Elderly patients assessing

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

Any concerns about a decline in memory or other intellectual skills in an elderly patient should lead you to perform an assessment for dementia. During your interview, you should look for signs of memory-related problems. You should ask the following questions of both the patient and a family member ... 

Hypertension - Usual dose is 5 mg once daily. Maximum dose is 10 mg once daily. Small, fragile, or elderly patients or patients with hepatic insufficiency may be started on 2.5 mg once daily this dose may also be used when adding amlodipine to other antihypertensive therapy. In general, titrate over 7 to 14 days proceed more rapidly if clinically warranted with frequent assessment of the patient. 

Elderly No overall differences in safety were observed between subjects 65 years of age or older and younger subjects. There were insufficient numbers of elderly subjects in controlled trials of epilepsy to adequately assess the efficacy of levetiracetam in these patients. Because elderly patients are more likely to have decreased renal function, take care in dose selection it may be useful to monitor renal function. 

Elderly Pharmacokinetic profile in elderly patients is not established. Because elderly individuals frequently have a reduced glomerular filtration rate, pay particular attention to assessing renal function before and during ganciclovir therapy. 

In a Canadian study of 200 000 automobile drivers, aged 67-84, who were followed from 1990 until they reached age 85, or until they emigrated from Quebec, or until 31 May 1993, those who had been involved in an automobile accident in which one person sustained a physical injury were assessed the controls were a 6% random sample of the others (172). Of 5579 patients 20 had been taking lithium within the year before the index date, 19 of whom had been taking it within 16 days before the accident. This compared with 27 of 13 300 patients in the control group (OR = 1.8) for current lithium use, the odds ratio was 2.08. The data on carbamazepine did not show a raised odds ratio. The authors concluded that elderly patients taking lithium have a two-fold increase... 

Wysenbeek AJ, Klein Z, Nakar S, Mane R. Assessment of cognitive function in elderly patients treated with naproxen. A prospective study. Clin Exp Rheumatol 1988 6(4) 399 100. 

Assessing the risk of ADRs in the elderly can be difficult because most clinical trials exclude the elderly because of comorbidities or age. There is also a bias in prescribing, thus, elderly patients at risk of experiencing adverse effects from a drug may not even be exposed to the medication. This provides an underestimate of the true incidence of ADRs in an entire population who may take the medication. ... 

A report from the Mayo Clinic has described 27 elderly patients (mean age 71 years) with aortic stenosis in whom dobutamine stress hemodynamic testing was used to assess the severity of the stenosis (12). There were no severe adverse effects, but relatively minor problems occurred in 16 patients, including chest pain and ventricular extra beats (n = 9 each) and atrial dysrhythmias (n — 4). The authors concluded that the procedure appears to be safe in these high-risk patients, although its diagnostic value may be limited. 

The effects of furosemide withdrawal on postprandial blood pressure have been assessed in 20 elderly patients (mean age 73 years) with heart failure and preserved left ventricular systolic function (ejection fraction 61%) (23). In 13 who were able to discontinue furosemide (mean dose 32 mg/day), maximum systolic blood pressure fell significantly from 25 mmHg to 11 mmHg and diastolic blood pressure from 18 to 9 mmHg over 3 months. In the continuation group (mean furosemide dose 21 mg/day), there was no change in the postprandial fall. 

Hase K, Meguro K, Nakamura T. Assessment of renal effects of sevoflurane in elderly patients using urinary markers. Anesth Analg 1999 88(6) 1426-7. 

The effect of COX-2 specific inhihitors on renal function, including sodium excretion, has heen assessed in prostaglandin dependent patients. Catella-Lawson et al. [26] enrolled 36 healthy elderly patients for her study, which evaluated not only sodium excretion and glomerular filtration rates, but also changes in body... 

It is important to gather a complete medication history to establish potential adverse side effects and barriers that prevent an elderly patient from being properly medicated. In assessing the medication history, the healthcare provider should ... 

Home care in elderly patients can help with the geriatric assessment of disability and functional status and the prevention of complications related or not related to drugs. Stuck et al. conducted a three-year, randomized, controlled trial of the effect of annual in-home comprehensive geriatric assessment and follow-up for people who were 75 years of age or older.The results showed that this intervention can delay the development of disability and can reduce permanent nursing home stays among elderly people living at home. 

Changes in elderly patients abilities to taste various substances do not necessarily affect the ease or difficulty of administration of medications, but these changes do have an effect on the patients acceptance of a product. For instance, although it may be easier for patients to swallow liquid medications, they may find the taste or smell of the product so objectionable that they will refuse to take any medication prepared in this manner. Indeed, even some solid dosage forms carry with them objectionable tastes or odors that result in limitation of patient acceptance. Although there have been few studies assessing elderly... 

All interventions must be documented, and the steps j ust ontfined mnst be repeated over time with elderly patients. During follow-np contacts, minimnm rnqniry should include questions as to whether the patient has any qnestions or concerns regarding medicines and determining whether the therapeutic end points previously established have been achieved. Moreover, ask patients whether they are or have recently experienced any side effects, unwanted reactions, or other problems with their medications to assess potential ADRs. ... 

Fondaparinux has been used safely in elderly patients, but the risk of major bleeding increases with age (1.8% in patients younger than 65 years of age, 2.2% in patients 65 to 74 years of age, and 2.7% in patients 75 years of age or older).This is an important consideration because many patients who undergo orthopedic surgery are elderly. Elderly patients are also more likely to have decreased renal function, and careful assessment of renal status should be conducted prior to initiating therapy. Fondaparinux is contraindicated in patients with a creatinine clearance of less than 30 mL/min. 

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