SOCIAL AND CLINICAL ASPECTS OF PHARMACOTHERAPY IN OLD AGE

  • Jože Drinovec Krka d.d. Novo mesto Dunajska 65 1000 Ljubljana
Keywords: pharmacotherapy, drugs, old age, polymorbidity, polypharmacotherapy

Abstract

Background. Older population has more symptoms and disease signs as elderly people are more prone to ilnesses. That is why they take both prescribed and unprescribed drugs more frequently. In 2003 Slovenian insured persons younger than 65 received on average 5.5 prescriptions while those above 65 received 19.4 prescriptions. During the same year 4,811 insured persons received a prescription for 10 drugs and 160 of them for 18 or more drugs.

There are many physiological changes that accompany aging and are important for pharmacotherapy. For example, body fat increases while total body water, plasma volume and serum albumin concentration decrease. There is also a significant decrease of kidney function, most notably seen in glomerular filtration rate.

Conclusions. Basic recommendations for pharmacotherapy in old age include a decrease in simultaneous drug consumation, if possible to the value of 4. Recommended dose for majority of drugs would be 1/2 to 2/3 of the one taken by a man of average age having an average body mass.

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References

Hanlon JT, Ruby CM, Shelton PS, Pulliam CC. Geriatrics. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy. A pathophysiologic approach. Stanford: Appleton & Lang, 1999: 52–61.

Ewing AB. Altered drug response in the elderly. In: Armour D, Cairns C eds. Medicines in the elderly. London: Pharmaceutical Press, 2002: 15–27.

Ruiz JG, Lowenthal DT. Geriatric pharmacology. In: Munson PL, Mueller RA, Breese GR. Principles of pharmacology. New York: Chapman & Hall, 1995: 1717–26.

Poredoš P. Predpisovanje zdravil starostnikom z vidika klinične medicine. In: Mencej M ed. Uporaba zdravil v starosti. Ljubljana: Gerontološko društvo Slovenije, 1999: 27–33.

Drinovec J. Posebnosti farmakoterapije v starosti. In: Keber D. Posebnosti bolezni v starosti. XXXI. Tavčarjevi dnevi, Ljubljana, 8.–10. 11. 1989. Ljubljana: Medicinski razgledi, 1989: 29–35.

Crimmins EM. Trends in the health of the elderly. Ann Rev Public Health 2004; 25: 79–98.

Stewart RB. Drug use in the elderly. In: Delafuente JC, Stewart RB eds. Therapeutics in the elderly. Second edition. Cincinnati: Harwey Hhithney Books, 1995: 174–89.

Cusack BJ, Nielson CP, Vestal RE. Geriatric clinical pharmacology and therapeutics. In: Speight TM, Holford NHG eds. Avery’s drug treatment. 4th edition. Auckland: Adis International Ltd., 1997: 173–223.

Jones D, Poole C. Medicine taking by elderly people: An overview. In: George CF, Woodhouse KW, Denham MJ, MacLennan WJ eds. Drug therapy in old age. Chichester: John Wiley & Sons Ltd., 1998: 1–22.

Abernethy DR. Drug therapy in the elderly. In: Atkinson AJ, Daniels CE, Dedrick RL, Grudzinskas CV, Markey SP eds. Principles of clinical pharmacology. San Diego: Academic Press, 2001: 307–17.

Avorn J. Medications and the elderly. In: Rowe JW, Besdine RW eds. Geriatric medicine. Boston: Little, Brown and Company, 1988: 114–21.

Huttin C. The use of prescription charges. Health Policy 1994; 27: 53–73.

Denham MJ, Barnett NL. Drug therapy and the older person. Drug Safety 1998; 19: 243–50.

Schwartz JB. Clinical pharmacology. In: Hazzard WR, Blass JP, Ettinger WH, Halter JB, Ouslander JG eds. Principles of geriatric medicine and gerontology. New York: McGraw-Hill, 1999: 303–31.

Chadwick R, Levitt M. When drug treatment in the elderly is not cost effective. Drugs & Aging 1995; 7: 416–9.

Borrego F, Gleckman R. Principles of antibiotic prescribing in the elderly. Drugs & Aging 1997; 11: 7–18

Primatesta P, Poulter NR. Hypertension management and control among English adults aged 65 years and older in 2000 and 2001. J Hypertens 2004; 22: 1093–8.

Ramanathan K, Ellis CJ, White HD. Thrombolytic therapy in the elderly. Drugs & Aging 1996; 8: 237–44.

Straznicky IT, White HD. Thrombolytic therapy for acute myocardial infarction in the elderly. Coronary Artery Disease 2000; 11: 299–304.

Mungall MMB, Gaw A, Shepherd J. Statin therapy in the elderly. Drugs & Aging 2003; 20: 263–75.

Probstfielde JL. Use of lipid lowering agents in the prevention of cardiovascular disease. In: Yusuf S, Cairns JA, Camm AJ, Fallen EL, Gersh BJ eds. Evidence-based cardiology. Second edition. London: BMJ Books, 2003: 130– 45.

Le Couteur DG, McLean AJ. The aging liver. Clin Pharmacokinet 1998; 34: 359–73.

Millstein LG. Issues in geriatric labeling revisions. In: Moore SR, Teal TW. Geriatric drug use – Clinical and social perspectives. New York: Pergamon Press, 1985: 17–21.

Hämmerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodinamic changes in the elderly. Clin Pharmacokinet 1998; 35: 49–64.

Burkhardt H, Gladisch R. Pharmakotherapie des älteren Menschen aus klinischer Sicht. Internist 2003; 44: 959–67.

Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2003; 57: 6–14.

Jackson SHD. Pharmacodynamics in the elderly. J Roy Soc Med 1994; 87: Suppl 23: 5–7.

Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol 2003; 57: 121–6.

Kennedy AG, Maclean CD. Clinical inertia: Errors of omission in drug therapy. Am J Health-Syst Pharm 2004; 61: 401–4.

Salzman C. Medication compliance in the elderly. J Clin Psychiatry 1995; 56: Suppl 1: 18–23.

Ennis KJ, Reichard RA. Maximizing drug compliance in the elderly. Postgraduate Medicine 1997; 102: 211–24.

Tamblyn R. Medication use in seniors: challenges and solutions. Therapie 1996; 51: 269–82.

Michocki RJ, Lamy PP, Hooper FJ, Richardson JP. Drug prescribing in the elderly. Arch Farm Med 1993; 2: 331–4.

Novielli KD, Koenig JB, White E, Wertheimer A, Nash DB. Individualized prescribing for elderly. Philadelphia: The Pharmacy and Therapeutics Society, 2001: 1–29.

How to Cite
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Drinovec J. SOCIAL AND CLINICAL ASPECTS OF PHARMACOTHERAPY IN OLD AGE. ZdravVestn [Internet]. 1 [cited 23Aug.2019];73(10). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2364
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