Pharmacotherapy Considerations in Elderly Adults

James M. Wooten, PharmD

Disclosures

South Med J. 2012;105(8):437-445. 

In This Article

Abstract and Introduction

Abstract

Life expectancy for Americans has increased dramatically since 1900, as have the available pharmacotherapeutic options. Unfortunately, pharmacotherapy mishaps occur commonly in the older adult population. This problem greatly affects the morbidity and mortality of elderly patients and greatly increases healthcare costs. To improve patient care among elderly adults, healthcare practitioners must consider several issues when developing a pharmacotherapy plan. A thorough understanding of pharmacokinetics, pharmacodynamics, adverse drug reactions, drug interactions, and several other factors is necessary for practitioners to develop a safe and effective drug therapy plan for older adults. This review provides a general but comprehensive review of the issues pertaining to pharmacotherapy in elderly people and offers several suggestions for improving their pharmaceutical care.

Introduction

Elderly patients represent an extremely large and continuously growing population of healthcare consumers. The evidence-based guidelines developed for younger patients with specific disease states actually improve mortality such that the population of patients living to old age is increasing. Data from 2003 show that US life expectancy at birth for the total population was 77.5 years compared with 49.2 years at the turn of the 20th century.[2] As a group, elderly adults are difficult to distinguish. Patients can be classified as "young-elderly" (70–85 years old) or "old-elderly" (85 years old and older). This distinction may be important when evaluating drug studies in different age groups. Gender also can be used to distinguish patients. Because most elderly patients have more than one disease state and are prescribed many more medications than are nonelderly people, establishing definitive treatment guidelines can be difficult.[1–5]

Treatment guidelines must be tailored to fit each elderly individual's specific pharmacology for prescribed drugs and for each patient's unique comorbidity or comorbidities. A specific pharmacotherapy regimen should be considered based on the patient's specific condition, disease states, and pharmacotherapy history. Establishing specific pharmacokinetic and pharmacodynamic profiles for specific drugs in individual patients is imperative to developing a well-tolerated and effective pharmacotherapy plan. This can be difficult to accomplish. Most new drugs are not studied in elderly patients and even less in elderly sick patients with various comorbidities who are taking a large number of different medications.[6–13]

The establishment of an individualized pharmacotherapeutic plan is possible only if careful consideration is undertaken regarding each drug's pharmacokinetic and pharmacodynamic profile in a specific patient. Because drugs may behave differently in different patients, a specific profile must be developed for each patient. Aspects of this profile can include the following:

  • A drug's pharmacokinetic and pharmacodynamic profile in a specific patient

  • The potential for drug interactions in a specific patient

  • The potential for adverse drug reactions in a specific patient

  • The issue of patient compliance with the pharmacotherapy plan

If each of these issues is considered, then a safe and effective pharmacotherapy plan can be established for each elderly patient.[7–12]

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....