Psychopharmacology in the Elderly

Balaram, Kripa; Balachandran, Silpa

doi:10.1016/j.psc.2022.07.004

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Changes in both pharmacokinetics and pharmacodynamics in aging can produce geriatric conditions, such as delirium, falls, frailty, dizziness, syncope, and urinary incontinence, that interact highly with multimorbid chronic medical conditions, such as diabetes, hypertension, and psychiatric conditions. 100 Pharmacokinetic changes with aging include: 101,102 • Slightly decreased absorption of some drugs associated with increased gastric pH and delayed gastric emptying, although enteric coated tablets tend to undergo an increased rate of absorption given the coating breaks down more rapidly in alkaline fluid. Pharmacodynamic changes related to aging likely result from decreased brain volume and changes in vascular distribution and increased bloodbrain barrier permeability, 105 which increase the aging brain's susceptibility to many medication classes.…”

Section: Interactions Between Pharmacologic Treatments and Multimorbi...mentioning

confidence: 99%

Managing medical and psychiatric multimorbidity in older patients

Carlson,

Yarns

2023

Therapeutic Advances in Psychopharmacology

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Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity – the presence of two or more chronic conditions in an individual – which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors – including trauma and racism – that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.

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Section: Interactions Between Pharmacologic Treatments and Multimorbi...mentioning

confidence: 99%

Managing medical and psychiatric multimorbidity in older patients

Carlson,

Yarns

2023

Therapeutic Advances in Psychopharmacology

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“…First, they are more likely to have several morbidities, leading to an increased risk of polypharmacy. Age-related physiologic changes in cardiovascular, gastric, hepatic, and renal function can also lead to changes in the pharmacokinetics of medications and drug interactions [ 29 ]. Second, antipsychotic use has been associated with weight gain and metabolic syndrome through different affinities for histamine, serotonin, and muscarinic receptors [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Antipsychotics and Risks of Cardiovascular and Cerebrovascular Diseases and Mortality in Dwelling Community Older Adults

Perreault,

Boivin Proulx,

Brouillette

et al. 2024

Pharmaceuticals

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This study aims to investigate the effect of antipsychotic agents on cardiovascular and cerebrovascular diseases (CVD/CEV) and mortality risks in the older population living in a community. A cohort of 42,650 new users of antipsychotic agents was built using Quebec healthcare databases (1998–2011). The outcomes were CVD/CEV and mortality incidence in 5 years of follow-up in the total cohort, sub-cohort of patients with no schizophrenia/dementia, sub-cohort with schizophrenia, and sub-cohort with dementia. Comparisons were made between the new users who continued the treatment (adherent level ≥ 60%) vs. those ceasing treatment (adherence level < 60%) using inverse probability of treatment weighting and Cox models. Comparing high adherence vs. low levels, CVD/CEV risk was increased by 36% in the sub-cohort with schizophrenia for atypical antipsychotic users and by 25% in the sub-cohort with dementia for typical antipsychotic users. An increasing mortality risk of 2- to 3-fold was linked with the typical antipsychotic use in all cohorts except the sub-cohort with schizophrenia; in addition, mortality risk is linked with the use of high vs. low doses. Antipsychotics were not linked with CVD/CEV risk, except for atypical antipsychotics in patients with schizophrenia and typical antipsychotics in patients with dementia. The mortality risk was linked with the use of typical antipsychotics and the dose used.

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“…It takes place at a variable rate in adults, and it is possible to distinguish chronological aging from physiological aging [ 1 ]. Physiological aging is the result of the involvement not only of intrinsic factors (genetic factors) but also extrinsic factors that vary from one individual to another [ 2 , 3 ]. In this context, the multifactorial role of the exposome, including environmental factors but also lifestyles and life events, is preponderant [ 4 ] ( Figure 1 ).…”

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confidence: 99%