Review Article
Rules for Improving Pharmacotherapy in Older Adult Patients: Part 1 (Rules 1-5)
Abstract
The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Antimisiaris D. Polypharmacy: a modern day silent epidemic. http://www.polypharmacyinitiative.com/education.html. Published 2012. Accessed August 4, 2014.
2. Wooten JM. Pharmacotherapy considerations in elderly adults. South Med J 2012;105:437-445.
3. Wooten J, Galavis J. Polypharmacy. Keeping the elderly safe. RN 2005;68:44-50.
4. Sieck GC. Physiology of aging. J Appl Physiol 2003;95:1333-1334.
5. Seward JB. Physiological aging. Window of opportunity. JACC Cardiovasc Imaging 2011;4:243-245.
6. Kim J, Mak M. Geriatric drug use. In: Koda-Kimble MR, Young LY, Alldredge BK, et al, eds. Applied Therapeutics: The Clinical Use of Drugs. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009:99-1-99-20.
7. Starner CI, Gray SL, Guay DRP, et al. Geriatrics, in DiPiro JT, Talbert RL, Yee GC, et al, (eds): Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York: McGraw-Hill, 2011:57-66.
8. Pervin L. Polypharmacy and aging. Is there cause for concern? http://www.rehabnurse.org/pdf/GeriatricsPolypharmacy.pdf. Published February/March 2008. Accessed August 4, 2014.
9. Abdulraheem IS. Polypharmacy. A risk factor for geriatric syndrome, morbidity & mortality. J Aging Sci 2013;1:1-2.
10. Shah BM, Hajjar ER. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med 2012;28:173-186.
11. Stawicki SP, Gerlach AT. Polypharmacy and medication errors. Stop, listen, look, and analyzeI. OPUS 12 Scientist 2008;3:7-10.
12. Schaefer K, Mærkedahl H, Birk HO, et al. Polypharmacy in general practice. Dan Med Bull 2010;57:A4165.
13. Fogel RW. Changes in the physiology of aging during the twentieth century. http://www.nber.org/papers/w11233. Published 2005. Accessed January 20, 2015.
14. Petrone K, Katz P. Approaches to appropriate drug prescribing for the older adult. Prim Care Clin Office Pract 2005;32:755-775.
15. Jose J. Promoting drug safety in elderly--needs a proactive approach. Indian J Med Res 2012;136:362-364.
16. Peters KE, Gupta S, Stoller N, et al. Implications of the aging process: opportunities for prevention in the farming community. J Agromed 2008;13:111-118.
17. Stegemann S, Ecker F, Maio M, et al. Geriatric drug therapy. Neglecting the inevitable majority. Ageing Res Rev 2010;9:384-398.
18. Scibona P, Angriman F, Vazquez C, et al. Individualization of drug therapy in older people. Rev Clin Gerontol 2014;24:145-157.
19. Family Caregiver Alliance-National Center on Caregiving. Caregivers’ guide to medications and aging. https.//www.caregiver.org/caregivers-guide-medications-and-aging. Published 2004. Accessed August 4, 2014.
20. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence-based medicine. What it is and what it isn’t. Br Med J 1996;312:71-72.
21. Ramsdale E, Dale W. Evidence-based guidelines and quality measures in the care of older adults. Virtual Mentor 2013;15:51-55.
22. Akobeng AK. Principles of evidence based medicine. Arch Dis Child 2005;90:837-840.
23. Mutasingwa DR, Ge H, Upshur R. How applicable are clinical practice guidelines to elderly patients with comorbidities? Can Fam Physician 2011;57:e253-e262.
24. Food and Drug Administration, Health and Human Services. International Conference on Harmonisation; Guidance on E7 Studies in Support of Special Populations; Geriatrics; Questions and Answers; Availability. Notice. Fed Regist 2012;77:9948-9949.
25. Campisi G, Chiappelli M, De Martinis M, et al. Pathophysiology of age-related diseases. Immun Ageing 2009;6:12.
26. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults. Toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006;54:991-1001.
27. Pfaff H, Driller E, Ernsmann N, et al. Standardization and individualization in care for the elderly: proactive behavior through individualized standardization. Open Longev Sci 2010;4:51-57.
28. Jansen PAF, Brouwers JRBJ. Pharmacology in old persons. Scientifica 2012; http://dx.doi.org/10.6064/2012/723678.
29. Burkle A, Caselli G, Franceschi C, et al. Pathophysiology of ageing, longevity and age related diseases. Immun Ageing 2007;4:1-7.
30. Bressler R, Bahl J. Principles of drug therapy for the elderly patient. Mayo Clin Proc 2003;78:1564-1577.
31. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics. Basic principles and practical applications. Br J Clin Pharmacol 2003;57:6-14.
32. Fassett RG. Current and emerging treatment options for the elderly patient with chronic kidney disease. Clin Interv Aging 2014;9:191-199.
33. Lassiter J, Bennett W, Olyaei A. Drug dosing in elderly patients with chronic kidney disease. Clin Geriatr Med 2013;29:657-705.
34. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41.
35. 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;130:461-470.
36. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612.
37. Simon J, Made M, Poggio ED. Interpreting the estimated glomerular filtration rate in primary care. Benefits and pitfalls. Cleve Clin J Med 2011;78:189-195.
38. Flamant M, Haymann JP, Vidal-Petiot E, et al. GFR estimation using the Cockcroft-Gault, MDRD study, and CKD-EPI equations in the elderly. Am J Kidney Dis 2012;60:847-849.
39. Murthy KN, Takkalaki N, Ashakiran S, et al. A study of estimated glomerular filtration rate in chronic kidney disease. J Clin Biomed Sci 2012;2:22-30.
40. Meyer D, Damm T, Jensen K. Drug dosage adjustments in chronic kidney disease. The pharmacist’s role. http://medsask.usask.ca/documents/newsletters/29.3.Renal_newsletter.pdf. Accessed May 23, 2014.
41. Delco F, Tchambaz L, Schlienger R, et al. Dose adjustment in patients with liver disease. Drug Saf 2005;28:529-545.
42. Hilmer SN, Shenfield GM, Le Couteur DG. Clinical implications of changes in hepatic drug metabolism in older people. Ther Clin Risk Manag 2005;1:151-156.
43. Dose adjustment of drugs with high hepatic extraction are required in patients with severe liver disease. Drugs Ther Perspect 2006;22:23-26.
