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Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies)

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dc.contributor.authorFialová, Daniela
dc.contributor.authorLaffon, Blanca
dc.contributor.authorMarinkovic, Valentina
dc.contributor.authorTasic, Ljiljana
dc.contributor.authorDoro, Peter
dc.contributor.authorSóos, Gyongyver
dc.contributor.authorMota, Jorge
dc.contributor.authorDogan, Soner
dc.contributor.authorJovana, Brkic
dc.contributor.authorTeixeira, João Paulo
dc.contributor.authorValdiglesias, Vanessa
dc.contributor.authorCosta, Solange
dc.contributor.authorEUROAGEISM H2020 project and WG1b group “Healthy clinical strategies for healthy aging” of the EU COST Action IS 1402
dc.date.accessioned2019-03-06T13:05:42Z
dc.date.available2019-03-06T13:05:42Z
dc.date.issued2019-01
dc.description.abstractIntroduction: The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the “age-blind” approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. Methodology: A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). Results: Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. Conclusion: Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.pt_PT
dc.description.sponsorshipThe work has been supported by the EU COST Action IS1402 initiative BAgeism - a multi-national, interdisciplinary perspective^ (2015–2018), the EUROAGEISM H2020 project no. 764632, Horizon 2020-MSCA-ITN -764632 (2017–2021), and by the scientific program PROGRESS Q42 at the Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Czech Republic.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationEur J Clin Pharmacol. 2019 Jan 4. doi: 10.1007/s00228-018-2603-5. [Epub ahead of print]pt_PT
dc.identifier.issn0031-6970
dc.identifier.urihttp://hdl.handle.net/10400.18/6071
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectDrug Prescribingpt_PT
dc.subjectOlder Patientspt_PT
dc.subjectAgeismpt_PT
dc.subjectFrailtypt_PT
dc.subjectAge-related Changespt_PT
dc.subjectPotentially Inappropriate Medicationspt_PT
dc.subjectPolypharmacypt_PT
dc.subjectObservational Studiespt_PT
dc.subjectRandomized Controlled Trialspt_PT
dc.titleMedication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies)pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleEuropean Journal of Clinical Pharmacologypt_PT
rcaap.rightsembargoedAccesspt_PT
rcaap.typearticlept_PT

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