Understanding and managing medication in elderly people

Lonsdale, Derrick; Baker, Emma H.

doi:10.1016/j.bpobgyn.2013.06.002

Cited by 11 publications

(16 citation statements)

References 105 publications

(118 reference statements)

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“…. One criticism of the focus on paediatric patients in these studies is that a common standard adult mature value is assumed, whereas we know that drug clearance declines with age . To recommend beta‐lactam dosing for patients of all ages, it would seem sensible to develop a model based on data from the whole population.…”

Section: Introductionmentioning

confidence: 99%

Scaling beta‐lactam antimicrobial pharmacokinetics from early life to old age

Lonsdale

Baker

Kipper

et al. 2018

Brit J Clinical Pharma

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Section: Introductionmentioning

confidence: 99%

Scaling beta‐lactam antimicrobial pharmacokinetics from early life to old age

Lonsdale

Baker

Kipper

et al. 2018

Brit J Clinical Pharma

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“…4 Older people are known to be particularly at increased risk of anticholinergic adverse effects due to a decrease in central cholinergic receptors and an increase in blood-brain barrier permeability. 5,6 Anticholinergic adverse drug effects may occur peripherally (eg, dry mouth, dry eyes and constipation) or centrally (eg, drowsiness, dizziness and confusion). 4 Furthermore, anticholinergic drug use has been associated with both cognitive and functional decline.…”

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confidence: 99%

Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes

et al. 2018

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Summary What is known and objective Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self‐reported symptoms in older community‐dwelling persons with and without diabetes. Methods The basic population was comprised of Finnish community‐dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD‐10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross‐sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire. Results and discussion The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self‐reported symptoms. What is new and conclusion There is no difference in anticholinergic drug use in older community‐dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.

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“…Age-related changes in pharmacokinetics lead to a changed permeability of the blood-brain barrier, and a decreased clearance, resulting in a higher serum and brain concentration [9,[12][13][14]. Moreover, changes in pharmacodynamics may further augment the risk of adverse events, as the cholinergic activity is reduced because of a decrease in the number and binding affinity of receptors, homeostatic mechanisms tend to fail, and signal transduction is diminished [15][16][17][18][19][20][21]. Additionally, older adults often have multimorbidity [9,[12][13][14], resulting in concurrent use of multiple drugs (i.e.…”

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A Novel Scale Linking Potency and Dosage to Estimate Anticholinergic Exposure in Older Adults: the Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale

Klamer

Wauters

Azermai

et al. 2017

Basic Clin Pharma Tox

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Quantification of the anticholinergic exposure insufficiently or imprecisely incorporates dosage information, leading to inaccurate estimations. The aim was to construct a novel scale, including potency and dosage for the quantification of the anticholinergic exposure in older adults. Potency information was retrieved from a previous systematic review. The dosage range for each drug was delineated in minimal, maintenance and maximal dosage for adults and older adults. Dosage information was collected from authoritative sources and reviewed in an expert panel. The Muscarinic Acetylcholinergic Receptor ANTagonist Exposure (MARANTE) scale was tested for clinimetric properties using cohorts of community-dwelling older adults and nursing home residents. After three data collection rounds, data for the dosage ranges remained incomplete for 32 active substances. Remaining gaps were filled in, and 11 dosage adjustments were proposed during the expert panel meeting. We chose the values {0; 1; 2) for the categories of potency and {0; 0.5; 1; 1.5; 2) for the levels of dosage ranges, showing good clinimetric properties. Forty-one anticholinergic drugs were prescribed in the two cohorts. Most (61%) were low potency anticholinergics and used for depression (19%, e.g. citalopram). There were 31.8% (median MARANTE 1.5, IQR 1.5-2.5) and 37.6% (median 2, IQR 1.5-2.5) anticholinergic users in the community-dwelling cohort and nursing home cohort, respectively. The MARANTE scale combines potency with the dosage spectrum, to quantify the anticholinergic exposure in older adults. An open feedback system on the list of anticholinergic and proposed anticholinergic potency and dosage values is advised.

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Understanding and managing medication in elderly people

Cited by 11 publications

References 105 publications

Scaling beta‐lactam antimicrobial pharmacokinetics from early life to old age

Scaling beta‐lactam antimicrobial pharmacokinetics from early life to old age

Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes

A Novel Scale Linking Potency and Dosage to Estimate Anticholinergic Exposure in Older Adults: the Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale

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