Skip to main content

Altered Pharmacology and Pill Burden in Older Adults: A Balancing Act

  • Chapter
  • First Online:
Dialysis in Older Adults

Abstract

Older adults represent one of the fasting growing age groups in many countries including the United States [1]. This rate of growth is mirrored in the dialysis population. The number of incident dialysis patients over the age of 65 years is greater than 50 %. The number of incident dialysis patients greater than 75 years of age represents the fasting growing population of dialysis patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Department of Health & Human Services AoA. U.S. Population by Age: July 1, 2010; 2010 [updated July 1 2010; cited 2014 1 Jul]

    Google Scholar 

  2. Chiu YW, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R (2009) Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol CJASN 4(6):1089–1096

    Article  PubMed  Google Scholar 

  3. Lassiter J, Bennett WM, Olyaei AJ (2013) Drug dosing in elderly patients with chronic kidney disease. Clin Geriatr Med 29(3):657–705

    Article  PubMed  Google Scholar 

  4. Olyaei AJ, Bennett WM (2009) Drug dosing in the elderly patients with chronic kidney disease. Clin Geriatr Med 25(3):459–527

    Article  PubMed  Google Scholar 

  5. Rolita L, Freedman M (2008) Over-the-counter medication use in older adults. J Gerontol Nurs 34(4):8–17

    Article  PubMed  Google Scholar 

  6. Larsen PD, Martin JL (1999) Polypharmacy and elderly patients. AORN J 69(3):619–622, 25, 27–28

    Article  CAS  PubMed  Google Scholar 

  7. Hubbard RE, O’Mahony MS, Woodhouse KW (2013) Medication prescribing in frail older people. Eur J Clin Pharmacol 69(3):319–326

    Article  PubMed  Google Scholar 

  8. Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB (2010) Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis Off J National Kidney Found 56(3):439–446

    Article  Google Scholar 

  9. Pai AB, Cardone KE, Manley HJ, St Peter WL, Shaffer R, Somers M et al (2013) Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach. Clin J Am Soc Nephrol CJASN 8(11):1988–1999

    Article  PubMed  Google Scholar 

  10. Hammerlein A, Derendorf H, Lowenthal DT (1998) Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet 35(1):49–64

    Article  CAS  PubMed  Google Scholar 

  11. Bender AD (1968) Effect of age on intestinal absorption: implications for drug absorption in the elderly. J Am Geriatr Soc 16(12):1331–1339

    Article  CAS  PubMed  Google Scholar 

  12. Van Vlem B, Schoonjans R, Vanholder R, De Vos M, Vandamme W, Van Laecke S et al (2000) Delayed gastric emptying in dyspeptic chronic hemodialysis patients. Am J Kidney Dis Off J National Kidney Found 36(5):962–968

    Article  Google Scholar 

  13. Van V, Schoonjans RS, Struijk DG, Verbanck JJ, Vanholder RC, Van B et al (2002) Influence of dialysate on gastric emptying time in peritoneal dialysis patients. Perit Dial Int J Int Soc Perit Dial 22(1):32–38

    Google Scholar 

  14. Joy MS, Frye RF, Nolin TD, Roberts BV, La MK, Wang J et al (2014) In vivo alterations in drug metabolism and transport pathways in patients with chronic kidney diseases. Pharmacotherapy 34(2):114–122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Naud J, Nolin TD, Leblond FA, Pichette V (2012) Current understanding of drug disposition in kidney disease. J Clin Pharmacol 52(1 Suppl):10s–22s

    Article  CAS  PubMed  Google Scholar 

  16. Schmucker DL (2005) Age-related changes in liver structure and function: Implications for disease? Exp Gerontol 40(8–9):650–659

    Article  CAS  PubMed  Google Scholar 

  17. Schmucker DL (1985) Aging and drug disposition: an update. Pharmacol Rev 37(2):133–148

    CAS  PubMed  Google Scholar 

  18. Nolin TD, Frye RF, Le P, Sadr H, Naud J, Leblond FA et al (2009) ESRD impairs nonrenal clearance of fexofenadine but not midazolam. J Am Soc Nephrol JASN 20(10):2269–2276

    Article  CAS  PubMed  Google Scholar 

  19. Fleg JL, Schulman S, O’Connor F, Becker LC, Gerstenblith G, Clulow JF et al (1994) Effects of acute beta-adrenergic receptor blockade on age-associated changes in cardiovascular performance during dynamic exercise. Circulation 90(5):2333–2341

    Article  CAS  PubMed  Google Scholar 

  20. Fleg JL, Strait J (2012) Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease. Heart Fail Rev 17(4–5):545–554

    Article  PubMed  PubMed Central  Google Scholar 

  21. White M, Roden R, Minobe W, Khan MF, Larrabee P, Wollmering M et al (1994) Age-related changes in beta-adrenergic neuroeffector systems in the human heart. Circulation 90(3):1225–1238

    Article  CAS  PubMed  Google Scholar 

  22. Newgard CB, Pessin JE (2014) Recent progress in metabolic signaling pathways regulating aging and life span. J Gerontol A Biol Sci Med Sci 69(Suppl 1):S21–S27

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bowie MW, Slattum PW (2007) Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother 5(3):263–303

    Article  CAS  PubMed  Google Scholar 

  24. Andros E, Detmar-Hanna D, Suteparuk S, Gal J, Gerber JG (1996) The effect of aging on the pharmacokinetics and pharmacodynamics of prazosin. Eur J Clin Pharmacol 50(1–2):41–46

    Article  CAS  PubMed  Google Scholar 

  25. Peters R (2006) Ageing and the brain. Postgrad Med J 82(964):84–88

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dardano A, Penno G, Del Prato S, Miccoli R (2014) Optimal therapy of type 2 diabetes: a controversial challenge. Aging 6(3):187–206

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Diaz-Buxo JA (2000) Use of intraperitoneal insulin with CCPD. Semin Dial 13(3):207

    Article  CAS  PubMed  Google Scholar 

  28. Nevalainen PI, Lahtela JT, Mustonen J, Taskinen MR, Pasternack A (1999) The effect of insulin delivery route on lipoproteins in type I diabetic patients on CAPD. Perit Dial Int J Int Soc Perit Dial 19(2):148–153

    CAS  Google Scholar 

  29. Quellhorst E (2002) Insulin therapy during peritoneal dialysis: pros and cons of various forms of administration. J Am Soc Nephrol JASN 13(Suppl 1):S92–S96

    CAS  PubMed  Google Scholar 

  30. Torun D, Oguzkurt L, Sezer S, Zumrutdal A, Singan M, Adam FU et al (2005) Hepatic subcapsular steatosis as a complication associated with intraperitoneal insulin treatment in diabetic peritoneal dialysis patients. Perit Dial Int J Int Soc Perit Dial 25(6):596–600

    Google Scholar 

  31. Chan KE, Lazarus JM, Hakim RM (2010) Digoxin associates with mortality in ESRD. J Am Soc Nephrol JASN 21(9):1550–1559

    Article  CAS  PubMed  Google Scholar 

  32. Dager WE, Kiser TH (2010) Systemic anticoagulation considerations in chronic kidney disease. Adv Chronic Kidney Dis 17(5):420–427

    Article  PubMed  Google Scholar 

  33. Santoro D, Satta E, Messina S, Costantino G, Savica V, Bellinghieri G (2013) Pain in end-stage renal disease: a frequent and neglected clinical problem. Clin Nephrol 79(Suppl 1):S2–S11

    PubMed  Google Scholar 

  34. Pasticci F, Fantuzzi AL, Pegoraro M, McCann M, Bedogni G (2012) Nutritional management of stage 5 chronic kidney disease. J Ren Care 38(1):50–58

    Article  PubMed  Google Scholar 

  35. Andres E, Serraj K, Federici L, Vogel T, Kaltenbach G (2013) Anemia in elderly patients: new insight into an old disorder. Geriatr Gerontol Int 13(3):519–527

    Article  PubMed  Google Scholar 

  36. Andro M, Le Squere P, Estivin S, Gentric A (2013) Anaemia and cognitive performances in the elderly: a systematic review. Eur J Neurol Off J Eur Fed Neurol Soc 20(9):1234–1240

    CAS  Google Scholar 

  37. American Geriatrics Society Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60(4):616–631

    Article  Google Scholar 

  38. Gallagher P, O’Mahony D (2008) STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing 37(6):673–679

    Article  PubMed  Google Scholar 

  39. Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D (2011) Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 171(11):1013–1019

    Article  PubMed  Google Scholar 

  40. Desrochers JF, Lemieux JP, Morin-Belanger C, Paradis FS, Lord A, Bell R et al (2011) Development and validation of the PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria to assess medication safety and use issues in patients with CKD. Am J Kidney Dis Off J National Kidney Found 58(4):527–535

    Article  Google Scholar 

  41. Manley HJ, Drayer DK, McClaran M, Bender W, Muther RS (2003) Drug record discrepancies in an outpatient electronic medical record: frequency, type, and potential impact on patient care at a hemodialysis center. Pharmacotherapy 23(2):231–239

    Article  PubMed  Google Scholar 

  42. George J, Phun YT, Bailey MJ, Kong DC, Stewart K (2004) Development and validation of the medication regimen complexity index. Ann Pharmacother 38(9):1369–1376

    Article  PubMed  Google Scholar 

  43. Browne T, Merighi JR (2010) Barriers to adult hemodialysis patients’ self-management of oral medications. Am J Kidney Dis Off J National Kidney Found 56(3):547–557

    Article  Google Scholar 

  44. Lee DS, de Rekeneire N, Hanlon JT, Gill TM, Bauer DC, Meibohm B et al (2012) Cognitive impairment and medication complexity in community-living older adults: the health, aging and body composition study. J Pharm Technol JPT Off Publ Assoc Pharm Tech 28(4):156–162

    CAS  Google Scholar 

  45. Power A, Brown E (2013) Optimising treatment of end-stage renal disease in the elderly. Nephron Clin Pract 124(3–4):202–208

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Darren W. Grabe PharmD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media New York

About this chapter

Cite this chapter

Grabe, D.W., Cardone, K.E. (2016). Altered Pharmacology and Pill Burden in Older Adults: A Balancing Act. In: Misra, M. (eds) Dialysis in Older Adults. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3320-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-3320-4_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-3318-1

  • Online ISBN: 978-1-4939-3320-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics