Adverse drug reactions in special populations - the elderly
Adverse drug reactions in special populations - the elderly
复制标题
DOI：
10.1111/bcp.12596
复制
发表时间：
2015-10-01
影响因子：
3.4
通讯作者：
O'Mahony, M. S.
中科院分区：
文献类型：
--
作者：
Davies, E. A.;O'Mahony, M. S.
人用药品注册技术要求国际协调会议认为老年人是一个特殊人群，因为老年人在合并症、多种用药、药代动力学和更容易发生药物不良反应（ADR）方面与年轻人不同。医疗实践通常基于来自临床试验的单一疾病指南，这些临床试验不包括虚弱的老年人或患有多种疾病的人。这对老年人的护理提出了挑战，因为试验中的药物剂量可能无法在真实的世界患者中实现，并且临床试验人群中的ADR风险被低估。老年人中的大多数ADR是A型，可能是可以避免的，并且与常用处方药有关。一些ADR与老年人的主要不良后果特别相关，因此减少ADR是临床优先事项。福尔斯与苯二氮卓类药物、抗精神病药、抗抑郁药和抗高血压药密切相关。有很好的证据表明，药物审查作为多因素干预的一部分，以减少社区居住老年人的福尔斯风险。多种药物也会导致谵妄，这是另一种多因素综合征，导致死亡率过高，特别是在体弱的老年人中。与广谱抗生素使用相关的艰难梭菌主要影响虚弱的老年人，并导致住院时间延长，发病率和死亡率较高。抗精神病药物使痴呆患者中风的风险增加三倍以上。不适当的处方可以通过遵守处方指南，适当的监测和定期药物审查来减少。鉴于老年人群的异质性，提供个性化护理是预防ADR的关键。
The International Conference on Harmonization considers older people a special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (ADRs). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. This presents a challenge caring for older people, as drug doses in trials may not be achievable in real world patients and risks of ADRs are underestimated in clinical trial populations. The majority of ADRs in older people are Type A, potentially avoidable and associated with commonly prescribed medications. Several ADRs are particularly associated with major adverse consequences in the elderly and their reduction is therefore a clinical priority. Falls are strongly associated with benzodiazepines, neuroleptics, antidepressants and antihypertensives. There is good evidence for medication review as part of a multifactorial intervention to reduce falls risk in community dwelling elderly. Multiple medications also contribute to delirium, another multifactorial syndrome resulting in excess mortality particularly in frail older people. Clostridium difficile associated with use of broad spectrum antibiotics mainly affects frail older people and results in prolonged hospital stay with substantial morbidity and mortality. Antipsychotics increase the risk of stroke by more than three-fold in patients with dementia. Inappropriate prescribing can be reduced by adherence to prescribing guidelines, suitable monitoring and regular medication review. Given the heterogeneity within the older population, providing individualized care is pivotal to preventing ADRs.