1,721,427 research outputs found
Drug use and iatrogenic illness in complex older adults with kidney disease
No full textThe aging process is characterized by a high level of complexity, which makes the care of older adults particularly challenging. This complexity results from the presence of an array of concomitant clinical conditions, whose integration and cumulative effect result in different degrees of functional deficits, cognitive deterioration, nutritional problems, geriatric syndromes in addition to lack of social support and financial resources. The presence of these factors may reduce the efficacy of prescribed drugs and increase the risk of iatrogenic illness making the pharmacologic treatment of this complex patient a difficult task for the prescribing physician. The presence of renal disease further contributes to increasing this complexity and to increasing the risk of iatrogenic illness because it is associated with pharmacokinetics and pharmacodynamics that may alter drug metabolism. For this reason, a complete and global examination of patient characteristics is mandatory in the drug prescribing process. Assessment of renal function must be considered part of this process
Medications Affecting Functional Status in Older Persons
No full textCurrent evidence suggests that functional status is an important outcome of pharmacologic treatments in older people. At the moment, studies have shown diverse effects of medications on functional status. For example, some have shown potentially detrimental effects, while others have found improvements on physical function in elders. Overall, suboptimal prescribing and the occurrence of adverse drug reactions (ADRs) may negatively affect functional status. The use of selected drugs acting on central nervous system (CNS), e.g. benzodiazepines and antipsychotics, is generally associated with an increased risk of functional decline. The greater sensitivity of older people to these drugs, together with age-related changes in pharmacokinetics and pharmacodynamics, account for the observed detrimental effect and suggests a cautious approach to older and frail patients when prescribing CNS agents. On the other hand, selected drugs may slow or delay functional decline in older people. In particular, drugs aimed at targeting sarcopenia (loss in muscle mass and strength), such as testosterone in androgen deficiency, ACE-inhibitors, vitamin D and β-hydroxy β-methyl butyrate (HMB), as well as the recently developed selective androgen receptor modulators (SARMs) may hold extreme importance. This review will provide available evidence of the diverse impacts of drug medications on functional status in older persons
Adverse drug reactions in older people: detection and prevention
No full textAdverse drug reactions (ADRs) in older adults are an important healthcare problem since they are frequently a cause of hospitalization, occur commonly during admission, and are an important cause of morbidity and mortality. Older adults are particularly susceptible to ADRs because they are usually on multiple drug regimens and because age is associated with changes in pharmacokinetics and pharmacodynamics. The presentation of an ADR in older adults is often atypical, which further complicates its recognition. One potential strategy for improving recognition of ADRs is to identify those patients who are at risk of an ADR. The recently developed GerontoNet ADR Risk Score is a practical tool for identification of older patients who are at increased risk for an ADR and who may represent a target for interventions aimed at reducing ADRs. Provision of adequate education in the domain of clinical geriatric pharmacology can improve recognition of ADRs. Besides formal surveillance systems, built-in computer programs with electronic prescribing databases and clinical pharmacist involvement in patient care within multidisciplinary geriatric teams might help to minimize the occurrence of ADRs. In addition, a number of actions can be taken in hospitals to stimulate appropriate prescribing and to assure adequate communication between primary and hospital care. In older adults with complex medical problems and needs, a global evaluation obtained through a comprehensive geriatric assessment may be helpful in simplifying drug prescription and prioritizing pharmacological and healthcare needs, resulting in an improvement in quality of prescribing
Multimorbidity in risk stratification tools to predict negative outcomes in adult population
No full textRisk stratification tools were developed to assess risk of negative health outcomes. These tools assess a variety of variables and clinical factors and they can be used to identify targets of potential interventions and to develop care plans. The role of multimorbidity in these tools has never been assessed
- …
