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Total

Population group

75+ yre

Figure 1 Limitation of activity by chronic conditions: United States, 1997. Source: From Ref. 150.

Table 8 Physical Impairments and Conditions with Impact on Drug Delivery

Capability

Disease

Affected formulations/drug handling

Dexterity

Vision

Hearing Swallowing

Consciousness

Arthritis

Parkinson's disease Frailty

Diabetes

Macula degeneration Glaucoma Amblyacousia Dehydration Mucosa degeneration Reduced saliva production Alzheimer's disease Obliviousness

Bottle/blister opening Tablet splitting Subcutaneous injections Inhalers Eye drops Sublingual sprays Subcutaneous injections Measuring liquids Read instructions

Clicking noise (e.g., inhalers, pens)

Tablets

Capsules

Medication instructions Differentiate medication Time of dosing

Dexterity Dexterity may be impaired in the elderly for a variety of reasons, such as the following: (i) Over 43% of the elderly suffer from some form of arthritis (137); (ii) Many elderly experience tremors associated with Parkinsonism or other neurological disorders; and (i'h) Frailty and weakness are prevalent in many elderly patients. The U.S. National Institute on Aging has been conducting a comprehensive study to assess all of the characteristics common among the elderly. This study reveals that at least 13% of the elderly have some difficulty in handling small objects (e.g., tablets) (149). Another government study reports that more than 4% of the elderly experience difficulty preparing their own meals and, therefore, are likely to encounter problems when self-administering

Figure 2 Syringe for single use for patients with reduced dexterity (Wyeth, Collegeville, Pennsylvania, U.S.).
Figure 3 Multiple-dose container with special closure for patients with reduced dexterity (medac, Hamburg, Germany). The patient may apply a pencil, drawing the closure if he is not able to do it manually.

medication (148). Reduced motor capabilities have a direct impact on the drug dosing from numerous devices such as MDIs; powder inhalers; insulin pens; subcutaneous (SC) syringes; eye or nose spray containers, bottles, and tubes. Typical insulin pens need a force between 10 and 30 N for delivering the dose. When applying a lower force to the device, a lower dose might be released. The activation of inhalers or pressing eye drop containers also requires up to 30 N, which might be too much for a geriatric patient. In those cases the treatment will fail. For diseases that affect dexterity, e.g., arthritis, special delivery systems, and packaging materials have been developed. The syringes for SC injections in arthritis patients have been equipped with a broad mount to handle (Fig. 2). The multiple-dose containers have been improved (Fig. 3). The patient may use a pen applied to the closure, which is much easier than drawing the closure in the hand. Further, various devices are available for facilitating the application of eye drops. Some are

Xal-Ease®

AnwfiHtungsMfe fir XALÀTAN® oderXALACOM® Augentropfen

Mu ng emtàli X)|-bie® jmf emen Versc^ilinifcapDiT'OfTrier

Figure 4 Devices for enabling arthritis patients to apply eye drops (A): Pfizer, Sandwich, Kent, U.K.; (B): Opticare Arthro 5, International Glaucoma Association, Ashford, Kent, U.K.

Xal-Ease®

Figure 4 Devices for enabling arthritis patients to apply eye drops (A): Pfizer, Sandwich, Kent, U.K.; (B): Opticare Arthro 5, International Glaucoma Association, Ashford, Kent, U.K.

AnwfiHtungsMfe fir XALÀTAN® oderXALACOM® Augentropfen

Mu ng emtàli X)|-bie® jmf emen Versc^ilinifcapDiT'OfTrier activated by using a pistol-like button to deliver a drop of the drug solution, others use the law of the lever to decrease the required force (Fig. 4). There are other devices available ftt» yr __rrri jt that help to target the conjunctiva, such as the Autodrop or Easydrop devices.

Vision Many people experience visual decline as they age (Fig. 5) (137,146). Moreover, there are typical diseases in the geriatric populations that affect the application of medicines. Macula degeneration and glaucoma diseases reduce the visual capabilities and may lead to blindness. A number of diabetic patients also show reduced visual potency. A special insulin pen has been developed, which is easy to handle and where the graduations are enlarged to facilitate the adjustment of the correct dose (Fig. 6). Impaired vision hinders one's ability to self-administer medication and to read instructions for the

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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