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Chapter 5 - Appropriate Use of Medications

from Section I - General Approach to the Care of the Elderly

Published online by Cambridge University Press:  30 June 2022

By
Emily R. Hajjar  and
Lauren Hersh
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
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Summary

Safe and effective medication use in the elderly requires heightened awareness in comparison to other patient populations. The issues of increased sensitivity to drug effects, use of many medications to treat comorbidities, and a high incidence of medication nonadherence increase the need for due diligence in prescribing and monitoring drug therapy in this population. The employment of an interprofessional approach to patient care as well as the use of known methods for improving medication adherence are key to long-term success in the medical management of the elderly patient.

Keywords

pharmacokineticspharmacodynamicspolypharmacyadherencedeprescribing
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 44 - 53
Publisher: Cambridge University Press
Print publication year: 2022

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References

Administration for Community Living. https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2017OlderAmericansProfile.pdf. Accessed on 6/4/2020.Google Scholar
Qato, DM, Wilder, J, Schumm, LP, et al. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016; 176: 473–482.CrossRefGoogle ScholarPubMed
Corsonello, A, Pedone, C, Incalzi, RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem. 2010; 17:571–584.Google Scholar
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; 17:737–743.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–G1231.Google ScholarPubMed
Corazza, GR, Frazzoni, M, Gatto, MR, et al. Aging and small-bowel mucosa: A morphometric study. Gerontology. 1986; 32:60–65.Google Scholar
Anantharaju, A, Feller, A, Chedid, A. Aging liver: A review. Gerontology. 2002; 48:343–353.Google Scholar
Brenner, SS, Klotz, U. P-glycoprotein function in the elderly. Eur J Clin Pharmacol. 2004; 60:97–102.CrossRefGoogle ScholarPubMed
Kaestli, LZ, Wasilewski-Rasca, AF, Bonnabry, P, Vogt-Ferrier, N. Use of transdermal formulations in the elderly. Drugs Aging. 2008; 25:269–280.Google Scholar
Beaufrere, B, Morio, B. Fat and protein redistribution with aging: Metabolic considerations. Eur J Clin Nutr. 2000; 54:S48–53.CrossRefGoogle ScholarPubMed
Cusack, BJ. Pharmacokinetics in older persons. Am J Geriatr Pharm. 2004; 2:274–302.Google Scholar
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:M18–M20.CrossRefGoogle ScholarPubMed
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; 27:91–97.CrossRefGoogle ScholarPubMed
Schmucker, DL. Liver function and phase I drug metabolism in the elderly: A paradox. Drugs Aging. 2001; 18:837–851.CrossRefGoogle ScholarPubMed
Hammerlein, A, Derendorf, H, Lowenthal, DT. Pharmacokinetic and pharmacodynamic changes in the elderly: Clinical implications. Clin Pharmacokinet. 1998; 35:49–64.CrossRefGoogle ScholarPubMed
McLachlan, AJ, Pont, LG. Drug metabolism in older people: A key consideration in achieving optimal outcomes with medicines. J Gerontol A Biol Sci Med Sci. 2012; 67A:175–180.CrossRefGoogle Scholar
Bressler, R, Bahl, JJ. Principles of drug therapy for the elderly patient. Mayo Clin Proc. 2003; 78:1564–1577.Google Scholar
Muhlberg, W, Platt, D. Age-dependent changes of the kidneys: Pharmacological implications. Gerontology. 1999; 45:243–253.Google Scholar
Church Sera, L, McPherson, ML. Pharmacokinetics and pharmacodynamics changes associated with aging and implications for drug therapy. Clin Geriatr Med. 2012; 28:273–286.Google Scholar
Fliser, D. Assessment of renal function in elderly patients. Curr Opin Nephrol Hypertens. 2008; 17:604–608.CrossRefGoogle ScholarPubMed
Dowling, TC, Wang, ES, Ferrucci, L, Sorking, JD. Glomerular filtration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore longitudinal study on aging (BLSA): Impact on renal drug dosing. Pharmacotherapy. 2013; 33:912–921.Google Scholar
Bowie, MW, Slattum, PW. Pharmacodynamics in older adults: A review. Am J Geriatr Pharmacother. 2007; 5:263–303.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; 60:697–702.CrossRefGoogle Scholar
Trifior, G, Spina, E. Age-related changes in pharmacodynamics: Focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab. 2011; 12:611–620.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; 151:1825–1832.Google Scholar
American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019; 67:674–694.Google Scholar
Xing, XX, Zhu, C, Liang, HY, et al. Associations between potentially inappropriate medications and adverse health outcomes in the elderly: A systematic review and meta-analysis. Ann Pharmacother. 2019; 53:1005–1019.Google Scholar
Hanlon, JT, Semla, TP, Schmader, KE. Alternative medication for medications in the use of high risk medications in the elderly and potentially harmful drug-disease interactions in the elderly. J Am Geriatr Soc. 2015; 63:e8–e18.CrossRefGoogle ScholarPubMed
Steinman, MA, Beizer, JL, DuBeau, CE, et al. How to use the American Geriatrics Society 2015 Beers Criteria: A guide for patients, clinicians, health systems, and payors. J Am Geriatr Soc. 2015; 63(12):e1–e7.Google Scholar
O’Mahony, D, O’Sullivan, D, Byrne, S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age and Ageing. 2015; 44:213–218.Google Scholar
Edwards, IR, Aronson, JK. Adverse drug reactions: Definitions, diagnosis, and management. Lancet. 2000; 356:1255–1259.CrossRefGoogle ScholarPubMed
Shehab, N, Lovegrove, MC, Geller, AI, Rose, KO, Weidle, NJ, Budnitz, DS. US emergency department visits for outpatient adverse drug events, 2013–2014. JAMA. 2016; 316(20):2115–2125.CrossRefGoogle ScholarPubMed
Khan, L. Comparative epidemiology of hospital-acquired adverse drug reactions in adults and children and their impact on cost and hospital stay: A systematic review. Eur J Clin Pharmacol. 2013 (Dec.); 69(12):1985–1996.CrossRefGoogle ScholarPubMed
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):192–199.Google Scholar
Lavan, AH, Gallagher, P. Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf. 2016 (Feb.); 7(1):11–22.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; 1:82–89.Google Scholar
Tinetti, ME, Speechley, M, Ginter, SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319:1701–1707.Google Scholar
Musich, S, Wang, SS, Ruiz, J, Hawkins, K, Wicker, E. Falls-related drug use and risk of falls among older adults: A study in a US Medicare population. Drugs Aging. 2017. 34:555–565.Google Scholar
U.S. Department of Health and Human Services. Bone health and osteoporosis: A report of the surgeon general – 2004. www.surgeongeneral.gov/library/bonehealth/content.html. Accessed on 10/5/2007.Google Scholar
Centers for Disease Control and Prevention (CDC). Fatalities and injuries from falls among older adults: United States, 1993–2003 and 2001–2005. MMWR. 2006; 55:1221–1224.Google Scholar
Moylan, KC, Binder, EF. Falls in the older adult: Risk assessment, management and prevention. Am J Med. 2007; 493:e1–e6.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; 61:218–223.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; 47:30–39.Google Scholar
Gareri, P, Segura-Garcia, C, Manfredi, VGL, Bruni, A, Ciambrone, P, Cerminara, G, De Sarro, G, De Fazio, P. Use of atypical antipsychotics in the elderly: A clinical review. Clin Interv Aging. 2014; 9:1363–1373.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; 50:1629–1637.Google Scholar
Cook, PJ. Benzodiazepine hypnotics in the elderly. Acta Psychiatr Scand. 1986; 73 (suppl. 332):149–158.CrossRefGoogle Scholar
Guerriero, F. Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. World J Clin Cases. 2017 (Mar. 16); 5(3):73–81.Google Scholar
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; 47:40–50.CrossRefGoogle ScholarPubMed
Liang, SY, Mackowiak, PA. Infections in the elderly. Clin Geriatr Med. 2007; 23:441–456.Google Scholar
Cohen, MB, Mather, PJ. A review of the association between congestive heart failure and cognitive impairment. Am J Geriatr Cardiol. 2007; 16:171–174.CrossRefGoogle ScholarPubMed
Knopman, DS, Peterson, RC. Mild cognitive impairment and mild dementia: A clinical perspective. Mayo Clin Proc. 2014; 89:1452–1459.Google Scholar
Gareri, P, DeFazio, P, Mafredi, VGL, De Sarro, G. Use and safety of antipsychotics in behavioral disorders in elderly people with dementia. J Clin Psychopharmacol. 2014; 34:109–123.Google Scholar
Collamati, A, Martone, AM, Osica, A, Brandi, V, Celi, M, Marzetti, E, Cherubini, A, Landi, F. Anticholinergic drugs and negative outcomes in the older population: From biological plausibility to clinical evidence. Aging Clin Exp Res. 2016; 28:25–35.Google Scholar
Salahudeen, MS, Dufull, SB, Nishtala, PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: A systematic review. BMC Geriatr. 2015; 15:31.Google Scholar
Van den Heuvel, PM, Los, M, van Marum, RJ, Jansen, PA. Polypharmacy and underprescribing in older adults: Rational underprescribing by general practitioners. J Am Geriatr Soc. 2011 (Sep.); 59(9):1750–1752.Google Scholar
Kuijpers, MAJ, vanMarum, RJ, Egberts, ACG, Jansen, PAF. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol. 2008; 65:130–133.CrossRefGoogle ScholarPubMed
Steinman, MA, Landefeld, CS, Rosenthal, GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006; 54:1516–1523.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:M398–M400.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; 55:658–665.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; 22:231–255.Google Scholar
Bisonette, JM. Adherence: A concept analysis. J Ad Nurs. 2008; 63:634–643.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 of Systematic Reviews. 2008; 2. Art. No.: CD000011. doi: 10.1002/14651858.CD000011.pub3.Google Scholar
Brown, MT, Bussel, J, Dutta, S, Davis, K, Strong, S, Mathew, S. Medication adherence: Truth and consequences. Am J Med Sci. 2016 (Apr.); 351(4):387–399.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; 157:785–795.CrossRefGoogle ScholarPubMed
McDonald, HP, Garg, AX, Haynes, RB. Interventions to enhance patient adherence to medication prescriptions: Scientific review. JAMA. 2002; 288:2868–2879.Google Scholar
Kripalani, S, Yao, X, Haynes, RB. Interventions to enhance medication adherence in chronic medical conditions: A systematic review. Arch Intern Med. 2007; 167:540–550.CrossRefGoogle ScholarPubMed
Bangalore, S, Kamalakkannan, G, Parkar, S, et al. Fixed-dose combinations improve medication compliance: A meta-analysis. Am J Med. 2007; 120:713–719.Google Scholar
Holmes, HM, Hayley, DC, Alexander, GC, Sachs, GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006; 166:605–609.Google Scholar
Bemben, NM. Deprescribing: An application to medication management in older adults. Pharmacotherapy. 2016; 36:774–780.Google Scholar
Bain, KT, Holmes, HM, Beers, MH, Maio, V, Handler, SM, Pauker, SG. Discontinuing medications: A novel approach for revising the prescribing stage of the medication use process. J Am Geriatr Soc. 2008; 56:1946–1952.Google Scholar
Farrell, B, Tannebaum, C. https://deprescribing.org. Accessed on 6/2/2020.Google Scholar

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