Drug Use In The Elderly: Risk or Protection?

Christel Cornelius

Disclosures

Curr Opin Psychiatry. 2004;17(6) 

In This Article

Drug Use In the Elderly

Medication use in elderly persons requires special attention because of increasing drug use with age, and age-related changes in handling the drugs in the body.

Polypharmacy is a common problem in an elderly population, increasing the risk of adverse reactions and drug-drug interactions. In most studies of drug use in the elderly, the number of drugs used increases with age, and women use more medicines than men. These results were confirmed in a study from the Kungsholmen Project, exploring drug use patterns in one urban and one rural population in Sweden, with participants 75 years and older.[14*] Medication has also increased during the last few decades, leading to a higher mean number of drugs per person.[15*] In the two studies,[14*,15*] the most commonly used drugs were cardiovascular agents, sedatives/hypnotics and analgesics, which is in line with earlier studies. Many of these drugs have anticholinergic effects that can cause problems in the elderly, especially for those who already have a cognitive impairment. Hence, increasing drug use and the types of drugs commonly used emphasize the importance of optimizing medication in the elderly. Furthermore, the drug consumption of all elderly persons should be reviewed on a regular basis to avoid polypharmacy and the potential negative effects due to age-related changes in pharmacokinetics and pharmacodynamics, as suggested by Murray and Callahan.[16*]

Why women use more medicines than men is unclear. One interesting finding in the Kungsholmen Project was that women 85 years and older had higher morbidity than men, mainly due to the higher prevalence of fractures and osteoarticular disorders.[17*] This could also explain why women used more analgesics and sedatives/hypnotics than men.

Inappropriate medication in the elderly includes polypharmacy, wrong choice of drugs, potentially toxic or insufficient dosages, problems with compliance, and deficient control of duration of treatment. More than one chronic disease, frequent physician visits, and high depressive symptoms were associated with the use of at least one inappropriate drug among Mexican Americans.[18*] In one study of Australian veterans and war widows, an estimated 25% were using a medication classified as 'usually inappropriate'.[19*] The same proportion of inappropriate drug use was found in a study from Norway.[20*] Psychoactive drugs represented the most frequent inappropriate use found in two studies,[21*,22*] concerning, for example, risk of anticholinergic side effects, risk of sustained sedation because of long-acting sedatives/hypnotics, but also possible undertreatment of depression. In earlier studies, depression has been found to be underdiagnosed in older people,[23] and has been reported to be frequently treated with anxiolytics and sedatives instead of antidepressants.[24] This probably reflects the difficulties of using medication such as tricyclic antidepressants in older people because of frequent and serious side effects. The selective serotonin reuptake inhibitors have been introduced as an alternative antidepressant therapy. These drugs have been found to have positive effects on memory in the elderly,[25*] and usually are well tolerated. There is a trend of increasing use of antidepressants in many countries.[26] In addition, beneficial effects of selective serotonin reuptake inhibitors on behavioural disturbances, like agitation, have been described in patients with dementia.[27**] Consequently, physicians should be aware of the variations of depressive symptoms in the elderly, since depression can be treated with good results, also in those with cognitive impairment or dementia.

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