Understanding and managing medication in elderly people

Ageing alters drug handling by the body (pharmacokinetics) and response to medications (pharmacodynamics). Multiple comorbidities increase the risk of adverse drug reactions and medication burden, with increased potential for drug interactions. Elderly people are seldom included in clinical trials,...

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Published in:Best practice & research. Clinical obstetrics & gynaecology 2013-10, Vol.27 (5), p.767-788
Main Authors: Lonsdale, Dagan O., BSc, MRCP, Baker, Emma H., PhD, FRCP
Format: Article
Language:English
Subjects:
adverse drug reactions
Aged
Aging - metabolism
clinical trials
cognition
comorbidities
Drug Interactions
Female
gynaecology formulary
Humans
Medication Therapy Management
Obstetrics and Gynecology
pharmacodynamics
pharmacokinetics
Pharmacological Phenomena
Polypharmacy
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Summary:Ageing alters drug handling by the body (pharmacokinetics) and response to medications (pharmacodynamics). Multiple comorbidities increase the risk of adverse drug reactions and medication burden, with increased potential for drug interactions. Elderly people are seldom included in clinical trials, so underestimation of benefits and overestimation of risk may lead to under-treatment. Cognitive and functional changes associated with ageing may make it difficult for elderly people to adhere to treatment regimens. In this review, we consider these issues, with particular reference to drugs prescribed for gynaecology patients (the ‘gynaecology formulary’). It will focus on key areas of gynaecological practice, including prescribing anticholinergic drugs, hormone treatments and anticancer drugs, and perioperative issues relating to anaesthesia, analgesia and anticoagulation. Implications of common comorbidities, including osteoporosis, diabetes mellitus and cardiovascular disease, for prescribing in gynaecological patients will also be considered.
ISSN:1521-6934
1532-1932
DOI:10.1016/j.bpobgyn.2013.06.002