title: Medicines optimisation in older people: Taking age and sex into account.
abstract: There are a number of complex and seemingly ignored issues around prescribing safely and effectively for older people, particularly for very old women. These issues include polypharmacy, possible compliance issues and communication barriers between patient, specialists and general practitioners (GPs). There are specific pharmacokinetic (PK) and pharmacodynamic (PD) parameters that change in older age generally, and in women more specifically, which if ignored are likely to cause symptoms and to impair quality of life when drug dosage is unchanged. These changed PK and PD parameters are not all-or-nothing processes, but a continuum across age, sex and comorbidity. Very old people also have less 'reserve' when drugs are used in 'standard' doses, are more likely to have multiple concurrent therapies, and the risk of adverse effects of drugs in this group is very high. Doctors need to consider these issues when providing therapy for this group, or when trying to unravel the complex prescribing cascade here. This review outlines general principles to consider when prescribing for older people, focusing on age- and sex-related changes in both PK and PD processes.
authors: Clinical Pharmacologist, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
authors: Catherine
authors: C
authors: Lucas
authors: Head of Public Health, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
authors: Julie
authors: J
authors: Byles
authors: Chair of Clinical Pharmacology, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia. Electronic address: jen.martin@newcastle.edu.au.
authors: Jennifer H
authors: JH
authors: Martin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058005:General Practitioners; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D019338:Polypharmacy; D011788:Quality of Life; D012737:Sex Factors
keywords: 65 and over; Aged; Drug interactions; Drug prescriptions; Female; Inappropriate prescribing; Polypharmacy