Challenges and innovations of delivering medicines to older adults

Abstract

Older adults with multimorbidity, polypharmacy, and complex health needs are the major consumer of health care. Ensuring that medicines are used safely, effectively, and delivered efficiently in this population is challenging. In this context, the approach to medicines delivery should seek to overcome some of the difficulties of delivering medicines to older people, and ensure each medication is delivered by the optimal and most convenient route for the patient in question. However, this poses significant obstacles, as the development of medicines suitable for use in older populations does not often account for complex health needs, potential challenges in relation to drug disposition, safety of excipients and limitations with practical usability of dosage forms. The objective of this review is to summarise and discuss current challenges and novel approaches to delivering medications to older adults.

Pharmacological Interactions in the Elderly

“…Multimorbidity in the elderly can impair drugs handling and administration. This concerns especially chronic conditions like dementia, Parkinson’s disease, stroke, esophageal diseases (e.g., gastro-esophageal reflux disease), the presence of visual or cognitive impairments and swallowing difficulties [ 27 ].…”

Interventions to Address Potentially Inappropriate Prescriptions and Over-The-Counter Medication Use Among Adults 65 Years and Older in Primary Care Settings: Protocol for a Systematic Review

“…Potentially inappropriate prescriptions and OTC medication use among adults aged 65 years and older are commonly associated with negative health outcomes, adverse drug events (including postural hypotension, falls, injuries leading to hospitalization among others), increased risk of frailty, disability, morbidity, mortality, and reduced health-related quality of life and activities of daily living [6], [9]- [19]. The risk of adverse events is likely to increase with rising levels of frailty, multi-morbidity, and functional decline among older adults [20], [21]. Medication regimens for older people are often complex and can be challenging with the increased presence of various chronic conditions and multiple therapies (prescribed or non-prescribed) [22]- [24].…”

Patient Centric Pharmaceutical Drug Product Design—The Impact on Medication Adherence

“…This demographic change has pushed manufacturers to design and produce medicinal products based on the biopharmaceutical features of the elderly [33]. Indeed, their health is generally affected by a gradual decline of motor function (e.g., dysphagia, trembling hands, reduced flexibility), cognition (e.g., impaired cognition, dementia) and sensory acuity (e.g., impaired vision, hearing loss).…”

“…Since the decline of motor and sensory function of the elderly, an increased risk of medication errors and poorer adherence to the pharmacological therapies are observable in the real world due to difficulties in swallowing and handling the drug products [33,37]. As a consequence, several aspects have to be considered in the quality target product profile of a drug product intended to be administered in older people [38].…”