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Predicting and Preventing Adverse Drug Reactions in the Very Old

Drugs & Aging volume 22, pages 375–392 (2005)Cite this article

Abstract

The size of the elderly population has been increasing steadily for several years. Individuals in this age group often have several concomitant diseases that require treatment with multiple medications. These drugs, for various reasons and especially as a consequence of potential accumulation, may be associated with adverse reactions. Of the numerous factors that can favour the occurrence of these adverse drug reactions, the most important are the pathophysiological consequences of aging, particularly as these apply to the very old.

Although absorption of drugs is not usually reduced in the elderly, diffusion, distribution and particularly elimination decline with age. Furthermore, while hepatic metabolic function is fairly normal, renal function is usually markedly depressed in very old individuals, and this can translate into clinical consequences if it is not taken into account. This is why, before administration of any drug in the elderly, evaluation of glomerular filtration rate is essential. Validated estimations such as those obtained from the classical Cockcroft-Gault formula or from more recent methodologies are required.

In addition to reductions in various organ functions, factors connected with very old age such as frailty, falls, abnormal sensitivity to medications and polypathology, all of which tend to be more common in the last years of life, all directly impact on adverse drug reaction occurrence.

Given these characteristics of the elderly population, the best way to reduce the prevalence of adverse drug reactions in this group is to limit drug prescription to essential medications, make sure that use of prescribed agents is clearly explained to the patient, give drugs for as short a period as possible, and periodically re-evaluate all use of drugs in the elderly.

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Acknowledgements

Each of the authors participated in this study and none has any conflict of interest to disclose.

We acknowledge the financial support of the French Drugs Agency, AFSSaPS (Agence Française de Sécurité Sanitaire des Produits de Santé).

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Affiliations

  1. Service de Pharmacologie, Toxicologie, Centre Régional de Pharmacovigilance, CHU Dupuytren, Limoges, 87042, France

    Louis Merle & Marie-Laure Laroche

  2. Département de Gérontologie Clinique, CHU Dupuytren, Limoges, France

    Marie-Laure Laroche, Thierry Dantoine & Jean-Pierre Charmes

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  1. Louis Merle
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  2. Marie-Laure Laroche
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Correspondence to Louis Merle.

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Merle, L., Laroche, ML., Dantoine, T. et al. Predicting and Preventing Adverse Drug Reactions in the Very Old. Drugs Aging 22, 375–392 (2005). https://doi.org/10.2165/00002512-200522050-00003

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Keywords

  • Digoxin
  • Adverse Drug Reaction
  • Atrial Natriuretic Peptide
  • Serum Creatinine Concentration
  • Splanchnic Blood Flow