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elderly

Interaction
Polypharmacy has been defined as the use of ≥ 5 medications per person. A more appropriate definition would be the administration of more medications than clinically indicated, resulting in inappropriate medication use. The latter definition fits well with Quality Use of Medicines principles….

……Around 2.4-3% of all hospital admissions are drug related and the risk for these admissions has consistently been shown to be increased with increased medication use. It is evident that there is an increased need for an expanded evidence base that will guide medication withdrawal in older people. There are few, if any, published systematic reviews of evidence from clinical studies focusing on medication
withdrawal in the elderly.

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

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Interaction

The prevalence of benzodiazepine (BZD) use increases with age. The prevalence rates in community settings are reported to be between 10-40%. Elderly patients are at risk of adverse effects including dependence, which occurs to some extent in 15-44% of those prescribed benzodiazepines. Detection of benzodiazepine dependence in patients, especially the elderly, is very important as this helps in reducing the impact of withdrawal syndrome when discontinuation is initiated with gradual dose reduction.

Other serious adverse effects of benzodiazepines in the elderly include cognitive impairment, psychomotor effects, increased risk of falls, motor vehicle accidents and urinary incontinence. Adverse effects tend to be more significant amongst the elderly because of comorbidities, polypharmacy, and altered pharmacodynamic and pharmacokinetic characteristics.

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The 2009 RGH E-Bulletins are archived here.

If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.

A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

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According to Australian Bureau of Statistics projections our Indigenous population is expected to reach somewhere between 713,300 and 721,100 people in 2021. This is a growth rate of 2.2% from 2006 to 2021. It could be nearly double what the total Australian growth rate is expected to be (1.2% – 1.7%).

statisticsOn June 30 2006 the estimated Indigenous population of Australia was 517,200 (2.5% of the total population). New South Wales (148,200) and Queensland (146,400) had the largest Indigenous populations. The Northern Territory with 66,600 Indigenous Australians was fourth after western Australia (77900).

The Indigenous population increased by 13% (58700) from 2001 to 2006. Western Australia with an 18% increase had the largest rise in Indigenous population, closely followed by the Northern Territory (17%) and Queensland (16%).

This high growth rate will be driven by an increase in births due to larger numbers of Indigenous women entering ‘peak’ child bearing ages. The number of Indigenous children aged 0-14yrs will be up to 243,400 in 2021 (194,200 in 2006). Despite this big increase the numbers of children will drop from 38% of the indigenous population down to 34% in 2021. By comparison in 2008 the percentage of children aged 0-14 years was 19.3%.


Indigenous Children make up 38% of the indigenous population. In the whole of Australia children make up only 19.3% of the population.

However this is only an estimate. In their calculations it would be impossible to include an improvement in childhood mortality rate that hopefully will occur with the Close The Gap campaign. The current mortality rate in Indigenous children is 12.5 per 1,000 live births. The non-Indigenous rate is only 4.3 per thousand. If this is improved over the next 10 years it will substantially increase these figures.

The number of elderly Indigenous Australians (55 and over) will possibly reach 86,600. This is more than double the 40,000 elderly Indigenous people around in 2006.


Only 8% of the indigenous population is over 55 years of age. 13.3% of the total Australian population is 65 years or over.

By 2021 the percentage of elderly indigenous people will increase to nearly 12% of the indigenous population by 2021.

PopStats

If we assume this population growth to be even across Indigenous Australia in remote Australia the total increase in child numbers will result in a small increase in children and services such as maternity, antenatal etc. As mentioned earlier, hopefully the life expectancy in kids will improve, boosting these numbers.

However it appears there will be a significant increase in the elderly from currently about 10,000 remote Indigenous Australians increasing to over 17000 people in 2021. This is going to place great strain on all services, from medical, nursing posts, chronic disease management, currently non-existent remote dialysis and in particular Aged Care Services and very rare remote Aged Care facilities so people can stay on country during their last years.

That will be one of the big challenges.

References:

3201.0 – Population by Age and Sex, Australian States and Territories, Jun 2008
3238.0 – Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021
Newborn and Child Survival in Australia Report; Save The Children Australia

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Common causes of insomnia in the elderly include pain due to arthritis or leg cramps, dyspnoea due to cardiovascular or respiratory disease, nocturia due to benign prostatic hypertrophy (BPH) or caffeine ingestion, reflux due to GORD or depression/anxiety. Medications such as salbutamol, diuretics, anticholinesterases, SSRI antidepressants, beta blockers, and corticosteroids may also be implicated. Environmental factors such as intrusive noise or light may be a problem for those in residential care. The elderly are also more likely to take daytime naps which may disturb sleep at night. The patient’s beliefs about sleep and their own sleep problem may also provide useful information.

This article could also be looked read looking at a wider patient group in mind such as those with a chronic disease as intimated above.

Download the complete article here

For more information on drug therapy in the elderly visit Pharmamotion’s post Pharmacology in the elderly: pharmacokinetics, polypharmacy and related topics for a collection of video and slide shows by health professionals around the world

The 2009 RGH E-Bulletins are archived by topic here.

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