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Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches

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Key summary points

AbstractSection Aim

To analyze the process from the prescription of the drug to the health outcome, from a medical and pharmaceutical perspective, to prevent the occurrence of drug-related problems (DRPs) in older adults.

AbstractSection Findings

A mapping of a logical process of drug use from the perspective of physicians, pharmacists, and patients has been established, but many fields remain unexplored (e.g. off-label use, substance use disorders, therapeutic failure), especially in some settings (e.g. home-dwelling) as little data is available in older adults.

AbstractSection Message

Prevention of DRPs imperatively requires taking into account the opinions of all healthcare professionals as well as those of patients and their caregivers.

Abstract

Purpose

To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs.

Materials and methods

A narrative overview.

Results

The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient’s clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen.

Discussion/conclusion

Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.

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Authors and Affiliations

  1. Centre de Pharmacovigilance, de Pharmacoépidémiologie et D’information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France

    Marie-Laure Laroche, Thi Hong Van Ngo, Muriel Grau, Barbara Roux & Louis Merle

  2. Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France

    Marie-Laure Laroche, Thi Hong Van Ngo & Barbara Roux

  3. Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France

    Marie-Laure Laroche, Muriel Grau & Louis Merle

  4. Université Laval, Faculté de Pharmacie, Québec, Canada

    Caroline Sirois

  5. Centre de Recherche VITAM en Santé Durable, Centre D’excellence sur le Vieillissement de Québec, Québec, Canada

    Caroline Sirois

  6. Centre d’addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France

    Amélie Daveluy

  7. Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France

    Amélie Daveluy

  8. Centre de Pharmacovigilance de Pharmacoépidémiologie et d’information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France

    Michel Guillaumin & Marie-Blanche Valnet-Rabier

  9. Département de Gériatrie, CHU de Besançon, Besançon, France

    Michel Guillaumin

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  1. Marie-Laure Laroche
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  9. Louis Merle
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MLL and VNTH designed the study and oversaw the management of all aspects of the study. All authors met the requirements for authorship as defined by the ICMJE; all authors made substantial contributions to drafting and revising the work, approved the final version submitted herein, and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Laroche, ML., Van Ngo, T.H., Sirois, C. et al. Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches. Eur Geriatr Med 12, 485–497 (2021). https://doi.org/10.1007/s41999-021-00482-8

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