Age-Related Medicine

Wahlich, John; Orlu, Mine; Mair, Alpana; Stegemann, Sven; Riet–Nales, Diana van

doi:10.3390/pharmaceutics11040172

Cited by 10 publications

(11 citation statements)

References 38 publications

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“…Drug withdrawal effects are in particular associated with psychotropic and cardiovascular drugs, and older patients are at risk due to reduced homeostatic capacity. Furthermore, drug formulation is increasingly important in the patient-centric care of older patients [ 11 ]. Due to the high risk of adverse drug reactions and interactions in this population, questions concerning drug initiation and drug switching is common.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate indication, formulation, dose, administration, co-prescribing, and length of treatment are frequent clinical issues. Patient-centric pharmaceutical drug product design, formulation, and optimisation for the older population is of current interest [ 11 ]. However, scientific progress in this field has to take into account the heterogeneous population and the complexity associated with medicine optimisation.…”

Section: Introductionmentioning

confidence: 99%

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Review of Clinical Questions Submitted to Norwegian Drug Information Centres Concerning Administration and Dosage to Older Patients of Relevance to Patient-Centric Care

et al. 2021

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Patient-centric care entails optimising healthcare provision to patients based on their perspective and opinion. It involves appropriate treatment at a reasonable cost and a focus on patient characteristics in the decision-making process to make it more personally useful. The optimisation of medicines in the older population is a challenge due to physiological changes, comorbidity, and polypharmacy. Furthermore, patient-centric care is difficult to achieve due to the high proportion of patients with dementia and frailty. Decision support concerning the appropriateness of indication, formulation, dose, administration, co-prescribing, and length of treatment to older patients is frequently in demand. In the current study, we aimed to review clinical questions concerning administration and dosage to older patients of relevance to patient-centric care. We analysed questions concerning medicines to patients 65 years or older in the database of the network of Norwegian drug information centres from 2010 to 2020. The analysis included the distribution of drugs, diseases, and recurring topics among the questions. Through a Boolean search that combined the indexed categories of “older” and “administration and dosage”, we retrieved 84 question-answer pairs. Questions about psychotropic and cardiovascular drugs in relation to therapy, adverse drug reactions, and pharmacokinetics dominated, and more than 60% of the questions came from physicians. Topics relevant to patient-centric pharmacotherapy were drug withdrawal (10 questions), drug formulation (8 questions), drug initiation (8 questions), and switching drugs (5 questions). One question concerned drug withdrawal and switching, and one question drug formulation and switching. Answers provided decision support regarding appropriate formulations of drugs to patients with dementia who chew capsules or tablets, the use of parenteral administration in patients who refuse to take oral formulations, and the pharmacokinetics of transdermal or rectal drug administration. The results highlight the importance of including pharmacological factors in the assessment of the acceptability and appropriateness of oral and parenteral medicine to older patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Review of Clinical Questions Submitted to Norwegian Drug Information Centres Concerning Administration and Dosage to Older Patients of Relevance to Patient-Centric Care

et al. 2021

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“…When it comes to older patients with dysphagia, nowadays SODF administration still remains an unresolved challenge within the subject of pharmaceutical technology. Besides the development of technical approaches and solutions, clinical data in the concerned patient populations will be required to confirm the theoretical models underlying the scientific and technical rationales for drug products claiming enhanced swallowability or appropriateness for older patient populations [215][216][217][218].…”

Section: Discussionmentioning

confidence: 99%

Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience

Drumond

Stegemann

2020

Pharmaceutics

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Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.

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“…Furthermore, special attention is drawn to differences of older people from younger adults with regard to cognition, sensory functions, motor functions and, in particular, to physiology and pathophysiology 7 ). Today, only few, mostly recently authorized, pharmaceutical products are specifically intended for a specific age group of the general population 28 with older people being the major user group of medications and the fastest growing population with potential need for medicines. 27 In 2019, more than 50% of novel drug approvals in the US referred to oral products (www.fda.gov/drugs/development approvalprocess/druginnovation, accessed 20 August 2020).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Contents of Lower intestine in the 65–74 Years of Age Range Could Impact the Performance of Safe and Efficacious Modified Release Products

Vertzoni

Sulaiman

Goumas

et al. 2021

Journal of Pharmaceutical Sciences

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We characterized the contents of distal ileum and proximal colon of older people from a pharmaceutical product performance perspective, under two extreme situations, i.e. 5 h after a glass of water to fasted volunteers (fasted state) and 5 h after a high-calorie, high-fat meal to fasted volunteers (fed state). Five males and three females (65-70 y) participated in a two-phase crossover study. Contents were collected via colonoscopy. In distal ileum, luminal pH was lower and buffer capacity was higher than in young adults; differences reached significance for pH in the fed state. In proximal colon, differences reached significance for pH/fasted state and for buffer capacity/both fasted and fed states. Aqueous fraction of contents contained more short chain fatty acids than previously observed in young adults. In distal ileum, osmolality was significantly higher than in young adults. In proximal colon, aqueous fraction in the fasted state was significantly lower and long chain fatty acids 5 h after meal was significantly higher than in young adults. Characteristics of contents of lower intestine that are relevant to the performance of certain modified release products differ between individuals 65e74 years old and young adults, the typical age group employed in safety and efficacy studies of oral drug products.

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Age-Related Medicine

Cited by 10 publications

References 38 publications

Review of Clinical Questions Submitted to Norwegian Drug Information Centres Concerning Administration and Dosage to Older Patients of Relevance to Patient-Centric Care

Review of Clinical Questions Submitted to Norwegian Drug Information Centres Concerning Administration and Dosage to Older Patients of Relevance to Patient-Centric Care

Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience

Characteristics of Contents of Lower intestine in the 65–74 Years of Age Range Could Impact the Performance of Safe and Efficacious Modified Release Products

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