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Drugs & Aging
Published in: Drugs & Aging 5/2005

01-05-2005 | Leading Article

Predicting and Preventing Adverse Drug Reactions in the Very Old

Authors: Dr Louis Merle, Marie-Laure Laroche, Thierry Dantoine, Jean-Pierre Charmes

Published in: Drugs & Aging | Issue 5/2005

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Abstract

The size of the elderly population has been increasing steadily for several years. Individuals in this age group often have several concomitant diseases that require treatment with multiple medications. These drugs, for various reasons and especially as a consequence of potential accumulation, may be associated with adverse reactions. Of the numerous factors that can favour the occurrence of these adverse drug reactions, the most important are the pathophysiological consequences of aging, particularly as these apply to the very old.
Although absorption of drugs is not usually reduced in the elderly, diffusion, distribution and particularly elimination decline with age. Furthermore, while hepatic metabolic function is fairly normal, renal function is usually markedly depressed in very old individuals, and this can translate into clinical consequences if it is not taken into account. This is why, before administration of any drug in the elderly, evaluation of glomerular filtration rate is essential. Validated estimations such as those obtained from the classical Cockcroft-Gault formula or from more recent methodologies are required.
In addition to reductions in various organ functions, factors connected with very old age such as frailty, falls, abnormal sensitivity to medications and polypathology, all of which tend to be more common in the last years of life, all directly impact on adverse drug reaction occurrence.
Given these characteristics of the elderly population, the best way to reduce the prevalence of adverse drug reactions in this group is to limit drug prescription to essential medications, make sure that use of prescribed agents is clearly explained to the patient, give drugs for as short a period as possible, and periodically re-evaluate all use of drugs in the elderly.
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Metadata
Title
Predicting and Preventing Adverse Drug Reactions in the Very Old
Authors
Dr Louis Merle
Marie-Laure Laroche
Thierry Dantoine
Jean-Pierre Charmes
Publication date
01-05-2005
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 5/2005
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/00002512-200522050-00003

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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