Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment

Pain is highly prevalent in frail older people who often have multiple co‐morbidities and multiple medicines. Rational prescribing of analgesics in frail older people is complex due to heterogeneity in drug disposition, comorbid medical conditions, polypharmacy and variability in analgesic response...

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Bibliographic Details
Published in:British journal of clinical pharmacology 2011-03, Vol.71 (3), p.351-364
Main Authors: McLachlan, Andrew J., Bath, Sally, Naganathan, Vasi, Hilmer, Sarah N., Le Couteur, David G., Gibson, Stephen J., Blyth, Fiona M.
Format: Article
Language:English
Subjects:
Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Aging
Analgesics
Analgesics - therapeutic use
Biological and medical sciences
Clinical trials
Clinical Trials as Topic
Cognition - drug effects
Cognition Disorders - drug therapy
Cognitive ability
Dementia disorders
Disposition
Drugs
Frail Elderly
frailty
Humans
Medical sciences
oxycodone
Pain
Pain - drug therapy
Pain Measurement
paracetamol
Pharmacodynamics
Pharmacokinetics
Pharmacology
Pharmacology. Drug treatments
Reviews
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Summary:Pain is highly prevalent in frail older people who often have multiple co‐morbidities and multiple medicines. Rational prescribing of analgesics in frail older people is complex due to heterogeneity in drug disposition, comorbid medical conditions, polypharmacy and variability in analgesic response in this population. A critical issue in managing older people with pain is the need for judicious choice of analgesics based on a comprehensive medical and medication history. Care is needed in the selection of analgesic medicine to avoid drug–drug or drug–disease interactions. People living with dementia and cognitive impairment have suboptimal pain relief which in part may be related to altered pharmacodynamics of analgesics and challenges in the systematic assessment of pain intensity in this patient group. In the absence of rigorously controlled trials in frail older people and those with cognitive impairment a pharmacologically‐guided approach can be used to optimize pain management which requires a systematic understanding of the pharmacokinetics and pharmacodynamics of analgesics in frail older people with or without changes in cognition.
ISSN:0306-5251
1365-2125
DOI:10.1111/j.1365-2125.2010.03847.x