Drug therapies in older adults (part 2)

In this, the second of two articles, we continue our evaluation of drug therapies in older adults. Having previously described the pharmacokinetic and pharmacodynamic consequences of physiological ageing, along with the challenge of appropriate prescribing, we proposed four key questions which shoul...

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Bibliographic Details
Published in:Clinical medicine (London, England) England), 2015-04, Vol.15 (2), p.155-159
Main Authors: Mukhtar, Omar, Jackson, Stephen HD
Format: Article
Language:English
Subjects:
Age Factors
Cardiovascular Agents - administration & dosage
Drug Therapies In
elderly
Geriatrics - methods
Heart Failure, Systolic - drug therapy
Heart Failure, Systolic - physiopathology
Humans
Hypotension, Orthostatic - drug therapy
Hypotension, Orthostatic - physiopathology
left ventricular dysfunction
orthostatic hypotension
Pharmacology
postural hypotension
systolic heart failure
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Summary:In this, the second of two articles, we continue our evaluation of drug therapies in older adults. Having previously described the pharmacokinetic and pharmacodynamic consequences of physiological ageing, along with the challenge of appropriate prescribing, we proposed four key questions which should be considered when prescribing for this cohort of the population. Does this agent reflect the priorities of the patient? Are there alternatives – with greater efficacy, effectiveness or tolerability – that might be considered? Are the dose, frequency and formulation appropriate? How does this prescription relate to concurrent medication? We also highlighted the reliance on subgroup analysis to demonstrate the efficacy of drug therapies for older adults in osteoporosis and the underutilisation of appropriate treatments for patients with Alzheimer’s disease as a result of flawed guidelines. Here we describe current drug therapies in systolic heart failure, noting the limited inclusion of older adults in key trials, while also reviewing the pharmacological treatment of orthostatic hypotension. In doing so, we advocate the intermittent use of midodrine as a first-line treatment for orthostasis in older adults, counter to the generic guidelines produced by various learned societies, but in keeping with the scant trial data available.
ISSN:1470-2118
1473-4893
DOI:10.7861/clinmedicine.15-2-155