G Glaeske1. 1. SOCIUM - Forschungszentrum Ungleichheit und Sozialpolitik, Gesundheit, Pflege, Alterssicherung, Universität Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Deutschland. gglaeske@uni-bremen.de.
Abstract
BACKGROUND: Although older people are frequently prescribed more drugs than younger people, they are rarely included in clinical trials. Elderly patients often suffer from multimorbidity and are prescribed many drugs simultaneously. With age, physiological changes occur that can affect the pharmacokinetics and pharmacodynamics of the drugs used, e.g., changes in the duration of action. There are several problematic implications to this, particularly relating to tolerability and possible negative effects for patients. OBJECTIVES: Not only are guidelines for the treatment of elderly patients lacking, but also basic information about efficacy, tolerability, and interactions of drugs that are commonly prescribed to the elderly often missing. Physicians sometimes have no choice but to estimate the correct dosages for the elderly. METHODS: Evaluations of secondary data and clinical trials, discussion, and analysis of basic research work on the basis of expert analysis. RESULTS: There are very few clinical trials that include people over the age of 70. On the one hand, elderly people receive more drug prescriptions due to multimorbidity, compared with younger people, while on the other hand the risk of adverse drug reaction increases for precisely these individuals. CONCLUSIONS: In order to improve treatment safety in older people in terms of duration and dosage, randomized control trials (RCT) are essential to provide evidence of the benefits of a drug to patients. For this reason, the call for clinical trials after as well as before authorization, on patients treated with these drugs-and that especially means elderly patients-is long overdue.
BACKGROUND: Although older people are frequently prescribed more drugs than younger people, they are rarely included in clinical trials. Elderly patients often suffer from multimorbidity and are prescribed many drugs simultaneously. With age, physiological changes occur that can affect the pharmacokinetics and pharmacodynamics of the drugs used, e.g., changes in the duration of action. There are several problematic implications to this, particularly relating to tolerability and possible negative effects for patients. OBJECTIVES: Not only are guidelines for the treatment of elderly patients lacking, but also basic information about efficacy, tolerability, and interactions of drugs that are commonly prescribed to the elderly often missing. Physicians sometimes have no choice but to estimate the correct dosages for the elderly. METHODS: Evaluations of secondary data and clinical trials, discussion, and analysis of basic research work on the basis of expert analysis. RESULTS: There are very few clinical trials that include people over the age of 70. On the one hand, elderly people receive more drug prescriptions due to multimorbidity, compared with younger people, while on the other hand the risk of adverse drug reaction increases for precisely these individuals. CONCLUSIONS: In order to improve treatment safety in older people in terms of duration and dosage, randomized control trials (RCT) are essential to provide evidence of the benefits of a drug to patients. For this reason, the call for clinical trials after as well as before authorization, on patients treated with these drugs-and that especially means elderly patients-is long overdue.
Entities:
Keywords:
Chronic disease; Clinical trials as topic; Comorbidity; Drug evaluation; Polypharmacy
Authors: Nigel S Beckett; Ruth Peters; Astrid E Fletcher; Jan A Staessen; Lisheng Liu; Dan Dumitrascu; Vassil Stoyanovsky; Riitta L Antikainen; Yuri Nikitin; Craig Anderson; Alli Belhani; Françoise Forette; Chakravarthi Rajkumar; Lutgarde Thijs; Winston Banya; Christopher J Bulpitt Journal: N Engl J Med Date: 2008-03-31 Impact factor: 91.245
Authors: Emma C Davies; Christopher F Green; Stephen Taylor; Paula R Williamson; David R Mottram; Munir Pirmohamed Journal: PLoS One Date: 2009-02-11 Impact factor: 3.240