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Drug Therapy for the Elderly 2012

Elderly people are the main drug consumers in Western societies, as multimorbidity seems to justify a high load of drugs to be supplied to them. People above 65 years of age take an average of five drugs, and this figure increases to almost ten drugs at the age of 75. Serious adverse events (SAE) related to drug use are considered to lead to 100,000 deaths per year in the United States. The primary motivation of doctors resulting in polypharmacy is the treatment of all diagnoses according to the guidelines which recommend three drugs per disease, on average. The mean number of diagnoses at age 80+ is 3.3, leading to ten drugs prescribed to each elderly patient.

As this multimorbidity/polypharmacy challenge apparently leads to therapies which are costly, ineffective and potentially harmful, there is a need to structure drug load reduction approaches. This must be coupled with the enormous and contradictory challenge of undertreated diseases. The DETECT study on the prevalence of hypertension in the Western world, for example, shows that 75% of 75-year-old patients required antihypertensive treatment, but only 20% were sufficiently treated.

The solution is rooted in the skills and experiences which lead medicine in the pre-EBM era. Though the strengths of EBM are indisputable, without evidence-based guidelines applicable to the elderly, careful reasoninig, patient assessment, treatment observation, and integration are the keys to success. Drug Therapy for the Elderly provides the practitioner with:

- Background information on the elderly population regarding their needs for particular drugs (with an eye to frailty, co-morbidity patterns, and special sensitivities regarding drug metabolism and excretion)

- Practical advice about drug treatment surveillance paramters in the elderly

- In-depth discussion of drugs in relation to the elderly with specific diagnoses

- Integration of multimorbidity/polypharmacy situations into prioritization schems

- A plan for how to deal with the complexity of polypharmacy situations in a five-minute consultation

An original classification of drugs is proposed by the editor which relates the power of effects, prognostic data, and tolerability to a prioritization scoring with labels ranging from A (indispensible, clear-cut benefit for efficacy/safety ration proven even in elderly patients for a given indiacation, unanimous morbidity and/or mortality data) to D (avoid in elderly, delete first). Whereas current lists intend to eliminate unsafe drugs for the elderly, this novel approach underlines both indispensable and dispensable elements of drug therapy. This approach is the first to not only provide a negative liesting, but also integrates positive data into an overall assessment for drugs fit for the aged.

The demographic revolution of an aging society will lead to increased pressure to come to a rationalistic and age-tailored process of diagnosing and treating increasingly complex situations in the elderly. Drug Therapy for the Elderly is focused on the most important treatment modality in medicine and serves as a timely reference for a wide array of physicians.