Internal Medicine Department, S. Anna Hospital, Ferrara, Italy.
Drugs Aging. 2009 Dec;26 Suppl 1:41-51. doi: 10.2165/11534650-000000000-00000.
In western countries approximately a quarter of the population is 65 years and older. People in this age group often have several coexisting medical problems and take multiple drugs, and older people receive the greatest proportion of dispensed prescriptions. The prevalence of cardiovascular diseases, the leading cause of death and a major cause of physical and cognitive disability, increases steeply with increasing age. Drugs for the prevention and treatment of cardiovascular conditions account for a large proportion of medication prescription in older persons. Despite a number of published guidelines and expert recommendations supporting a standardized use of many cardiovascular agents, there is growing evidence of a tremendous variability in cardiovascular drug prescriptions according to demographics, health characteristics, and setting of care. In particular, evidence shows an inverse relationship between treatment propensity and age. To date, there is little evidence of benefit of most pharmacotherapy in frail, older subjects or elderly individuals with multiple comorbidities and polypharmacotherapy. However, effective treatment should not be denied solely on the basis of age. A major challenge in geriatric practice is to ensure safe and effective pharmacological treatments, avoiding the risk of polypharmacy and inappropriate drug prescription.
在西方国家，大约有四分之一的人口年龄在 65 岁及以上。这个年龄段的人常常同时患有多种疾病，并服用多种药物，而且老年人所开的处方比例最大。心血管疾病的患病率随着年龄的增长急剧上升，是死亡的主要原因，也是身体和认知功能障碍的主要原因。预防和治疗心血管疾病的药物在老年人的药物处方中占很大比例。尽管有许多已发表的指南和专家建议支持许多心血管药物的标准化使用，但越来越多的证据表明，根据人口统计学、健康特征和护理环境，心血管药物的处方存在巨大的差异。特别是，有证据表明治疗倾向与年龄呈反比关系。迄今为止，大多数在体弱、高龄患者或患有多种合并症和多药治疗的老年人中进行的药物治疗的益处证据有限。然而，不应仅仅基于年龄而拒绝有效的治疗。老年病学实践中的一个主要挑战是确保安全有效的药物治疗，避免多药治疗和不适当的药物处方的风险。
