Drug-related problems in the elderly (eBook)

Preface 5
Contents 6
1 Aging and Drugs 11
1.1 Introduction 11
1.2 Epidemiology 12
1.3 Drug-Related Problems 12
1.4 Evidence Based Medicine 13
1.5 Polypharmacy 14
1.6 General Improved Quality 14
1.7 Specific Problems, Consequences, and Improvements 15
1.8 Conclusions 16
References 16
2 Physiological Alterations with Aging 18
2.1 Introduction 18
2.2 Pharmacokinetics 19
2.3 Pharmacodynamics 23
2.4 Drug-Drug Interactions 24
2.5 Drug-Disease Interactions 25
2.6 Adverse Drug Reactions 25
2.7 Adverse DrugWithdrawal Events 26
2.8 Conclusions 26
References 27
3 Quality of Care in the Elderly 29
3.1 Quality Assurance 29
3.2 Patient Benefit and -Risks 30
3.3 Efficacy of (New) Drugs in the Elderly 31
3.4 Evidence Based Medicine 32
3.5 Shortcomings for EBM in the Elderly 37
3.6 Organisational and Professional Aspcts 39
3.7 Conclusions 42
References 42
4 Inappropriate Drugs in the Elderly 44
4.1 Introduction 44
4.2 Benzodiazepines 45
4.3 Antipsychotic Drugs 48
4.4 NSAID 49
4.5 Drugs with Anticholinergic Effects 50
4.6 Conclusions 51
References 51
5 Drugs and Common Health Conditions in Old Age 55
5.1 Gastrointestinal Health Problems 55
5.2 Constipation 56
5.3 Dryness of the Mouth 57
5.4 Peptic Ulcers and Chronic Gastritis 59
5.5 Hiatus Hernia 62
5.6 Urinary Incontinence 64
5.7 Renal Failure in Old Age 68
5.8 Obstruction of Urinary Flow 70
5.9 Falls and Fractures 70
5.10 Osteoporosis 73
5.11 Sarcopenia, MuscleWeakness in Old Age 76
5.12 Orthostatic Hypotension 76
5.13 Vertigo 79
5.14 Conclusions 81
References 82
6 Drugs and Neuro-Psychiatric Disorders 85
6.1 Introduction 85
6.2 Delirium in the Elderly 85
6.3 Dementia 90
6.4 Affective Disorders 91
6.5 Psychotic Disease 92
6.6 Conclusions 93
References 93
7 Errors, Problems, Events and Reactions on Medication 96
7.1 Introduction 96
7.2 Medication Errors 97
7.3 Drug-Related Problems 100
7.4 Adverse Drug Events 100
7.5 Adverse Drug Reactions 100
7.6 Risk Medications 102
7.7 Risk PatientsÛThe Elderly 103
7.8 Conclusions 104
References 104
8 Practical Problems Related to the Patients Medication Intake 106
8.1 Confusing Names 106
8.2 Problem to Remember 109
8.3 Problem in Handling 110
8.4 Problem to Swallow 110
8.5 Food Interactions 112
8.6 Short Use Before Date 114
8.7 Conclusions 115
References 115
9 Compliance and Concordance 116
9.1 Introduction 116
9.2 From Compliance to Concordance 117
9.3 Compliance/Adherence in the Elderly 117
9.4 Clinical Consequences 118
9.5 Practical Problems 119
9.6 Knowledge, Attitudes and Motivation 119
9.7 Tools to Detect Problems Related to Non-compliance 119
9.8 Interventions for Improvement 120
9.9 Conclusions 121
References 122
10 Strategies and Interventions for Improvement 124
10.1 Introduction 124
10.2 Information Technology DevelopmentWithin Health Care 125
10.3 Evidence Based Database Sources for Effective Clinical Practices 125
10.4 Pharmaceutical Care and Medicines Management 126
10.5 Medication Reconciliation 127
10.6 Medication Review 129
10.7 Trigger Tools 129
10.8 Personalised Medicine 130
10.9 Conclusions 130
References 131
11 Summary and Perspectives 133
11.1 Vision and Objectives for Medication Use in the Elderly 133
11.2 Quality Improvement 134
11.3 Product- or Patient- Centred Treatment 134
11.4 Summary of Simple Practice Conclusions 135
References 136