Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies)
Language English Country Germany Media print-electronic
Document type Journal Article, Review
Grant support
EU COST Action IS1402 "Ageism - a multi-national, interdisciplinary perspective" (2015-2018)
European Cooperation in Science and Technology
EUROAGEISM Horizon 2020 project EC no. 764632 MSCA-ITN (2017-2021)
H2020 Marie Skłodowska-Curie Actions
PubMed
30610276
DOI
10.1007/s00228-018-2603-5
PII: 10.1007/s00228-018-2603-5
Knihovny.cz E-resources
- Keywords
- Age-related changes, Ageism, Drug prescribing, Frailty, Observational studies, Older patients, Polypharmacy, Potentially inappropriate medications, Randomized controlled trials,
- MeSH
- Geriatric Assessment MeSH
- Drug Prescriptions standards statistics & numerical data MeSH
- Humans MeSH
- Inappropriate Prescribing statistics & numerical data MeSH
- Polypharmacy * MeSH
- Prevalence MeSH
- Randomized Controlled Trials as Topic statistics & numerical data MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Potentially Inappropriate Medication List statistics & numerical data MeSH
- Age Factors MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Geographicals
- Europe MeSH
- Turkey MeSH
INTRODUCTION: The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY: A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS: Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION: Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
Centro de Investigação em Actividade Fìsica Saúde e Lazer University of Porto Porto Portugal
Department of Clinical Pharmacy Faculty of Pharmacy University of Szeged Szeged Hungary
Department of Environmental Health Portuguese National Institute of Health Porto Portugal
Department of Medical Biology School of Medicine Yeditepe University Istanbul Turkey
DICOMOSA Group Department of Psychology Area of Psychobiology Universidade da Coruña A Coruña Spain
EPIUnit Institute of Public Health University of Porto Porto Portugal
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