Elderly and drugs: risks and necessity of rational use

Baldoni, André Oliveira; Chequer, Farah Maria Drumond; Ferraz, Elisa Raquel Anastácio; Oliveira, Danielle Palma de; Pereira, Leonardo Régis Leira; Dorta, Daniel Junqueira

doi:10.1590/s1984-82502010000400003

Cited by 25 publications

(26 citation statements)

References 97 publications

(105 reference statements)

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“…Esse envelhecimento tem como consequências aumento da prevalência de doenças crônicas não transmissíveis, de incapacidades, bem como aumento na demanda por serviços de saú-de e de benefícios 4,5 . A elevada prevalência de múltiplas doenças crônicas e sua coexistência, associadas a mudanças fisiológicas relacionadas ao envelhecimento, favorece a exposição da população idosa ao uso de múltiplos medicamentos e ao surgimento de problemas relacionados a esse uso 6,7,8 .…”

Section: Introductionunclassified

Uso de medicamentos potencialmente inadequados entre idosos do Município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional

et al. 2015

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Resumo Avaliou-se o uso de medicamentos potencialmente inadequados entre idosos de Viçosa, Minas Gerais, Brasil, de acordo com os critérios de Beers 2012 e STOPP, bem como os fatores associados a esse uso. Estudo transversal com 621 idosos não institucionalizados, abordados por entrevista domiciliar. As variáveis explicativas foram sexo, idade, escolaridade, percepção da saúde, restrição de atividades nos últimos 15 dias, capacidade funcional, história de internação hospitalar, número de doenças autorreferidas e polifarmácia. Realizou-se análise de regressão de Poisson multivariada. Observou-se alta prevalência de uso de medicamentos potencialmente inadequados, 43,8% (IC95%: 37,8%-47,8%) e 44,8% (IC95%: 40,9%-48,8%), segundo os critérios de Beers 2012 e STOPP respectivamente. Sexo feminino e polifarmácia se mantiveram independentemente associados ao uso de medicamentos potencialmente inadequados, de acordo com os critérios de Beers. Para o critério STOPP, as variáveis independentemente associadas ao uso de medicamentos potencialmente inadequados foram sexo feminino, percepção de saúde regular e polifarmácia. Esforços são necessários para se qualificar a prática da polifarmácia entre idosos.

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Section: Introductionunclassified

Uso de medicamentos potencialmente inadequados entre idosos do Município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional

et al. 2015

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“…These changes affect the pharmacokinetics and pharmacodynamics of drugs, making it difficult to draw a clear-cut line between risks and benefits of their use in this population (Mangoni, Jackson, 2003;Baldoni et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…This increase enhances the absorption of alkali drugs and reduces the absorption of acidic drugs. Aging also promotes reduced surface intestinal absorption and lower esophageal sphincter pressure and peristalsis (Baldoni et al, 2010;Ferreira, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, liposoluble drugs tend to accumulate in adipose tissue, increasing their plasma half-life and period of action, and the risk of adverse effects. Reduced distribution volume for watersoluble may increase their initial concentration in the central compartment, resulting in higher plasma concentrations (Baldoni et al, 2010). Biotransformation can be affected by hepatic blood flow, which can be reduced by as much as half in the elderly.…”

Section: Introductionmentioning

confidence: 99%

“…For drugs with a narrow therapeutic safety margin, such as digoxin, aminoglycosides and warfarin, serious side effects may occur in elderly patients if a dosage adjustment is not based on creatinine clearance value (Mangoni, Jackson, 2003;Baldoni et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate medication use in institutionalized older adults according to the Beers Criteria

Ganassin

Matos

Toffoli-Kadri

2014

Braz. J. Pharm. Sci.

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The need for specific care, coupled with new family arrangements, has contributed to the increasing institutionalization of elderly members. The purpose of this study was to evaluate drug use by institutionalized older adults according to Beers Criteria. This prospective, longitudinal study was conducted in the three non-profit long-stay geriatric care institutions of Campo Grande, in the Central-West region of Brazil. All subjects aged 60 years and above on November 2011 were included and followed until November 2012. Eighteen subjects were excluded and the final sample consisted of 133 individuals aged 60 to 113 years. Overall, 212 medications were used at geriatric care institution A, 532 at B, and 1329 at C. Thirty-four drugs were inappropriately prescribed 89 times at geriatric care institution A (41.98%), 49 prescribed 177 times at B (33.27%), and 91 prescribed 461 times at C (34.68%). Statistical differences in the inappropriate drug use were found between genders (p=0.007). The most commonly used potentially inappropriate medication were first-generation antihistamines (15.34%). There was a high frequency in the use of potentially inappropriate medications which can initiate marked side effects and may compromise the fragile health of institutionalized elderly. Thus, adopting the Beers Criteria in prescribing medication contributes to minimize adverse reactions and drug interactions.

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Pharmacokinetics, Safety, and Tolerability of Metformin in Healthy Elderly Subjects

Jang

Chung

Yoon

et al. 2016

The Journal of Clinical Pharma

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Age-related physiological changes are known to alter the pharmacokinetics (PK) and pharmacodynamics (PD) of drugs. Metformin is commonly used as first-line medication for management of diabetes in elderly patients. However, the PK and PD of metformin have not been sufficiently studied in elderly subjects. Here, 12 elderly subjects, aged 65 to 85 years, and 20 younger healthy volunteers were orally administered 750 mg of metformin 2 hours after dinner, followed by administration of a second dose (500 mg) 12 hours later. An oral glucose tolerance test (OGTT) was performed 2 hours after the second dose, with 75 g of glucose administered. Blood samples were collected at specific time points after the second metformin dose for the assessment of PK and the glucose-lowering effect of metformin. Elderly subjects exhibited 1.7 and 2.0 times higher average Cmax and AUC∞ than the younger subjects, respectively (P = .007 and .001, respectively), and t1/2 was comparable between the elderly and younger subjects. However, relative glucose level changes from baseline after metformin administration tended to be lower in elderly subjects. Systemic exposure to metformin was elevated by 50% or more in elderly subjects, whereas the glucose-lowering effect was similar compared to younger subjects after 2 doses of metformin.

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Elderly and drugs: risks and necessity of rational use

Cited by 25 publications

References 97 publications

Uso de medicamentos potencialmente inadequados entre idosos do Município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional

Uso de medicamentos potencialmente inadequados entre idosos do Município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional

Potentially inappropriate medication use in institutionalized older adults according to the Beers Criteria

Pharmacokinetics, Safety, and Tolerability of Metformin in Healthy Elderly Subjects

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