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Coping with the management of medicine at old age: What older people think? What formulations scientists can do?

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Coping with the management of medicine at old age: What older people think? What formulations scientists can do? Dr Mine ORLU GUL Lecturer in Pharmaceutics – PowerPoint PPT presentation

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Title: Coping with the management of medicine at old age: What older people think? What formulations scientists can do?


1
Coping with the management of medicine at old
age What older people think? What formulations
scientists can do?
Dr Mine ORLU GUL Lecturer in Pharmaceutics UCL
School of Pharmacy m.gul_at_ucl.ac.uk
2
Patient centric drug delivery A changing
paradigm in healthcare
  • Key challenges and opportunities
  • What is patient centric ?
  • Development paradigm
  • and the reality
  • Patient centric product design
  • Case studies
  • Conclusions

3
Patient Public Involvement
4
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5
Demographic change
  • By 2025, more than 20 of the European
    population will be 65 years of age or older
  • By 2050, India and China will have about 80 of
    the world's elderly living there
  • By 2050, 65 years or older Americans
  • 88.5 million

Need for investment in quality of health care
Awareness is growing
6
Current Vision
National
European
Global
7
  • Heterogeneity there is no standard geriatric
    patient ageing occurs at different rates
  • We are born as copies and die as originals
  • from Bo. G. Eriksson thesis on Studying ageing

8
Comorbidity
  • Defined as those with three or more diagnoses
    during the last 12 months, 19 days at hospital or
    three or more stays in hospital or more than
    seven visits to specialised physicians in
    outpatient care

9
Polypharmacy
  • Categorized as a
  • geriatric syndrome !!
  • Unfavourable adherence
  • Incalculable interactions
  • Accumulated ADR risk
  • Increased risk of hospitalization
  • Increased risk of medication errors
  • Increased costs

Threshold value to define critical polypharmacy
5 or more POM OTC risk
10
Polypharmacy
  • ED-North London 1 month data from 75 Banerjee
    et al. International Journal of Emergency
    Medicine 2011, 422

45 were on five or more POM
11
What is patient centric ?
12
Regulatory framework
13
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14
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15
Individualization of drug delivery
strategy required PATIENT-CENTRIC MEDICINE
The product should be designed to meet patients
needs From ICH Q8 (R2)
16
Different Factors Affecting Acceptability of
Medicines in Paediatric and Geriatric Patients
17
Patient centric product design
18
Addressing motoric dysfunction
  • Ability to open pharmaceutical packaging
  • in impacted by disease
  • (Parkinson, stroke, dementia, RA)

19
Addressing visual decline
  • Visual impairments and poor vision are common in
    elderly. As the most important sensory organ this
    might impact the drug therapy
  • Polypharmacy is common among older adults
    increasing the challenge of product
    identification

20
Addressing cognitive capabilities
  • Health literacy
  • Set of skills needed to read, understand, locate
    and interpret healthcare information

21
Addressing cognitive capabilities
22
Addressing swallowing problems
  • Swallowing functions are declining with age
  • and dysphagia are increasing with impact on
  • Oral medicines intake
  • Nutritional and hydration state
  • Morbidity and co-morbidity
  • Participation to social life

23
Drug delivery considerations as we age
Decline in tear flow, tear volume increase in
tear evaporation rate
Fluctuations in drug plasma conc. due to
re-administration
Weak tongue, poor control of muscles in the mouth
Forced vital capacity reduction decrease in
inspiratory residual volume thickened pulmonary
arteries thickening mucus layer calcification
of bronchial cartilage
Increased gastric pH increased gastric emptying
time decreased GI surface area
Replenishment of SC declines increased SC
dryness decrease in skin surface lipids
reduction in sebaceous gland activity atrophy of
skin capillary network
24
Strategies to overcome limitations
25
Multi-particulate formulations
26
Dual-release (sprinkle)
27
Fixed dose combinations
28
Research Themes in Geriatric Drug Delivery Group
  • Formulation of better medicine for older people
  • Tailored conventional formulations considering
    the effect of ageing on physiological and
    functional capacity
  • Advanced drug delivery systems designed for older
    people (micro- nano- particles / bubbles)
  • Improving off label medicine use in elderly
    including manipulations and extemporaneous
    dispensing
  • Developing palatable formulations and taste
    assessment

29
Ongoing research projects
  • Development of Amorphous Solid Dispersions
  • of Melatonin for Pulmonary Delivery
  • DQAsomes for lung delivery of curcumin
  • Brief-access taste aversion (BATA) model
  • (lickometer) for in vivo taste assessment)
  • Human Panels (swirl and spit) for
  • in vivo taste assessment
  • Production of dye-tagged ternary
    polymeric microparticles with novel K-type
    microfluidic
  • junction

30
Ongoing research projects
  • Study into Thin orodispersible film Acceptability
    as Medicine for Preschool children (STAMP)
  • Clonidine for Sedation of Paediatric Patients in
    the Intensive Care Unit (CLOSED study)
  • Learning about carer errors and resilience
    strategies (CARE-ERRS) Equipment usability in
    using home enteral nutrition for older people
  • Investigation of the potential influence of
  • thickening agents co-administered with medicine
  • Investigating the stability of repackaged
    medicine
  • stored in multicompartment compliance aids
  • Development of fixed dose combinations using
    electrohydrodynamic approaches for the treatment
    of older people

31
APS Age Related Medicines Focus Group
  • Main interest area
  • Medicines for the older adult while being
  • cognisant of and learning from the various
    paediatric initiatives
  • Aims and objectives
  • Creating a platform that facilitates rapid
    translation of ideas to the older persons and
    carers benefit
  • Involving pharmaceutical scientists / clinical
    researchers / representatives of the
    pharmaceutical industry committed to work in
    age-related medicines to prioritise and deliver
    the focus groups research agenda
  • Providing strategic leadership and facilitating
    collaboration for joint research and grant
    applications
  • Developing links to associations / other age
    related networks / charities devoted to helping
    older people and carers
  • http//www.apsgb.co.uk/focus_groups/

32
  • Interaction with scientific community
  • Meetings / conferences
  • Interaction with regulatory bodies
  • APS FG position statement on clinical and
    practical issues of geriatric drug delivery to
    the EMA Quality Working Party,
  • as a contribution to the Reflection Paper that
    they will be drafting
  • Submitted and acknowledged
  • Interaction with professional associations

Use of medicines in older people the role of
pharmaceutical sciences in the forgotten
majority
Age-related medicines Better outcomes for
vulnerable patients
Pharmaceutical approaches into overcoming
polypharmacy
33
Geriatric Medicine Society
  • A multidisciplinary network place to address the
    challenge of medicines for older patients
  • from a holistic perspective
  • Established in 2010
  • Registered non-for-profit organisation

www.geriatric-medicine.org
34
Conclusions
  • Geriatric patient populations have their special
    drug delivery requirements with increasing
    importance considering current regulatory
    expectations and demographic trends of the older
  • Older patients deviate from the standard patient
    with regards to PK and PD, especially considering
    multimorbidity in old patients. These changes
    require dose adaptations and careful choice of
    excipients and dosage forms/application routes
  • Polypharmacy in geriatric patients represents a
    significant compliance challenge
  • New drug delivery systems and taste testing
    systems are now commercially available and
    developed trying to fulfill patient centric
    delivery requirements
  • Improvement of packaging aspects help to
    facilitate geriatric delivery
  • Patients will get more involved in therapeutic
    decision through their own perception of the
    disease and available therapies

35
Thank you.. Dr Mine ORLU GUL m.gul_at_ucl.ac.uk
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