Medication Use By Ambulatory Elderly

Darnell, Jeffrey C.; Murray, Michael D.; Martz, B. L.; Weinberger, Morris

doi:10.1111/j.1532-5415.1986.tb06332.x

Cited by 122 publications

(36 citation statements)

References 16 publications

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“…More specifically, nonadherence to pharmacotherapy has been associated with such variables as daily dosing frequencies [24••,28,29, 49-51], the number of concurrent medications [22,29,52], and therapeutic turbulence, including such changes as switches, additions, or removal of medication [25••,52].…”

Section: Regimen Complexitymentioning

confidence: 99%

Observational studies of antihypertensive medication use and compliance: Is drug choice a factor in treatment adherence?

Payne¹,

Esmonde-White²

2000

Curr Hypertens Rep

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Real-world adherence to pharmacotherapy cannot be studied in the confines of the traditional clinical trial. Thus, to better understand adherence to antihypertensive medication in actual practice, a literature search was conducted to identify observational database studies of the use of antihypertensive medication. Ten studies were identified: half studied adherence patterns after initial prescriptions to patients with a new diagnosis of hypertension, and the others evaluated antihypertensive medication use in a mix of patients with newly diagnosed or chronic hypertension. Overall, results demonstrated that adherence to treatment for hypertension in the first year is very poor. In addition, it appears that initial treatment with newer classes of drugs, such as angiotensin II antagonists, angiotensin converting enzyme inhibitors, and calcium channel blockers favors treatment adherence. This review also highlights and discusses possible under-lying factors contributing to these results and implications for physicians.

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Section: Regimen Complexitymentioning

confidence: 99%

Observational studies of antihypertensive medication use and compliance: Is drug choice a factor in treatment adherence?

Payne¹,

Esmonde-White²

2000

Curr Hypertens Rep

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“…While the elderly comprise just 12 percent of the total population, they consume 31 percent of all prescription medications.2 It is common for elders to be taking multiple medications simultaneously. [3][4][5][6] Many have underlying heart, liver, kidney, or lung diseases, any ofwhich might complicate an overdose situation or affect the pharmacokinetics of a drug or toxin.7-9 Also, 2-4 million older Americans suffer from dementia'0; such patients may be confused and have difficulty complying with complicated dosage regimens. Failing eyesight and memory may be responsible for medication errors or for mistaking household products as potables.…”

Section: Discussionmentioning

confidence: 99%

Serious poisonings among older adults: a study of hospitalization and mortality rates in Massachusetts 1983-85.

Woolf

Fish²,

Azzara³

et al. 1990

Am J Public Health

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We analyzed poisoning-related hospitalization and mortality rates among older adults living in Massachusetts during 1983-85. While poisoning-related hospitalization rates of individuals .60 years were near the state average, death rates for men .70 years and for women over 60 were higher than those of younger individuals. Medications and carbon monoxide were commonly implicated agents in these poisoning deaths. Older adults are more vulnerable to death from a poisoning than are younger age groups. (Am J Public Health 1990; 80:867-869.) IntroductionThe incidence of serious poisonings among older individuals is poorly documented. The purpose of this study was to determine poisoning hospitalization and death rates among older people in Massachusetts, and to compare such rates with those of younger age groups in order to assess relative risk.

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“…Their use of NSAlDs is more than 3.5 times greater than their younger counterparts (4). Our own survey of elderly persons living in urban public housing complexes revealed that NSAlDs were the most frequently used OTC and prescription drugs (11). Worldwide statistics from 1987 regarding NSAID use and sales of NSAlDs (including the USA) revealed that three of the top 10 most-used drugs were NSAlDs and that their sales had increased 21% from 1986 to 1987 (12).…”

Section: Introductionmentioning

confidence: 97%

Renal Toxicity of the Nonsteroidal Anti-Inflammatory Drugs

Murray¹,

Brater²

1993

Annu. Rev. Pharmacol. Toxicol.

272

150

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NSAIDs pose little threat of renal insult in normal, healthy persons at therapeutic dosages. However, NSAID administration to susceptible persons may cause decrements in renal plasma flow and glomerular filtration rate within hours. Such acute noxious renal effects are mediated by products of arachidonic acid metabolism. Precipitous decrements in glomerular filtration and renal ischemia, manifested by increased serum creatinine and urea nitrogen, are possible. However, these effects are usually fully reversible with prompt discontinuation of the offending NSAID. Risk factors for the development of these acute renal effects are known. Acute interstitial nephritis with or without nephrotic syndrome is a rare form of renal toxicity that typically occurs between 2-18 months of use. Renal impairment may be so severe as to require temporary hemodialysis; however, renal function usually returns to normal upon discontinuation of the NSAID. The mechanism of acute interstitial nephritis is presumed to be of allergic origin but could also be caused by a reactive metabolite. Fenoprofen use appears to be associated with a much higher risk for its development. In contrast to the acute effects of NSAIDs, irreversible, analgesic-associated nephropathy manifested by papillary necrosis and chronic interstitial nephritis may occur following months to years of high doses of analgesic mixtures. The mechanism by which combination analgesics produce this form of renal injury is unknown and could be either a result of medullary ischemia or a direct effect of a reactive metabolite. An important issue to be resolved is the relationship between the acute, reversible, prostaglandin-mediated renal effects of the NSAIDs and chronic, irreversible destruction, if such a relationship exists. Theoretically, continual or repeated decrements in renal function in patients with predisposing risk factors could cause or contribute to progressive deterioration in renal function. Elevations in blood pressure or interference with the effects of antihypertensive medications could theoretically also contribute to long-term renal deterioration. In addition to renal syndromes caused by NSAIDs that result in renal impairment, other transient effects on electrolyte and water metabolism may also occur. Reduced secretion of sodium may result in formation of edema, exacerbation of heart failure, or increased blood pressure. Hyporeninemic-hypoaldosteronism may produce hyperkalemia. Finally, reduced excretion of water has rarely caused hyponatremia. It has been suggested that NSAIDs may be renoprotective in patients with nephrotic syndrome. Others have suggested that sulindac is "renal-sparing" because of a unique metabolic pathway that supposedly limits the exposure of the kidney to the active sulfide metabolite.(ABSTRACT TRUNCATED AT 400 WORDS)

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Medication Use By Ambulatory Elderly

Cited by 122 publications

References 16 publications

Observational studies of antihypertensive medication use and compliance: Is drug choice a factor in treatment adherence?

Observational studies of antihypertensive medication use and compliance: Is drug choice a factor in treatment adherence?

Serious poisonings among older adults: a study of hospitalization and mortality rates in Massachusetts 1983-85.

Renal Toxicity of the Nonsteroidal Anti-Inflammatory Drugs

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