Drug-Related Problems in the Elderly

Transcription

1 Drug-Related Problems in the Elderly

2 Patrik Midlöv Tommy Eriksson Annika Kragh Drug-Related Problems in the Elderly 123

3 Dr. Patrik Midlöv Lund University Faculty of Medicine SE Lund Sweden Dr. Tommy Eriksson Apoteket Farmaci AB and Lund University Faculty of Medicine SE Lund Sweden Dr. Annika Kragh Lund University Faculty of Medicine SE Lund Sweden ISBN e-isbn DOI / Springer Dordrecht Heidelberg London New York Library of Congress Control Number: c Springer Science+Business Media B.V No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permission from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Printed on acid-free paper Springer is part of Springer Science+Business Media (

4 Preface Drug-related problems in the elderly is intended to serve as a source of information and clinical support in geriatric pharmacotherapy for students as well as all health care professionals, e.g. physicians, nurses and pharmacists. Pharmacotherapy is of great importance to all mankind. Drugs are however powerful and must be handled appropriately. This is especially important for elderly patients. Drug-related problem is not a major subject in most university programmes in medicine or pharmacy. When there is no specific course, there is often no book covering the topic. In our view, as teachers at various university courses, there has been a shortage of literature that reflects the most important aspects of drug-related problems in the elderly. Medical practitioners, nurses and pharmacists, need to have this knowledge to be able to serve their patients in the best way. This book covers most aspects of drug-related problems in the elderly. With better knowledge of drug-related difficulties and risks we hope that elderly will have fewer drug-related problems and benefit more from their pharmacotherapy. Lund, Sweden Lund, Sweden Lund, Sweden Patrik Midlöv Tommy Eriksson Annika Kragh v

5 1 Aging and Drugs Introduction Epidemiology Drug-RelatedProblems Evidence Based Medicine Polypharmacy General Improved Quality Specific Problems, Consequences, and Improvements Conclusions References Physiological Alterations with Aging Introduction Pharmacokinetics AbsorptionofDrugs DistributionofDrugs Metabolism Renal Elimination Water and Electrolyte Balance Pharmacodynamics CardiovascularEffects CentralNervousSystem Drug-DrugInteractions Drug-DiseaseInteractions AdverseDrugReactions AdverseDrugWithdrawalEvents Conclusions References Quality of Care in the Elderly Quality Assurance Patient Benefit and -Risks vii

6 viii 3.3 Efficacy of (New) Drugs in the Elderly International Harmonisation on Registration of New Drugs Requirements for Documentation and Use in the Elderly Evidence Based Medicine WhatEBMIs PractisingEBM Grading Evidences and Clinical Recommendations Shortcomings for EBM in the Elderly General Aspects Documentation of Clinical Benefits Organisational and Professional Aspcts Resources, Priorities and Ethical Principles PatientChartOrderSystem Prescribing Conclusions References Inappropriate Drugs in the Elderly Introduction Benzodiazepines Pharmacology Risks Insomnia UseandDiscontinuation Antipsychotic Drugs NSAID DrugswithAnticholinergicEffects Conclusions References Drugs and Common Health Conditions in Old Age GastrointestinalHealthProblems Constipation Treatment Dryness of the Mouth Risk Factors for Dryness of the Mouth Treatment Peptic Ulcers and Chronic Gastritis Treatment HiatusHernia Treatment Urinary Incontinence Stress Urinary Incontinence Overactive Bladder/Urge Incontinence Drugs and Urinary Incontinence

7 ix 5.7 Renal Failure in Old Age Drugs that Can Increase the Risk of Renal Failure ObstructionofUrinaryFlow FallsandFractures FallPrevention Osteoporosis Symptoms and Signs of Osteoporosis Treatment Sarcopenia, Muscle Weakness in Old Age Orthostatic Hypotension Treatment Vertigo Treatment Conclusions References Drugs and Neuro-Psychiatric Disorders Introduction DeliriumintheElderly RiskFactors Features of Delirium Diagnosis Treatment Dementia AffectiveDisorders Depression Anxiety Psychotic Disease Conclusions References Errors, Problems, Events and Reactions on Medication Introduction MedicationErrors ToErrisHuman Million Live Campaign Drug-RelatedProblems AdverseDrugEvents AdverseDrugReactions WHO Programme for International Drug Monitoring Pharmacovigilance and Reporting RiskMedications RiskPatients TheElderly Conclusions References

8 x 8 Practical Problems Related to the Patients Medication Intake ConfusingNames Original and Generic Drugs ParallelImportedDrugs Analogue Drugs Other Product Names ProblemtoRemember ProbleminHandling ProblemtoSwallow FoodInteractions Short Use Before Date Conclusions References Compliance and Concordance Introduction From Compliance to Concordance Compliance/Adherence in the Elderly Clinical Consequences PracticalProblems Knowledge, Attitudes and Motivation Tools to Detect Problems Related to Non-compliance InterventionsforImprovement Systematic Reviews of Strategies to Improve Compliance intheelderly Communicating Evidences for Benefit and Harm Motivational Interviewing Conclusions References Strategies and Interventions for Improvement Introduction Information Technology Development Within Health Care Evidence Based Database Sources for Effective Clinical Practices Cochrane NICE Pharmaceutical Care and Medicines Management Medication Reconciliation MedicationReview Trigger Tools PersonalisedMedicine Conclusions References

9 xi 11 Summary and Perspectives VisionandObjectivesforMedicationUseintheElderly Quality Improvement Product- or Patient- Centred Treatment Summary of Simple Practice Conclusions References Index...133