Summary
Children under 6 years of age are involved in the majority of poisonings. However, the elderly are more likely to require hospitalisation and to die from poisonings compared with younger individuals. Drugs play an important role in the poisoning exposures of older patients. Analgesics, cardiovascular medications, theophylline preparations and antidepressants and other psychotropic medications are most commonly implicated in drug poisoning fatalities in elderly Americans.
Careful review of information which characterises drug poisonings in the elderly is essential to the development of effective preventative strategies. Most poison centre calls for elderly patients involve accidental exposures. The ingestion of extra doses of medications because of forgetfulness, mistaken identity of medications, incorrect route of administration, and improper storage of medications are among the primary reasons for unintentional drug poisonings in older patients.
A model for injury control composed of 3 phases can be applied to poison exposures in the elderly: activities in the pre-event phase focus on prevention; the goal of the event phase is to minimise the chance of injury from exposure if it should occur; the post-event phase is directed at appropriate management to reduce the consequences of injury from poison exposure once it occurs.
The general management of drug poisonings is similar in older and younger patients. However, management in the elderly is complicated by difficulties in the diagnosis of drug poisoning, pharmacokinetic and pharmacodynamic changes associated with aging, increased incidence of chronic illness, and increased medication use with the potential for clinically significant drug interactions. Aggressive initial treatment is imperative because the elderly are generally more susceptible to the toxic effects of drugs.
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References
Lamy PP. Pharmacotherapeutics in the elderly. Md Med J 1989; 38: 144–8
Brawn LA, Castleden CM. Adverse drug reactions: an overview of special considerations in the management of the elderly patient. Drug Saf 1990; 5: 421–35
Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med 1991; 114: 956–66
Ioannides-Demos LL, Christophidis N. Adverse drug reactions and the elderly. Aust J Hosp Pharm 1993; 23: 411–6
Walker J, Wynne H. Review: the frequency and severity of adverse drug reactions in elderly people. Age Ageing 1994; 23: 255–9
Kroner BA, Scott RB, Waring ER, et al. Poisoning in the elderly: characterization of exposures reported to a poison control center. J Am Geriatr Soc 1993; 41: 842–6
Klein-Schwartz W, Oderda GM, Booze L. Poisoning in the elderly. J Am Geriatr Soc 1983; 31: 195–9
Schernitski P, Bootman JL, Byers J, et al. Demographic characteristics of elderly drug overdose patients admitted to a hospital emergency department. J Am Geriatr Soc 1980; 28: 544–6
Lamminpaa A, Riihimaki V, Vilska J. Hospitalizations due to poisonings in Finland. J Clin Epidemiol 1993; 46: 47–55
Owens D, Dennis M, Jones S, et al. Self-poisoning patients discharged from accident and emergency: risk factors and outcome. J R Coll Physicians Lond 1991; 25: 218–22
Woolf A, Fish S, Azzara C, et al. Serious poisonings among older adults: a study of hospitalization and mortality rates in Massachusetts 1983-85. Am J Public Health 1990; 80: 867–9
Dean BS, Krenzelok EP. Poisoning in the elderly: an increasing problem for health care providers. J Toxicol Clin Toxicol 1987; 25: 411–8
McGoldrick MD, Urizar R, Cerda J. Drug poisoning patterns: the Albany experience, 1978 and 1988. NY State J Med 1992; 92: 134–6
Litovitz TL, Clark LR, Soloway RA. 1993 annual report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med 1994; 12: 546–84
Litovitz TL, Holm KC, Clancy C, et al. 1992 annual report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med 1993; 11: 494–555
Litovitz TL, Holm KC, Bailey KM, et al. 1991 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med 1992; 10: 452–509
Litovitz TL, Bailey KM, Schmitz BF, et al. 1990 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med 1991; 9: 461–98
Litovitz TL, Schmitz BF, Bailey KM. 1989 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med 1990; 8: 394–442
Litovitz TL, Schmitz BF, Holm KC. 1988 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med 1989; 7: 495–545
Litovitz TL, Schmitz BF, Matyunas N, et al. 1987 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med 1988; 6: 479–515
Litovitz TL, Martin TG, Schmitz B. 1986 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med 1987; 5: 405–45
Oderda GM, Klein-Schwartz W. Poison prevention in the elderly. Drug Intell Clin Pharm 1984; 18: 183–5
Chrischilles EA, Foley DJ, Wallace RB, et al. Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly. J Gerontol 1992; 47: M137–44
Haddon W, Baker SP Injury control. In: Clark D, editor. Preventive and community medicine. Boston: Little, Brown and Co., 1981: 109–40
Jinks MJ, Evenson LM, Campbell RK, et al. Prescription labels for aging eyes. Am Pharm 1989; NS29: 31–3
Watanabe RK. The ability of the geriatric population to read labels on over-the-counter medication containers. J Am Op-tomAssoc 1994; 65: 32–7
Kroner BA, Kelley CL, Baranowski EM. Labelling deficiencies and communication problems leading to medication misuse in the elderly. Drugs Aging 1994; 5: 403–10
Crome P. ABC of poisoning: the elderly. BMJ 1984; 289: 456–8
NIH Consensus Development Panel on Depression in Late Life. Diagnosis and treatment of depression in late life. JAMA 1992; 268: 1018–24
Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA 1994; 272: 292–6
Klein-Schwartz W, Oderda GM. Poisoning in the elderly: epi-demiological, clinical and management considerations. Drugs Aging 1991; 1: 67–89
Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. N Engl J Med 1989; 321: 303–9
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Haselberger, M.B., Kroner, B.A. Drug Poisoning in Older Patients. Drugs & Aging 7, 292–297 (1995). https://doi.org/10.2165/00002512-199507040-00004
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DOI: https://doi.org/10.2165/00002512-199507040-00004