Skip to main content Accessibility help
×
Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-17T01:16:43.793Z Has data issue: false hasContentIssue false

Chapter 5 - Appropriate use of medications in the elderly

from Section I - General approach to the care of the elderly

Published online by Cambridge University Press:  05 June 2016

Jan Busby-Whitehead
Affiliation:
University of North Carolina
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Samuel C. Durso
Affiliation:
The Johns Hopkins University School of Medicine
Daniel Swagerty
Affiliation:
University of Kansas
Laura Mosqueda
Affiliation:
University of Southern California
Maria Fiatarone Singh
Affiliation:
University of Sydney
William Reichel
Affiliation:
Georgetown University, Washington DC
Get access

Summary

Pharmacodynamic and pharmacokinetic changes occur with aging that affect drug therapy in the older adult population. Tools for assessing appropriateness, such as the Beer’s criteria and the STOPP/START criteria, have demonstrated their effectiveness and potential place in guiding prescribers. The consequences of inappropriate prescribing for older adults include falls and cognitive impairment. Medication adherence techniques and strategies can improve appropriate prescribing in older adults.  
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 58 - 68
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Federal Interagency Forum on Aging-Related Statistics. Older Americans Update 2010: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: US Government Printing Office; July 2010. Available at: www.agingstats.gov.Google Scholar
Corsonello, A, Pedone, C, Incalzi, RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem 2010;17:571–84.CrossRefGoogle ScholarPubMed
Kekki, M, Samloff, IM, Ihamaki, T, et al. Age- and sex-related behaviour of gastric acid secretion at the population level. Scand J Gastroenterol 1982;17:737–43.Google Scholar
Orr, WC, Chen, CL. Aging and neural control of the GI tract: IV. Clinical and physiological aspects of gastrointestinal motility and aging. Am J Physiol 2002;283:G1226–31.Google ScholarPubMed
Corazza, GR, Frazzoni, M, Gatto, MR, et al. Aging and small-bowel mucosa: a morphometric study. Gerontology 1986;32:60–5.CrossRefGoogle ScholarPubMed
Anantharaju, A, Feller, A, Chedid, A. Aging liver: a review. Gerontology 2002;48:343–53.Google Scholar
Le Couteur, DG, McLean, AJ. The aging liver: drug clearance and an oxygen diffusion barrier hypothesis. Clin Pharmacokinet 1998;34:359–73.CrossRefGoogle Scholar
Brenner, SS, Klotz, U. P-glycoprotein function in the elderly. Eur J Clin Pharmacol 2004;60:97102.CrossRefGoogle ScholarPubMed
Kaestli, LZ, Wasilewski-Rasca, AF, Bonnabry, P, Vogt-Ferrier, N. Use of transdermal formulations in the elderly. Drugs Aging 2008;25:269–80.Google Scholar
Beaufrere, B, Morio, B. Fat and protein redistribution with aging: metabolic considerations. Eur J Clin Nutr 2000;54:S4853.CrossRefGoogle ScholarPubMed
Cusack, B, Kelly, J, O’Malley, K, et al. Digoxin in the elderly: pharmacokinetic consequences of old age. Clin Pharmacol Ther 1979;25:772–6.CrossRefGoogle ScholarPubMed
Campion, EW, deLabry, LO, Glynn, RJ. The effect of age on serum albumin in healthy males: report from the Normative Aging Study. J Gerontol 1988;43:M1820.Google Scholar
Verbeeck, RK, Cardinal, JA, Wallace, SM. Effect of age and sex on the plasma binding of acidic and basic drugs. Eur J Clin Pharmacol 1984;27:91–7.Google Scholar
Woodhouse, KW, James, OF. Hepatic drug metabolism and ageing. British Medical Bulletin. 1990;46:2235.Google Scholar
Schmucker, DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging 2001;18:837–51.Google Scholar
Hammerlein, A, Derendorf, H, Lowenthal, DT. Pharmacokinetic and pharmacodynamic changes in the elderly: clinical implications. Clin Pharmacokinet 1998;35:4964.CrossRefGoogle ScholarPubMed
Benedetti, MS, Whomsley, R, Canning, M. Drug metabolism in the pediatric population and in the elderly. Drug Discov Today 2007;12:599610.CrossRefGoogle ScholarPubMed
Bressler, R, Bahl, JJ. Principles of drug therapy for the elderly patient. Mayo Clin Proc 2003;78:1564–77.Google Scholar
Muhlberg, W, Platt, D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology 1999;45:243–53.CrossRefGoogle ScholarPubMed
Fliser, D. Assessment of renal function in elderly patients. Curr Opin Nephrol Hypertens 2008;17:604–8.Google Scholar
Stevens, LA, Coresh, J, Greene, T, Levey, AS. Assessing kidney function: measured and estimated glomerular filtration rate. N Engl J Med 2006;354:2473–83.Google Scholar
Levey, AS, Bosch, JP, Lewis, JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–70.CrossRefGoogle ScholarPubMed
Verhave, JC, Fesler, P, Ribstein, J, du Cailar, G, Mimran, A. Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis 2005;46:233–41.Google Scholar
Bowie, MW, Slattum, PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother 2007;5:263303.CrossRefGoogle ScholarPubMed
Abernethy, DR, Schwartz, JB, Plachetka, JR, Todd, EL, Egan, JM. Comparison in young and elderly patients of pharmacodynamics and disposition of labetalol in systemic hypertension. Am J Cardiol 1987;60:697702.Google Scholar
Schwartz, JB, Gibb, WJ, Tran, T. Aging effects on heart rate variation. J Gerontol 1991;46:M99106.CrossRefGoogle ScholarPubMed
Trifior, G, Spina, E. Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab 2011;12:611–20.Google Scholar
Beers, MH, Ouslander, JG, Rollingher, J, Reuben, DB, Beck, JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991;151:1825–32.Google Scholar
American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatri Soc. 2012 Apr;60(4):616–31.Google Scholar
Jano, E, Aparasu, RR. Healthcare outcomes associated with Beers’ criteria: a systematic overview. Ann Pharmacother 2007;41:438–48.Google Scholar
Fialova, D, Onder, G. Medication errors in elderly people: contributing factors and future perspectives. Br J Clin Pharmacol 2009;67:641–5.Google Scholar
Onder, G, Pedone, C, Landi, F, Cesari, M, Della Vedova, C, Bernabei, Gambassi G. Adverse drug reactions as a cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 2002;50:1962–8.Google Scholar
Swagerty, D, Brickley, R. American Medical Directors Association and American Society of Consultant Pharmacists joint position statement on the Beers list of potentially inappropriate medications in older adults. J Am Med Dir Assoc 2005;6:80–6.Google Scholar
Gallagher, P, Ryan, C, Byrne, S, Kennedy, J, O’Mahony, D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 2008 Feb;46(2):7283.Google Scholar
Gallagher, P, O’Mahony, D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Ageing 2008;37(6):673–79.Google Scholar
Hamilton, H, Gallagher, P, Ryan, C, Byrne, S, O’Mahony, D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 2011;171(11):1013.CrossRefGoogle ScholarPubMed
Edwards, IR, Aronson, JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000;356:1255–9.CrossRefGoogle ScholarPubMed
Kongkaew, C, Noyce, PR, Ashcroft, DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother 2008;42:1017–25.Google Scholar
Hanlon, JT, Artz, MB, Lindblad, CI, Pieper, CF, Sloane, RJ, Ruby, CM, Schmader, KE. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 2003;1:82–9.Google Scholar
Ernst, FR, Grizzle, AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash) 2001 Mar–Apr;41(2):192–9.Google Scholar
Bootman, JL, Harrison, DL, Cox, E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med 1997 Oct 13;157(18):2089–96.Google Scholar
Tinetti, ME, Speechley, M, Ginter, SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–7.Google Scholar
Tinetti, ME. Clinical practice: preventing falls in elderly persons. N Engl J Med 2003;348:42–9.Google Scholar
Moylan, KC, Binder, EF. Falls in older adults: risk assessment, management and prevention. American Journal of Medicine 2007; 120(6):493 e1e6.Google Scholar
US Department of Health and Human Services. Bone health and osteoporosis a report of the surgeon general – 2004. Available at: www.surgeongeneral.gov/library/bonehealth/content.html (accessed October 5, 2007).Google Scholar
Zeire, G, Dieleman, JP, Hofman, A, et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2005;61:218–23.Google Scholar
Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999;47:30–9.Google Scholar
Maixner, SM, Mellow, AM, Tandon, R. The efficacy safety and tolerability of antipsychotics in the elderly. J Clin Psychiatry 1999;60:2941.Google ScholarPubMed
Ensrud, DE, Blackwell, TL, Mangione, CM, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 2002;50:1629–37.Google Scholar
Thapa, PB, Gideon, P, Cost, TW, Milam, AB, Ray, WA. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998;339:875–82.Google Scholar
Cook, PJ. Benzodiazepine hypnotics in the elderly. Acta Psychiatr Scand 1986;73(Suppl 332):149–58.Google Scholar
Hayes, BD, Klein-Schwartz, W, Barrueto, F Jr.. Polypharmacy and the geriatric patient. Clinics in Geriatric Medicine 2007; 23(2):371–90.Google ScholarPubMed
Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999;47:4050.Google Scholar
Buckeridge, D, Huang, A, Hanley, J, Kelome, A, Reidel, K, Verma, A, et al. Risk of injury associated with opioid use in older adults. J Am Geriatr Soc 2010;58(9):1664–70.Google Scholar
McEvoy, GK, ed. AHFS Drug Information 2007. Bethesda, MD: ASHP; 2007.Google Scholar
Carruthers, SG. Adverse effects of alpha 1-adrenergic blocking drugs. Drug Saf 1994;11:1220.Google Scholar
Liang, SY, Mackowiak, PA. Infections in the elderly. Clin Geriatr Med 2007;23:441–56.CrossRefGoogle ScholarPubMed
Cohen, MB, Mather, PJ. A review of the association between congestive heart failure and cognitive impairment. Am J Geriatr Cardiol 2007;16:171–4.Google Scholar
Knopman, DS, Peterson, RC. Mild cognitive impairement and mild dementia: a clinical perspective. Mayo Clin Proc 2014;89:1452–9.Google Scholar
Fick, DM, Cooper, JW, Wade, WE, Waller, JL, Maclean, JR, Beers, MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716–24.Google Scholar
McShane, R, Keene, J, Gedling, K, Fairburn, C, Jacoby, R, Hope, T. Do neuroleptic drugs hasten cognitive decline in dementia? Br Med J 1997;314:266–70.CrossRefGoogle ScholarPubMed
Mintzer, J, Burns, A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med 2000;93:457–62.Google Scholar
Ancelin, ML, Artero, S, Portet, F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. Br Med J 2006;332:455–9.Google Scholar
Higashi, T, Shekelle, PG, Solomon, DH, Knight, EL, Roth, C, Chang, JT, Kamberg, CJ, MacLean, CH, Young, RT, Adams, J, Reuben, DB, Avorn, J, Wenger, NS. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med 2004;140(9):714–20.Google Scholar
Kuijpers, MAJ, vanMarum, RJ, Egberts, ACG, Jansen, PAF. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008;65:130–3.CrossRefGoogle ScholarPubMed
Steinman, MA, Landefeld, CS, Rosenthal, GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006;54:1516–23.Google Scholar
Ghosh, S, Ziesmer, V, Aronow, WS. Underutilization of aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering drugs and overutilization of calcium channel blockers in older persons with coronary artery disease in an academic nursing home. J Gerontol 2002;57A:M398400.Google Scholar
Spinewine, A, Swine, C, Dhillon, S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc 2007;55:658–65.Google Scholar
MacLaughlin, EJ, Raehl, CL, Treadway, AK, et al. Assessing medication adherence in the elderly – which tools to use in clinical practice? Drugs Aging 2005;22:231–55.Google Scholar
Bisonette, JM. Adherence: a concept analysis. J Ad Nurs 2008;63:634–43.Google Scholar
Marzec, LN, Maddox, TM. Medication adherence in patients with diabetes and dyslipidemia: associated factors and strategies for improvement. Curr Cardiol Rep 2013;15:418.Google Scholar
Haynes, RB, Ackloo, E, Sahota, N, McDonald, HP, Yao, X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008:2:CD000011. DOI: 10.1002/14651858.CD000011.pub3.Google Scholar
Viswanathan, M, Golin, CE, Jones, CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med 2012;157:785–95.Google Scholar
McDonald, HP, Garg, AX, Haynes, RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002;288:2868–79.Google Scholar
Kripalani, S, Yao, X, Haynes, RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med 2007;167:540–50.Google Scholar
Bangalore, S, Kamalakkannan, G, Parkar, S, et al. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med 2007;120:713–9.CrossRefGoogle ScholarPubMed
Holmes, HM, Hayley, DC, Alexander, GC, Sachs, GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med 2006;166:605–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×