[Prevention of adverse drug reactions in older patients].
Adverse drug reactions are among the most common adverse events and a significant cause of preventable morbidity and mortality. As multimorbidity and polypharmacy are frequent in this population, the elderly are at special risk for adverse drug events, although the calendar age has not been proved as independent risk factor in this context. In particular falls and delirium are clinically significant and typical adverse drug events in the elderly. In this review mechanisms and factors which determine adverse drug re actions are described, and possible strategies for an effective prevention are given. This covers pharmacokinetic, pharmacogenetic and pharmacodynamic aspects as well as factors influencing individual adherence to drug therapy. A significant portion of adverse drug reaction may be prevented by a thorough indication and prudent monitoring of pharmacotherapy. Also adherence to pharmacotherapy may be improved by tailored and individual means referring to the patient's needs and expectancies. In the elderly functional limitations such as reduced cognitive abilities, reduced visual acuity and impaired dexterity determine an ineffective pharmacotherapy and medication errors. Hereby these functional limitations are significant predictors of adverse drug events in the context of self-management of pharmacotherapy. Testing of functional abilities as provided in the geriatric assessment is helpful to identify these factors. Among altered pharmacokinetic factors in the elderly, reduced renal function is most important to avoid overdosage. Although a precise measurement of renal function is not possible in a bed-side manner, an estimation of actual renal function utilizing estimation-formulas should always take place.
Burkhardt
H
H
Universität Heidelberg, Medizinische Fakultät Mannheim, IV. Medizinische Klinik, Schwerpunkt Geriatrie und Zentrum für Gerontopharmakologie, Universitätsklinikum Mannheim, 68135, Mannheim, Germany. heinrich.burkhardt@med.ma.uni-heidelberg.de
Wehling
M
M
Gladisch
R
R
D000058:Accidental Falls / Q000401:mortality / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003693:Delirium / Q000139:chemically induced / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions / Q000235:genetics; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D017891:Pharmacoepidemiology / Q000706:statistics & numerical data; D010597:Pharmacogenetics / Q000706:statistics & numerical data; D010599:Pharmacokinetics; D012307:Risk Factors
Cardiol Clin. 1999 Feb;17(1):17-34
10093763
BMJ. 1997 Oct 25;315(7115):1096-9
9366745
J Am Geriatr Soc. 2003 Nov;51(11):1539-46
14687382
Am Fam Physician. 1999 Jul;60(1):99-108
10414631
Am J Med. 1994 Sep;97(3):278-88
8092177
Gerontology. 2004 Mar-Apr;50(2):96-101
14963376
Arch Intern Med. 2001 Apr 23;161(8):1099-105
11322844
Nephron Clin Pract. 2005;101(1):c1-8
15886493
Drugs Aging. 1991 Jul-Aug;1(4):254-65
1794018
Drugs Aging. 1991 Jul-Aug;1(4):289-302
1794021
Eur Heart J. 2005 Feb;26(3):215-25
15642700
Arch Intern Med. 1995 May 8;155(9):930-5
7726701
Prim Care Companion J Clin Psychiatry. 2004;6(1):9-20
15486596
J Am Geriatr Soc. 1989 Jul;37(7):619-24
2738281
JAMA. 1968 Aug 26;205(9):645-7
5695107
Presse Med. 2000 Apr 1;29(12):673-80
10780208
Age Ageing. 2007 May;36(3):292-7
17387123
JAMA. 2001 Aug 8;286(6):708-13
11495621
J Am Geriatr Soc. 2004 Feb;52(2):195-204
14728627
Clin Pharmacokinet. 1996 Apr;30(4):300-13
8983860
Gerontology. 2002 May-Jun;48(3):121-7
11961363
Clin Med (Lond). 2005 Jan-Feb;5(1):12-5
15745190
J Am Geriatr Soc. 2001 Nov;49(11):1478-84
11890586
Arch Intern Med. 1991 Sep;151(9):1825-32
1888249
Drugs Aging. 1992 Mar-Apr;2(2):103-11
1596593
JAMA. 2003 Mar 5;289(9):1107-16
12622580
Am J Hosp Pharm. 1992 Jul;49(7):1696-700
1621726
J Am Geriatr Soc. 1991 Nov;39(11):1093-9
1753048
J Pers Soc Psychol. 2003 Feb;84(2):439-48
12585815
Ann Intern Med. 1999 Mar 16;130(6):461-70
10075613
Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
14662625
Eur J Clin Pharmacol. 2002 Jul;58(4):285-91
12136375
Drugs Aging. 1998 Jan;12(1):43-53
9467686
BMJ. 2003 Nov 22;327(7425):1222-5
14630763
N Engl J Med. 1991 Jun 13;324(24):1691-8
2034245
J Am Geriatr Soc. 2004 Aug;52(8):1349-54
15271125
BMC Med Res Methodol. 2007 Jan 11;7:1
17217545
JAMA. 1992 Feb 12;267(6):827-31
1732655
N Engl J Med. 1991 Feb 7;324(6):377-84
1824793
Toxicology. 2003 Oct 1;192(1):23-32
14511900
Lancet. 2005 Jan 1-7;365(9453):82-93
15639683
Drugs Aging. 1995 Sep;7(3):203-11
8535050
Age Ageing. 1994 Mar;23(2):113-6
8023717
Eur J Clin Pharmacol. 1996;49(4):255-9
8857069
J Pharmacol Exp Ther. 1987 Jan;240(1):159-66
3100765
Drugs Aging. 1993 Jul-Aug;3(4):335-48
8369593
J Clin Epidemiol. 2004 Aug;57(8):832-6
15551473
Drugs Aging. 1998 Nov;13(5):357-79
9829164
Drugs Aging. 1992 Jul-Aug;2(4):356-67
1504448
Nephrol Dial Transplant. 1997 Aug;12(8):1553-5
9269625
Arch Intern Med. 1997 Jul 28;157(14):1531-6
9236554
BMJ. 1997 Oct 25;315(7115):1059
9366735
Anesthesiology. 1999 Jun;90(6):1502-16
10360845
Clin Pharmacol Ther. 2003 May;73(5):468-74
12732846
Nephron. 1976;16(1):31-41
1244564
Heart Dis. 2003 Jul-Aug;5(4):241-3
12877757
Drugs Aging. 2002;19(9):685-93
12381237
BMJ. 2000 Mar 18;320(7237):741-4
10720355
J Intern Med. 1990 Aug;228(2):83-90
2394974
Psychosomatics. 2004 May-Jun;45(3):235-42
15123850
BMJ. 2004 Jul 3;329(7456):15-9
15231615
Br J Ophthalmol. 2000 Feb;84(2):165-70
10655192
Am J Cardiol. 1987 Sep 15;60(8):697-702
3661438
N Engl J Med. 1991 Feb 7;324(6):370-6
1987460
Lancet. 2000 Jul 15;356(9225):255
10963230
Ann Intern Med. 1992 Sep 15;117(6):502-10
1503353
J Clin Psychiatry. 2001;62 Suppl 21:11-4
11584981
Ann Intern Med. 1991 Jun 1;114(11):956-66
2024864
Age Ageing. 2006 Jul;35(4):449-50
16638757
JAMA. 2001 Jan 24-31;285(4):437-43
11242428
Z Gerontol Geriatr. 1995 Jan-Feb;28(1):54-61
7773833
J Am Geriatr Soc. 1999 Jan;47(1):40-50
9920228
Age Ageing. 2004 May;33(3):224-9
15082425
Ann Intern Med. 2004 Nov 16;141(10):781-8
15545678
BMJ. 1997 Oct 25;315(7115):1057-8
9366733
J Gerontol A Biol Sci Med Sci. 2000 Feb;55(2):M84-9
10737690