title: The risk of adverse drug reactions in older patients: beyond drug metabolism.
abstract: Changes in pharmacokinetics and pharmacodynamics, associated with increasing age, are often considered the only culprits of increasing Adverse Drug Reactions (ADR) rate observed in older adults, but other factors may be responsible for a reduction in drug efficacy and increase the risk of iatrogenic illness in this population. The aging process is characterized by a high level of complexity, which makes the care of older adults and the use of medications a challenging task. In particular, comorbidity, geriatric syndromes, cognitive and functional deficits, limited life expectancy are typical conditions observed in older adults which may reduce the efficacy of prescribed drugs and increase the risk of iatrogenic illness. As a consequence, a comprehensive assessment and management of the health care problems, with the goal of recognizing and preventing potential drug-related problems and improve quality of prescribing is necessary to reduce the risk of ADR. Several studies have assessed the effect of a comprehensive geriatric assessment and management on drug prescribing and drug related illness, showing a substantial improvement in quality of prescription and a reduction in rate of ADR. In addition, clinical guidelines providing recommendations regarding the use of drugs in chronic disease rarely assess the level of complexity observed in older adults and therefore they should be applied with caution in this population.
authors.affiliation: Centro Medicina dell' Invecchiamento Universita Cattolica del Sacro Cuore 00168, Rome, Italy. graziano_onder@rm.unicatt.it
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
authors.forename: Miriam
authors.initials: M
authors.lastname: Battaglia
authors.forename: Francesco
authors.initials: F
authors.lastname: Cerullo
authors.forename: Roberta
authors.initials: R
authors.lastname: Sportiello
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.forename: Francesco
authors.initials: F
authors.lastname: Landi
mesh_terms: D000368:Aged; D064420:Drug-Related Side Effects and Adverse Reactions / Q000139:chemically induced / Q000378:metabolism*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D004364:Pharmaceutical Preparations / Q000378:metabolism*; D012307:Risk Factors
chemical_list: D004364:Pharmaceutical Preparations