Drug safety in the elderly
EFNS Stockholm 2012
Barbro Westerholm
Prof.em, Member of Swedish
Parliament
The demograhic future
Who is old?
60+, 70+, 80+, 90+…?
We are born as copies and die as
originals
Bo G Eriksson
Elderly more sensitive to drugs
because (1)
• Reduced amount of water in the body -fat soluble drugs
remain longer in the body with prolonged effects – of
importance for some sedatives and anxiolytics
• Reduced kidney function - decreased excretion of some
cardiovascular drugs, some antibiotics, diabetic drugs,
antiinflammatory drugs – need to reduce dosage
• Reduced liver function – decreases metabolism of
opioids, bensodiazepines and some antidepressive
drugs
• Brain and nervous system more sensitive to
psychotropic and analgesic drugs – dizziness, confusion
Elderly more sensitive to drugs
because (2)
• Decreased capacity to regulate blood
pressure – blood pressure fall, fainting,
vertigo when using drugs for hypertension
• Gastrointestinal sensitivity to antiinflammatory drugs - bleeding
Drug safety in the elderly
Do we have a problem? Yes!
Top ten medicines reported by the EU member
states to WHO in 2010 - women and men 80+
1. Acetylsalicycic acid
2. Warfarin
3. Lefloxacin
4. Furosemide
5. Acenocoumarol
6. Enalapril
7. Rovecoxib
8.Digoxin
9. Clopidogrel
10. Ciprofloxacin
Drug safety in the elderly
Do we have a problem? Yes!
• Elderly run 2 – 3 times higher risks than younger adults
to get adverse drug reactions
• Drug related problems is a common cause of
hospitalization of older people
• 10 – 30 % of the admissions in emergency departments
of internal medicine in Sweden are due to drug related
problems
• In the US it has been estimated that
100 000 persons die per year of drug related problems
Drug safety in the elderly
Do we have a problem? Still yes.
Percentage of Swedish inhabitants 80+ with
2007
2008
2009
2010
Ten or more
medicines
16.4
14.2
11.1
10.8
Combinations
carrying risks
4.4
3.6
2.9
2.7
Three or more
psychotropics
6.4
5.9
4.6
4.5
Why do we have a problem with
safety of drug treatment in the elderly?
• Many drugs prescribed to older patients not tested in this
age group
• Prescribers lack education about how to treat older
patients with drugs
• Older people are treated for their symptoms, not based
on diagnosis
• Effects of drug treatment in the individual patient is not
monitored
• Lack of coordination between different doctors`
treatment of an individual treatment
• Patients lacking knowledge about drugs and how to use
them
What can we do to improve
drug safety in the elderly –
EMA geriatric medicines strategy
• Ensuring that medicines used by geriatric patients are of
high quality, and appropriately researched and
evaluated, throughout the lifecycle of the product, for use
in this population
• Improving the availability of information on the use of
medicines for older people, thereby helping informed
prescription
• Establishing specific pharmacovigilance activities
EMA continued
• Establishment of an Advisory Group on
Geriatrics
• Interaction with stakeholders
What can we do to improve drug safety in
the elderly
Pre- and postgraduate education on drugs
and their use especially in the elderly
should be strengthened and given not only
to medical students, physicians and
pharmacists but also to nurses and other
health and social welfare personnel.
What can we do to improve
drug safety in the elderly
As responsible physician• Have a comprehensive view – se the whole patient as a
part of whole
• Self-care and non-pharmacological treatment always
comes first
• The drug-list is the medical record for drugs and it should
always be updated and correct
• Team work – use all competencies
What can we do to improve drug safety in the elderly Prescribers
•
When meeting the patient – Identify the patient`s need of treatment – diagnosis
important
•
Symptoms can be adverse reactions to drugs
•
Record which other drugs the patient is using
•
Evaluate what has to be prescribed – make a benefit risk assessment, is there any
medication which should be stopped
•
Which dosage and administration form is appropriate
•
Make a plan for the treatment, when to meet for a follow-up of the effects of the
treatment and discuss this with the patient or her or his carer
•
Report adverse reactions if they occur
What can we do to improve drug safety in
the elderly
Pharmacies
Information in agreement with the
prescribing physicians
What can we do to improve drug safety in
the elderly
Consumers
• The elderly and their informal carers should obtain clear information
about the effects of drugs on the elderly
and
• Patients or their informal carers should always ask the prescribing
physician:
Why the drugs are being prescribed,
Is the dosage right - have you checked the kidney function
How should the drugs be taken and for how long.
Can the drugs used together with herbal medicines.
Which adverse reactions can occur
What to do when adverse reactions are suspected.
Adverse reactions to drugs is not a new
phenomenon but we should do all we can
to prevent it and there is much we can do
• Mencius 100 B.C If a drug does not cause
reactions in a patient it will not cure his disease
either
• Ovidius 9 A C. The same drug both makes harm
and cures
Thank you for your attention
.