Drug therapy in the elderly

Turnheim, Klaus

doi:10.1016/j.exger.2004.05.011

Cited by 158 publications

(101 citation statements)

References 51 publications

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“…These adverse reactions, which most frequently involve the alteration of drug bioavailability and efficacy, are most likely to occur in patients over 65 years with chronic medical illnesses such as liver or renal disease. 7 This patient population makes up a substantial portion of cardiology outpatient visits.…”

Section: Introductionmentioning

confidence: 99%

The cardiovascular patient's perceptions of complementary and alternative medicine

Krasuski

Michaelis

Eckart

2006

Clinical Cardiology

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SummaryBackground: Complementary and alternative medicine (CAM) use is common among patients with cardiovascular disorders and is generally underrecognized by physicians. The attitudes of these patients regarding these therapies and their perceptions of safety and efficacy have not been well defined.Methods: A written survey was received from a cohort of outpatients seen at a large outpatient cardiovascular clinic in Texas. Over 75% of patients responded, with more than 90% of returned surveys adequate for analysis.Results: Of the 210 respondents 113 admitted to CAM use, with Vitamins E and C being the most frequently utilized agents. Women were significantly more likely to take CAM than men (69 vs. 46%, p = 0.002), particularly those taking hormone replacement therapy. Over half of patients surveyed stated their cardiologist was unaware of their use of CAM. Only 15% of patients felt that CAM was more efficacious than their traditional medications, but almost half felt it was significantly safer. A similar number were unaware of any interactions between CAM and their other medications.Conclusions: Use of CAM is common in cardiology outpatients, and many patients remain unaware of potential health risks. Physicians should routinely question patients about use of CAM and attempt to educate users regarding potential health risks.

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Section: Introductionmentioning

confidence: 99%

The cardiovascular patient's perceptions of complementary and alternative medicine

Krasuski

Michaelis

Eckart

2006

Clinical Cardiology

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“…DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al, 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs.…”

Section: Introductionmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

256

198

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The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. Keywordsmedications; healthcare costs; geriatrics; adverse drug events Drug-related problems (DRPs) are prevalent in the older adult population and pose a major patient safety concern. DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al., 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs. The purpose of this study was to examine both the prevalence of potentially inappropriate medication (PIMs) use among community-dwelling older adults and the association between PIMs and health care outcomes.One method promoted to identify high-risk medications is the use of an explicit list of PIMs. PIMs were first devised and publicized by Beers et al. for nursing home residents and subsequently expanded to include older adults in all settings (Beers, 1997). PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al., 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al., 2004), acute care (Onder et al., 2005), and community settings (Zhan et al., 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.The clinical validity of using a list of medications based on expert panel review and explicit criteria has been questioned as being overly simplistic and not including all the common drugs causing problems in older adults (Crownover & Unwin, 2005;Shorr, 2004). Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.The Beers criteria have been revised recently; hence, the current prevalence of PIMs in...

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“…In the United States, nearly 90% of influenza and pneumonia deaths (1) and 20% of all reported cases of tuberculosis (42) are in the elderly. Because of this increased susceptibility to infection, in combination with decreased vaccine efficacy (24,28), poor antimicrobial drug tolerance (40), and a projected doubling of the elderly population by 2025 (18), a better understanding of immune responses in the elderly is essential. More importantly, identification of immune mechanisms that remain intact in old age could provide important information for the design of more efficacious vaccines and immunotherapies for the growing elderly population.…”

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confidence: 99%

Th1 Cytokines Facilitate CD8-T-Cell-Mediated Early Resistance to Infection withMycobacterium tuberculosisin Old Mice

2006

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Numerous immunological defects begin to emerge as an individual ages, the consequence of which is heightened susceptibility to infectious diseases. Despite this decline in immune function, old mice display an early transient resistance to Mycobacterium tuberculosis infection in the lung, which is dependent on CD8 T cells and gamma interferon (IFN-␥) production. In this study, we investigated the mechanism of resistance by examining the CD8 Further characterization of this mechanism should provide essential information regarding the aging immune system and should contribute to the development of novel strategies to decrease the morbidity and mortality of the aging population associated with infectious diseases.

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Drug therapy in the elderly

Cited by 158 publications

References 51 publications

The cardiovascular patient's perceptions of complementary and alternative medicine

The cardiovascular patient's perceptions of complementary and alternative medicine

Health outcomes associated with potentially inappropriate medication use in older adults

Th1 Cytokines Facilitate CD8-T-Cell-Mediated Early Resistance to Infection withMycobacterium tuberculosisin Old Mice

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