Pharmacotherapy in the ageing patient: The impact of age per se (A review)

Abstract

A literature search was carried out to review the influence of 'ageing' on pharmacotherapeutic decision-making, specifically how 'age' is defined and considered in the utilisation of medication. Embase, Medline, International Pharmaceutical Abstracts, and Google scholar were canvassed in a three-tiered search according to pre-established inclusion criteria. In tier 1, a total of 22 studies were identified highlighting the underutilisation of medication in elderly patients, with a particular focus on warfarin. Four studies highlighted an age-bias in medication-prescribing for elderly patients, specifically in relation to medicines for rheumatoid arthritis, angina, and hypertension. Tier 2 identified diverse definitions for 'elderly', including biological age, chronological age, physiological age, as well as various descriptions of 'elderly' in clinical trials and guidelines. Finally, medication optimisation tools were identified through the third tier, emphasising the use of chronological age to describe the 'elderly'. Old age influences pharmacotherapeutic decision-making at various levels, however, what complicates the situation is the absence of a comprehensive definition of 'elderly'. Clinical recommendations need to be based more on objective factors known to affect medication effectiveness and safety.

Epidemiology of constipation in adults: Why estimates of prevalence differ

“…Articles meeting the criteria were segmented into general adult and older adult populations based on the age range of the sample. Because the definition of the term "el-derly" is not always agreed, [6] this review has used the term "older adults" which refers to populations over the age of 50 years, as a subpopulation of the general adult population. The articles regarding general adult populations were grouped into five geographical regions.…”

Defining an ‘older’ patient in the context of therapeutic decision making: perspectives of Australian pharmacists and nurses

“…2,3 It is apparent that, despite acknowledging the inter-individual variability of older patients, a degree of ageism appears to exist among health professionals caring for older patients. [4][5][6][7] Singh and Bajorek observed that inappropriate prescribing (both over-treatment and under-treatment) is often detected in older patients, increasing the potential for adverse clinical outcomes. 8 Indeed, age-bias has been identified in the under-treatment of angina, rheumatoid arthritis, and hypertension.…”

“…8 Indeed, age-bias has been identified in the under-treatment of angina, rheumatoid arthritis, and hypertension. 5 It is reported that age-based decision-making in the use of high risk medications i.e. anticoagulants, may 'skew' a health care professionals risk-benefit assessment, resulting in potential patient harm such as stroke or even death.…”

“…anticoagulants, may 'skew' a health care professionals risk-benefit assessment, resulting in potential patient harm such as stroke or even death. 5 Furthermore, several studies highlight the risks of polypharmacy in older patients, including drug-drug interactions, anticholinergic burden as well as the use of potentially inappropriate medications (PIMs), which may result in hospitalisation and harm to patients including falls etc. [9][10][11][12] The inappropriate use of medicines in this patient group may be attributed to the lack of a standard definition that appropriately characterises an older adult patient.…”

“…14 Singh and Bajorek report that biological age is often defined using clinical markers, or biomarkers, which measure the rate or extent of aging. 5 Some proposed biomarkers include skin elasticity, vital capacity, total protein and serum creatinine, and have been shown to change significantly with age. [15][16][17] Biological age is more appropriate in addressing the heterogeneity observed within the older patient population, and may be more useful in providing individualised pharmacotherapeutic care to patients.…”