Drug therapies in older adults (part 2)

Abstract

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 refl ect the priorities of the patient? Are there alternatives -with greater effi cacy, 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 effi cacy of drug therapies for older adults in osteoporosis and the underutilisation of appropriate treatments for patients with Alzheimer's disease as a result of fl awed 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 fi rst-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.

Drug therapy in older people with heart failure

“…We believe it would be worth adding that both saprophytic (non-invasive) and invasive forms of Aspergillus tracheobronchitis exist. 1,2 The latter requires the demonstration of fungal hyphae invading the bronchial mucosa, which was not demonstrated in this case. Where fungal hyphae are found in the bronchial tree without invasion this could be due to obstructing bronchial aspergillosis, which requires the absence of allergic disease, 1 or mucoid impaction that is a non-specific sign of Aspergillus bronchial disease and is also a feature of allergic bronchopulmonary aspergillosis (ABPA).…”

“…Editor -We thank the correspondents for their letter in response to our recent article 'Drug therapies in older adults (part 2)'. 1 While digoxin is well established in the management of older patients with atrial fibrillation with or without heart failure, the evidence base for digoxin in frail older patients is not established.…”

“…Editor -We read with interest the review article by Mukhtar and Jackson entitled Drug therapy in older adults (part 2) . 1 In the article the authors provide an overview on the drug treatment of heart failure in older patients. However, we were surprised that digoxin, one of the oldest drugs in the management of heart failure was not mentioned as a treatment option.…”

Dosage Adjustments Related to Young or Old Age and Organ Impairment

“…Consequently, when evidence‐based clinical guidelines are developed based on the results of large‐scale clinical trials, the elderly are systematically underrepresented in the data on which the guidelines are based. Results obtained in middle‐aged people who for the most part are healthy except for the condition under study cannot simply be extrapolated to the frail elderly with multiple comorbid conditions, although it is the elderly population that is most likely to have chronic medical conditions requiring treatment …”

“…Results obtained in middle-aged people who for the most part are healthy except for the condition under study cannot simply be extrapolated to the frail elderly with multiple comorbid conditions, although it is the elderly population that is most likely to have chronic medical conditions requiring treatment. [8][9][10]34 Results obtained in middle-aged people cannot be extrapolated to the elderly for several reasons. The elderly frequently have multiple comorbid conditions and are taking multiple medications.…”