couteur DG. Aging Biology and Geriatric Clinical Pharmacology. Pharmacol Rev 2005;56:163-184. Viewed on 30/05/2007, at: http://pharmrev.aspetjournals.org/cgi/content/full/56/2/163
[4] Flather M, Yusuf S, Køber L, Pfeffer M, Hall A, Murray G et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 2000;355(9215):1575-81.
[5] International Pharmaceutical Federation. FIP Statement of Policy. Pharmaceutical research in older patients. Singapore:FIP Council;2001. Viewed on 30/05/2007, at: https://www.fip.org/www2/uploads/database_file.php?id=176&table_id=
[6] Indiana University School of Medicine Department of Clinical Pharmacology. P450 table.IN:Indiana University;2006. Viewed on 30/05/2007, at: http://medicine.iupui.edu/flockhart/table.htm
[7] McAuley DF. Guidelines for prescribing drugs in adults with impaired renal function. Detroit:GlobalRPh Inc.;2007. Viewed on 30/05/2007, at: http://www.globalrph.com/renaldosing2.htm
[8] Steinbrook R. How many medications are optimal for a patient with multiple medical problems? NEJM 1998;338(21):1541-1542.
[9] Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients
with chronic medical diseases. NEJM 1998;338:1516-1520.
[10] Roughead EE, Gilbert AL, Primrose JG, Sansom LN. Drug related hospital admissions: a review of Australian studies published 1988-1996. MJA 1998;168:405-8.
[11] Gleason OC. Delirium. American Family Physician 2003;67(5):1027-1034. Viewed on 30/05/2007, at: http://www.aafp.org/afp/20030301/1027.html
[12] Beers MH. Explicit criteria for determining potentially inappropriate medication
use by the elderly. Arch Intern Med1997;157:1531-36.
[13] Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716-2724. Viewed on 29/05/2007, at: http://archinte.ama-assn.org/cgi/content/full/163/22/2716
[14] Harms SH, Garrard J. The Fleetwood model: an enhanced method of pharmacist consultation. Consultant Pharmacist 1998;13:1350-5. Viewed on 30/05/2007, at: http://www.ascp.com/publications/tcp/1998/dec/fleetwood.shtml
[15] Berry DC, Knapp P, Raynor DK. Provision of information about drug side-effects to patients. Lancet 2002 Mar 9;359(9309):853-4.
[16] Cadieux RJ. Drug interactions in the elderly. Postgraduate Medicine 1989;86(8):179-186.
[17] Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997;315(7115):1096-9. Viewed on 29/05/2007, at: http://www.bmj.com/cgi/content/full/315/7115/1096
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| Time: |
1 hour 30 minutes |
| Catalogued by: |
- RACGP Domains of General Practice
- Applied professional knowledge and skills
- ACRRM Educational Domains and Curriculum Areas of Rural & Remote Medicine
- Quality Use of Medicine / Pharmacology (Area)
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