老年人的药物管理

Arduino A. Mangoni, Elzbieta A. Jarmuzewska
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引用次数: 0

摘要

老年人是世界上最大的药物消费群体,他们实际上被排除在调查药物有效性和安全性的临床试验之外。鉴于老年人群中不断增加的药物暴露和药物不良反应(adr)的高风险,因此缺乏关于药物对老年人群影响的有力证据令人担忧。此外,许多与年龄相关的药代动力学变化和体内平衡能力的个体间变异性表明,将在年轻和健康参与者中进行的试验的证据转化为老年患者的常规管理时要谨慎。已经开发了一些决策工具,以防止老年人的不当处方和多种用药;然而,需要进一步的研究来证明其广泛的临床应用是合理的。传统的以疾病为中心的终点的作用基于客观的反应标志,可能还需要重新审视和补充自我评估健康的措施,特别是在可能身体虚弱或生活质量较差的老年患者中。本文概述了老年人的药物管理,特别是与处方、多种药物和不适当药物使用的趋势有关,以及决策工具的发展,这些工具可能促进老年人的个性化治疗计划。
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Medication management in older adults

Older adults, the largest medication consumer group worldwide, are virtually excluded from participating in clinical trials that investigate the efficacy and safety of drugs. The consequent lack of robust evidence regarding the effects of medicines in the older population is concerning in view of the ever-increasing medication exposure and the high risk of adverse drug reactions (ADRs) in this group. Furthermore, a number of age-related alterations in pharmacokinetics and the inter-individual variability in homeostatic capacity suggest caution when translating the evidence from trials conducted in younger and healthier participants into the routine management of older patients. Several decision tools have been developed to prevent inappropriate prescribing and polypharmacy in older adults; however, additional research is warranted to justify their widespread clinical use. The role of traditional disease-centered end points, based on objective markers of response, might also need revisiting and complementation with measures of self-rated health, particularly in older patients who may also be frail or have a poor quality of life. This article provides an overview of medication management in older adults, particularly in relation with trends in prescribing, polypharmacy and inappropriate medication use, and the development of decision tools that might facilitate an individualized therapeutic plan in this group.

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