Clinical pharmacology in the geriatric patient

Hilmer, Sarah N.; McLachlan, Andrew J.; Couteur, David G. Le

doi:10.1111/j.1472-8206.2007.00473.x

Cited by 247 publications

(203 citation statements)

References 178 publications

Supporting

Mentioning

193

Contrasting

Unclassified

Order By: Relevance

“…Age‐related pharmacokinetic changes occur in all older people,20, 21, 22 and an altered blood‐brain permeability in people with dementia means that they may be more sensitive to neurological and cognitive effects of medications than their peers 23, 24. These pharmacokinetic changes are additional to drug‐disease interactions that occur in dementia 25.…”

Section: Introductionmentioning

confidence: 99%

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Page

Potter

Clifford

et al. 2016

Internal Medicine Journal

View full text Add to dashboard Cite

BackgroundMedication management for people living with dementia is a complex task as it is unclear what constitutes optimal medication management in this population due to the shifting focus of health priorities and the balance between the benefits and harms of medications.AimThis study sought expert opinion to create a consensus list to define appropriate medication management of co‐morbidities for people with dementia.MethodsThis study used the Delphi technique. We invited multidisciplinary experts in geriatric therapeutics including pharmacists, doctors, nurse practitioners, a patient advocate and a psychologist to participate. Participants were asked to engage into three or more rounds of questioning. Round 1 was a questionnaire comprised of one question defining dementia and seven open‐ended questions about appropriate management of co‐morbidities in people with dementia. Two investigators qualitatively analysed the responses to questions from Round 1 using thematic analysis. The results of this analysis were provided to participants as statements in the Round 2 survey. The participants were asked to rate their agreement with each statement on a 5‐point Likert scale. The median and interquartile range (IQR) were calculated for the responses to each statement. Consensus was pre‐specified as an IQR less than or equal to 1. Statements where consensus was not achieved were presented to participants in Round 3. The Round 2 median and IQR values were provided and participants were again asked to rate their agreement with each statement on a 5‐point Likert scale. The statements where participants agreed or strongly agreed were included in the Medication Appropriateness Tool for Co‐morbid Health conditions in Dementia criteria.ResultsFifty‐seven experts agreed to participate in the study, of whom 58% were pharmacists and 36% were medical practitioners. Fifty‐five participants completed the Round 1 (95% response rate). A total of 128 statements was included in the Round 2 survey. Consensus was reached on 93 statements in Round 2 (n = 48 responders, 84% response rate) and on 18 statements in Round 3 (n = 43 responders, 75% response rate). The participants reached consensus on 111 of 128 statements. Of these statements, 67 statements were included in the Medication Appropriateness Tool for Co‐morbid Health conditions in Dementia criteria. The statements were in the broad themes of preventative medication, symptom management, disease progression, psychoactive medication, treatment goals, principles of medication use, side‐effects and medication reviews.DiscussionThis research provides consensus‐based guidance for clinicians who manage co‐morbid health conditions in people with dementia.

show abstract

Section: Introductionmentioning

confidence: 99%

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Page

Potter

Clifford

et al. 2016

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…Optimising the safety and efficacy of medications in older people is complex and multi-factorial [Hilmer et al 2007b]. With old age, there is an increase in disease for which medications may provide benefit.…”

Section: Introductionmentioning

confidence: 99%

Drug-induced liver injury in older adults

Mitchell

Hilmer

2010

Therapeutic Advances in Drug Safety

Self Cite

View full text Add to dashboard Cite

Drug-induced liver injury (DILI) is an important cause of hospitalisation and of medication deregistration. In old age, susceptibility to DILI is affected by changes in physiology and increased interindividual variability, compounded by an increased prevalence of disease and the frailty syndrome. While dose-related or predictable DILI reactions are often detected in preclinical trials, the occurrence of rare hypersensitivity or idiosyncratic reactions cannot be reliably predicted from preclinical studies or even by clinical trials. The limited participation of older adults in clinical trials means that the susceptibility of this population to DILI is largely unknown. Vigilance during clinical trials and postmarketing surveillance must be universally practised. A systematic approach should be taken to determine not only which medicines are hepatotoxic and should be removed from the market, but also the hepatotoxicity risks from marketed drugs to consumers with different characteristics, many of whom are older people.

show abstract

“…16 The traditional belief was that with ageing there are reductions in phase I, but not phase II hepatic metabolism. 17 However, recent re-analysis of the data suggests that phase II metabolism may also be reduced with ageing. 18 Changes in the liver sinusoidal endothelium in old age have been associated with impaired hepatic drug extraction in animal studies.…”

Section: Pharmacokineticsmentioning

confidence: 99%

Deprescribing in the Last Year of Life

Hardy

Hilmer

2011

Pharmacy Practice and Res

View full text Add to dashboard Cite

Polypharmacy and adverse drug reactions are common with ageing. Deprescribing or ceasing unnecessary or harmful medications is an important component of aged care practice, especially in the final year of life. Changes in pharmacokinetics and pharmacodynamics with ageing can affect decisions about deprescribing. Similarly, the balance between risk and benefit for medications is often altered in patients in their final year of life and needs to be taken into account. There is evidence for medicines that can be safely ceased abruptly and medicines that need to be weaned. An individualised approach is required to assess prognosis, trajectory of decline and therapeutic goals for each patient. An algorithm is provided in this review to guide safe, rational deprescribing for patients who are believed to be in their last year of life.

show abstract

Clinical pharmacology in the geriatric patient

Cited by 247 publications

References 178 publications

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Drug-induced liver injury in older adults

Deprescribing in the Last Year of Life

Contact Info

Product

Resources

About