Prescribing for Elderly Patients

Professor Stephen Jackson, Professor of Geriatric Medicine, King's College London, UK. Dr Paul Jansen, Department of Geriatric Medicine, University Medical Centre Utrecht, The Netherlands. Dr Arduino Mangoni, Senior Lecturer and Consultant Physician in Clinical Pharmacology, Flinders University, Adelaide, Australia.

List of Contributors. Foreword.

Preface.

Acknowledgement.

1 Clinical Pharmacology of Ageing (Arduino Mangoni, Paul Jansen and Stephen Jackson).

Epidemiology.

Age-related changes in pharmacokinetics.

Age-related changes in pharmacodynamics.

Adverse drug reactions and drug interactions.

Adherence.

Polypharmacy versus appropriate prescribing.

Over-the-counter medicines.

Prescribing audit.

Medication review.

Undertreatment.

References.

2 Dementia, Delirium, Agitation and Behavioural Problems (Catherine Bryant).

Dementia.

Delirium.

Agitation and behavioural problems.

References.

3 Depression in Elderly Patients (Richard Weeks, Ross Kalucy and Jo Hill).

Introduction.

Aetiology.

Signs and symptoms.

Diagnosis.

Therapy.

References.

4 Psychotic Illness in Elderly Patients (Ross Kalucy, Jo Hill and Richard Weeks).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis.

Therapy.

Key points.

References.

5 Sleep Disorders in the Elderly: the Pros and Cons of Prescribing (R. Doug McEvoy and Karin S. Nyfort-Hansen).

Insomnia.

Restless legs syndrome and periodic limb movements of sleep.

Nocturnal leg cramps.

REM behaviour disorder.

References.

6 Stroke (Joseph A. Harbison and Gary A. Ford).

Introduction.

Aetiology.

Modifiable risk factors for stroke.

Therapy.

Key points.

References.

7 Orthostatic Hypotension, Postprandial Hypotension and Syncope in Older Patients (René W.M.M. Jansen).

Orthostatic hypotension in older patients.

Key points.

Postprandial hypotension in older patients.

Key points.

Syncope in older patients.

Key points.

Guidelines.

References.

8 Parkinson’s Disease (Gerrit Tissingh and Erik Ch. Wolters).

Introduction.

Symptoms and signs of PD.

Aetiology and pathology.

Diagnosis.

Therapy.

Key points.

Links.

References.

9 Epilepsy (John O. Willoughby, Joseph Frasca and Emma M. Whitham).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis.

Therapy.

Newer anti-epileptic drugs.

Safety of anti-epileptic drugs.

Therapy scheme of the advised drugs.

Clinically-important drug interactions within anti-epileptic drugs.

Clinically-important drug interactions with other drugs.

Important adverse effects.

Drug withdrawal.

Key points.

References.

10 Hypertension (Sanjeev Khindri and Stephen Jackson).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis.

Investigation.

Therapy.

Clinical pharmacology of antihypertensive therapy.

Key points.

Links.

References.

11 Lipid-Lowering in the Elderly Patient (Anthony S. Wierzbicki).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis.

Therapy.

Statins.

Fibrates.

Nicotinic acid.

Ezetimibe.

Bile acid sequestrants.

Omega-3 fatty acids.

Guidelines.

Key points.

Links.

References.

12 Acute Coronary Syndrome (Derek Yiu and Arduino Mangoni).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis.

Therapy.

Therapy scheme of the advised drugs.

Key points.

Guidelines.

Acknowledgements.

References.

13 Heart Failure (Arduino Mangoni).

Introduction.

Epidemiology.

Aetiology.

Clinical presentation.

Diagnosis.

Therapy.

Key points.

Guidelines.

Acknowledgements.

References.

14 Atrial Fibrillation and Other Rhythm Disturbances in the Elderly (Abhay Bajpai, Irina Savelieva and A. John Camm).

Introduction.

Atrial arrhythmias.

The epidemiology and cost of AF.

The mechanism of atrial tachyarrhythmias.

Symptoms and signs.

Diagnosis.

Classification of AF.

Causes of AF.

Principles of management of AF.

Treatment of acute onset AF.

Suppression of paroxysms of AF.

Strategies in persistent AF—rate versus rhythm control.

Rate control in permanent AF.

Risk of stroke and antithrombotic therapy in AF.

Non-pharmacological techniques to prevent thrombus formation.

Key points.

References.

15 Valvular Heart Disease (Andrew T. Elder).

Introduction.

Infective endocarditis.

Prevention of endocarditis.

Diagnosis and treatment of endocarditis.

Prevention of thromboembolism.

Prevention of progression of degenerative valvular disease.

References.

16 Anticoagulants for Thrombosis and Embolism in the Elderly (Alexander Gallus and Dolly Daniel).

Introduction.

The anticoagulants.

Thrombosis in the elderly and indications for anticoagulants.

References.

17 Haematological Disorders (Bryone J. Kuss and Sabria Alhashami).

Introduction.

Anaemia.

Vitamin B12 and folic acid deficiencies.

Thrombocytopenia.

Myelodysplastic syndromes.

Acute leukaemia.

Lymphoproliferative conditions.

Multiple myeloma.

Key points.

References.

18 COPD and Asthma in the Elderly (Martin Connolly and Tina L. Davies)

Risk factors and triggers.

Presentation and diagnosis.

Objective tests.

Differential diagnoses.

Management of COPD and asthma.

Acute asthma.

Management of exacerbations of COPD.

Management of stable COPD.

Conclusion.

Key Points.

Learning Resources.

Guidelines.

References.

19 Pneumonia in the Elderly (Peter A. Frith and Karin S. Nyfort-Hansen).

Introduction.

Epidemiology.

Aetiology and pathogenesis.

Symptoms and signs.

Diagnosis.

Patient assessment.

Therapy.

Important considerations for drug usage.

Prevention.

References.

20 Therapeutic Aspects of Pulmonary Tuberculosis (Paul van den Brande).

Introduction.

Pathogenesis.

Presentation of tuberculosis in the elderly.

Diagnosis of tuberculosis.

Treatment of tuberculosis.

Treatment of latent tuberculosis infection.

Key points.

References.

21 Interstitial Lung Disease in the Elderly (Jeffrey Bowden).

Introduction.

Presentation of interstitial lung disease.

Particular problems in the elderly.

General comments with regard to therapy.

Assessing the response to therapy.

Drugs used in ILD.

Treatment for specific forms of lung disease.

Key points.

Links.

References.

22 Lung Cancer in the Elderly (Jeffrey Bowden).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis and staging.

Goals of therapy.

Chemotherapeutic agents.

Treatment protocols for NSCLC.

Non cytotoxic agents: EGFR Inhibitors.

Treatment of small cell carcinoma.

Treatment of mesothelioma.

Anti-emetic therapy.

Key Points.

Guidelines.

References.

23 Nutritional Disorders and the Older Person (Robert K. Penhall and Renuka Visvanathan).

Introduction.

Obesity and the older person.

Nutritional frailty.

Under-nutrition in older people.

Screening and assessment of under-nutrition.

The management of the under-nourished older person.

Monitoring and change.

Conclusion.

References.

24 Mouth and Dental Disorders (Cees de Baat and Isaac van der Waal).

Introduction.

Periodontal disease.

Dental caries.

Odontogenic infections.

Alveolar osteitis.

Xerostomia and hyposalivation.

Candidiasis.

Angular cheilitis.

Denture stomatitis.

Burning mouth syndrome.

Recurrent aphthous stomatitis.

Recurrent herpes simplex.

Oral lichen planus.

25 Swallowing Disorders and Medication in the Elderly (Eddy Dejaeger).

Introduction.

Normal deglutition.

Changes with Age.

Aetiology of deglutition disorders.

Symptoms and signs.

Diagnosis.

Therapy.

Deglutition disorders and medication.

Key points.

Links.

References.

26 Upper Gastrointestinal Disorders (Geoffrey S. Hebbard).

Gastrooesophageal reflux disease.

Oesophageal motility disorders.

Non-cardiac chest pain.

Oesophageal infections.

Pill-induced oesophagitis.

Peptic ulcer disease.

Gastritis.

Non-ulcer dyspepsia.

References.

27 Gastric Emptying in Older Patients (Robert J. Fraser).

Introduction.

Aetiology of disturbed gastric motor function in ageing.

Symptoms and signs.

Diagnosis.

Therapy.

Therapy scheme of advised drugs for gastroparesis.

Key points.

Guidelines.

Effect of healthy ageing on appetite regulation—anorexia of ageing.

References.

28 Lower Gastrointestinal Disorders (Daniel L. Worthley, Graeme P. Young and Robert J. Fraser).

Malabsorption.

Inflammatory bowel disease.

Diverticulosis.

Mesenteric ischaemia.

Constipation.

Diarrhoea and faecal incontinence.

Haemorrhoids.

References.

29 Abdominal Malignancies (Sarah Zaidi and Guy Chung-Faye).

Introduction.

Epidemiology.

Aetiology.

Symptoms and signs.

Therapy.

Chemotherapy.

Key points.

Links.

References.

30 Liver Diseases in the Elderly (Réme Mountfield and Alan J. Wigg).

Introduction.

Physiological changes associated with ageing.

Drug induced liver disease.

Cirrhosis.

Alcoholic liver disease.

Non-alcoholic steatohepatitis (NASH).

Hepatitis C.

Hepatitis B.

Liver transplantation.

References.

31 Disorders of the lower urinary tract (Adrian Wagg).

Pathophysiology.

Incontinence subtypes.

Treatment cessation.

Assessment with a bearing on drug addition or withdrawal.

Rectal examination.

Vaginal examination.

The pharmacological treatment of urinary incontinence.

Cognition and antimuscarincs.

Bladder outflow tract obstruction.

Other pharmacological measures.

Stress urinary incontinence.

Summary.

References.

32 Management of Benign Prostatic Hyperplasia in Elderly Men (Ming Liu and Gordon H. Muir).

Assessment.

Prostate specific antigen (PSA).

Urinary retention.

Nocturnal frequency.

Treatment.

References.

33 Management of Erectile Dysfunction in the Elderly (Kevin Dennison).

Introduction.

Prevalence and aetiology of ED.

Physical or psychogenic?

Diagnosis and assessment of ed in primary care.

Treatment options.

Key points.

References.

34 Benign Gynaecological Disorders (Maria Vella, James Balmforth and Linda Cardozo).

Urogenital atrophy.

Prolapse.

Traditional anatomical site prolapse classification.

Urinary incontinence.

Detrusor overactivity.

Drug therapies.

Lichen sclerosis.

Lichen planus.

References.

35 Breast Cancer in Elderly Patients (Bogda Koczwara).

Introduction.

Presentation and diagnosis—special considerations in elderly patients.

Management of breast cancer.

Management of early breast cancer.

Treatment of advanced breast cancer.

Supportive care during breast cancer treatment.

Breast cancer therapeutics in an elderly patient.

Conclusion.

Key points.

References.

36 Pharmacological Management of Endocrine Conditions in the Elderly Patient (Nikolai Petrovsky).

Introduction.

Diabetes aetiology.

Diabetes symptoms and signs.

Diabetes diagnosis.

Type 2 diabetes management.

Pharmacokinetic and pharmacodynamic data of diabetes medications in elderly patients.

Clinically important drug interactions within diabetes drugs.

General adverse effects of diabetes medications in elderly patients.

Specific adverse effects and clinically-important drug interactions of diabetes drugs.

Pituitary adenomas.

Thyroid disease.

Hyperparathyroidism.

Hormone replacement.

Endocrine disease in the elderly—key points.

Further Reading.

37 Rheumatoid Arthritis, Osteoarthritis, Polymyalgia Rheumatica, Gout and Pseudogout (E. Michael Shanahan and Stephen Hedger).

Rheumatoid arthritis.

Key points in rheumatoid arthritis.

Osteoarthritis.

Key points in osteoarthritis.

Polymyalgia rheumatica.

Key points in PMR.

Gout and calcium pyrophosphate disease (CPPD).

Key points in gout and CPPD.

Links.

References.

38 Falls, Osteoporosis, Paget’s Disease and Osteomalacia (Harald J.J. Verhaar and Paul Jansen).

Falls and osteoporosis.

Paget’s disease.

Osteomalacia.

Key points.

References.

39 Drugs and Falls (Nathalie van der Velde and Tischa J.M. van der Cammen).

Introduction.

Pathophysiology.

Fall-risk-increasing drugs.

Clinical approach.

Treatment: drug withdrawal.

Key points.

References.

40 Pressure Ulcers (Rob J. van Marum).

Introduction.

The role of pressure in pressure ulcer development.

The role of nutrition in pressure ulcer development.

Risk assessment.

Prevention.

Local treatment.

Key points.

References.

41 Leg Ulceration (Gabrielle M. McMullin).

Introduction.

Aetiology.

Symptoms and signs.

Diagnosis.

Therapy.

Key points.

Guidelines.

References.

42 Xerosis and Asteatotic Eczema (Michael Yeung and Daniel Creamer).

Xerosis.

Actinic keratoses and Bowen’s disease.

Bullous pemphigoid

Candidiasis.

Erysipelas and cellulitis.

Contact dermatitis.

Herpes zoster (shingles).

Lichen planus.

Malignant melanoma.

Mycosis fungoides.

Basal cell carcinoma and squamous cell carcinoma.

Psoriasis.

Scabies.

Tinea.

Urticaria and angio-oedema.

Venous eczema and the dependency syndrome.

43 Age-Related Eye Diseases (Genevieve Larkin).

Cataract.

Glaucoma.

Age related macular degeneration.

Diabetic retinopathy.

References.

44 Ear Disorders (Wynia Derks and Gerrit Hordijk).

Introduction.

Hearing loss.

Tinnitus.

External otitis.

Drugs causing hearing problems.

References.

45 Pain (Albert J.M. van Wijck).

Introduction.

Aetiology.

Diagnosis.

Therapy.

Key points.

References.

46 Palliative Care in the Elderly (Alexander de Graeff and Saskia Teunissen).

Introduction.

Symptoms.

Palliative care in the elderly.

Treatment of common symptoms in elderly patients.

References.

Index.