Mukhtar Omar, Jackson Stephen H D
King's Health Partners, King's College Hospital, London, UK
Department of Clinical Gerontology, King's Health Partners, King's College Hospital, London, UK.
Clin Med (Lond). 2015 Feb;15(1):47-53. doi: 10.7861/clinmedicine.15-1-47.
Prescribing for older adults represents a significant challenge as the UK population ages. Physiological decline and the rising prevalence of frailty increase the likelihood of altered pharmacodynamics and pharmacokinetics, suboptimal prescribing and adverse effects among this growing cohort of the population. In the first of two articles, we begin by considering these issues and posit four key questions which should be considered when prescribing for older adults. Does this agent reflect the priorities of the patient? Are there alternatives - with greater efficacy, effectiveness or tolerability - that might be considered? Are the dose, frequency and formulation appropriate? How does this prescription relate to concurrent medication? We also describe current drug therapies in two disease states with a predilection for older adults: Alzheimer's disease (AD) and osteoporosis. Using these examples we highlight the limitations of evidence-based medicine and guidelines in this cohort of the population, illustrating the reliance on sub-group analysis to demonstrate the efficacy of drug therapies for older adults in osteoporosis and the underutilisation of appropriate treatments for patients with AD as a result of flawed guidelines.
随着英国人口老龄化，为老年人开处方是一项重大挑战。生理机能衰退和虚弱发生率的上升，增加了这一不断增长的人群中药物动力学和药效学改变、处方不当及出现不良反应的可能性。在两篇文章的第一篇中，我们首先考虑这些问题，并提出在为老年人开处方时应考虑的四个关键问题。这种药物是否反映了患者的优先需求？是否有疗效更高、效果更好或耐受性更佳的替代药物可供考虑？剂量、用药频率和剂型是否合适？这一处方与同时服用的其他药物有何关联？我们还描述了两种在老年人中高发的疾病状态下的当前药物疗法：阿尔茨海默病（AD）和骨质疏松症。通过这些例子，我们强调了循证医学和指南在这一人群中的局限性，说明了在骨质疏松症中依靠亚组分析来证明药物疗法对老年人的疗效，以及由于有缺陷的指南导致AD患者未充分使用适当治疗方法的情况。
