Best Practices for Drug Prescribing in Older Adults: A Call for Action

Abstract

Candida infections in the elderly are an important and expanding clinical problem, with significantly higher mortality in this group than in younger patients. The increasing problem of invasive Candida infections may be related to higher prevalence of immunocompromised older people and the emergence of treatment resistance. Older people, especially the frail and critically ill, are at higher risk of medication-related harmful effects due to changes in pharmacokinetics and pharmacodynamics, which may be further complicated by organ dysfunction, diminished homeostatic control, co-morbidities and polypharmacy. Here, we review the available options for the treatment of Candida infections and provide insights into the challenges surrounding the optimal use of antifungal drugs in the elderly. Key PointsCandida infections are a growing problem in elderly patients, with significant mortality in this group.Treatment in the elderly requires careful consideration of benefit and harm in the selection of both the drug and dose regimen.Therapeutic drug monitoring can be recommended for selected antifungal agents.

Factors associated with potentially harmful drug–drug interactions in older Korean people: A population‐based study

“…Aging affects the functions of body organs, leading to changes in pharmacokinetics and pharmacodynamics. Therefore, older adults are vulnerable to multiple chronic diseases as comorbidities, often resulting in co‐prescription of different medications . Polypharmacy can result in inappropriate drug use and potentially harmful drug–drug interactions (PHDI) in older adults.…”

“…Polypharmacy can result in inappropriate drug use and potentially harmful drug–drug interactions (PHDI) in older adults. The resultant side‐effects increase healthcare costs, as well as the rates of both morbidity and mortality . Polypharmacy and inappropriate drug use in older adults occur around the world .…”

“…Therefore, older adults are vulnerable to multiple chronic diseases as comorbidities, often resulting in co-prescription of different medications. 3 Polypharmacy can result in inappropriate drug use and potentially harmful drug-drug interactions (PHDI) in older adults. The resultant side-effects increase healthcare costs, as well as the rates of both morbidity and mortality.…”

Potentially Serious Drug-Drug Interactions in Older Patients Hospitalized for Acute Ischemic and Hemorrhagic Stroke

“…ADRs may be due to age-related changes such as reduction in hepatic and renal clearance of drugs, decreased total body water and lean body mass, decrease in cholinergic neurons or receptors in the brain, and increase in blood-brain barrier permeability, particularly during acute physical illness [3,4] . Besides, polypharmacy is often associated with poor quality of prescribing mainly due to the prescription of inappropriate drugs or the onset of drug-drug interactions (DDIs; the ability of a drug to modify the action or effect of another drug administered successively or simultaneously).…”

Clinical pharmacist implementation of a medication assessment tool for secondary prevention of stroke in older persons

“…[9,10] Optimisation of drug therapy in older patients involves consideration of whether a drug has the potential to cause more harm than benefit and whether the drug should be withdrawn or prescribed at a decreased dose. [32] Overprescribing is particularly relevant in the older population [32][33][34] and is addressed in various MAT-CVA criteria. MAT-CVA considers a moderate rather than a high-intensity statin in patients older than 75 years of age and no statin in patients with a poor health status.…”