Appropriate prescribing in the elderly: Current perspectives  

作　　者：Amanda Hanora Lavan John O'Grady Paul Francis Gallagher 

机构地区：[1]Department of Geriatric Medicine, Cork University Hospital

出　　处：《World Journal of Pharmacology》2015年第2期193-209,共17页世界药理学杂志

摘　　要：Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.Advances in medical therapeutics have undoubtedlycontributed to health gains and increases in lifeexpectancy over the last century. However, there isgrowing evidence to suggest that therapeutic decisionsin older patients are frequently suboptimal or potentiallyinappropriate and often result in negative outcomessuch as adverse drug events, hospitalisation andincreased healthcare resource utilisation. Several factorsinfluence the appropriateness of medication selection in older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients world-wide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drug-drug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various appro-aches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.

关 键 词：ELDERLY Inappropriate prescribing Polyphar-macy Beers criteria Screening Tool of Older Person’s potentially inappropriate Prescriptions/Screening Tool to Alert to Right Treatment Adverse drug reactions 

分 类 号：R161[医药卫生—公共卫生与预防医学]