Medications and the Older Adult

VickyRN, MSN, DNP, RN · Dec 28, 2006

polypharmacy: keeping the elderly safe

because they take more medications than younger patients, the elderly have a higher risk of adverse reactions. here's how to help your older patients avoid trouble.

if your elderly patient takes several medications at the same time, he's at high risk for drug-related problems.1 elderly patients are particularly susceptible to polypharmacy issues not only because aging affects how their body handles medications, but because they take more medications than younger patients: in the united states, people over 65 make up approximately 13% of the population but use about 30% of all prescriptions written.2 at any given time, an elderly patient takes, on average, four or five prescription drugs and two over-the-counter (otc) medications.3

an elderly patient is also more likely to be taking a medication that has been prescribed inappropriately--one that's unnecessary, ineffective, or potentially dangerous--and to suffer an adverse drug event (ade). in a study of more than 150,000 elderly patients, 29% had received at least one of 33 potentially inappropriate drugs.4 a study of approximately 27,600 medicare patients documented more than 1,500 ades in a single year.5

most ades are the result of drug interactions; the more drugs a patient takes, the higher the risk of interactions.6 the estimated incidence of drug interactions rises from 6% in patients taking two medications a day to as high as 50% in patients taking five a day.7

as the elderly population in the united states continues to grow, so will the incidence of ades. you can help your elderly patients avoid the negative consequences of polypharmacy by understanding how aging affects the body's reaction to medications, which drugs are the most problematic for older patients, and how to spot a drug-related problem and intervene.

polypharmacy: keeping the elderly safe - rnweb

VickyRN, MSN, DNP, RN · Dec 29, 2006

august, 2005 - risperdal warning - increased mortality in elderly patients with dementia

in accordance with an fda request to add warning information to all atypical antipsychotics, janssen has issued a "dear healthcare professional" letter about a new warning for their atypical antipsychotic risperidone (risperdal, risperdal consta). the new warning follows postmarketing studies that showed an increase in mortality in elderly patients with dementia who were treated with atypical antipsychotics versus a placebo group. a black box warning will appear in the prescribing information (pi) noting that elderly patients with dementia are at an increased risk of death when taking atypical antipsychotics. the box also notes that risperidone isn't approved for patients with dementia-related psychoses.

elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. analyses of seventeen placebo controlled trials (modal duration of 10 weeks) in these patients revealed a risk of death in the drug-treated patients of between 1.6 to 1.7 times that seen in placebo-treated patients. over the course of a typical 10 week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. risperdal(risperidone) is not approved for the treatment of patients with dementia-related psychosis.

ndhnow.com - drug updates - risperidone

http://www.fda.gov/medwatch/safety/2005/aug_pi/risperdal_oral_pi.pdf

note: the same warning exists for seroquel:

ndhnow.com - drug updates - quetiapine fumarate