Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
Department of Medicine, University College Cork, Cork, Ireland.
Age Ageing. 2022 Feb 2;51(2). doi: 10.1093/ageing/afab269.
With population ageing, the number of older people is growing, which results in increasing number of people with multimorbidity and related polypharmacy. Polypharmacy in its turn leads to drug-related problems (DRPs) and potentially inappropriate prescribing (IP) in older people. In this commentary, susceptibility of older people to DRPs due to changes in pharmacokinetics and pharmacodynamics, plurality of prescribing physicians, inadequate consideration of patients' characteristics, polypharmacy and its consequences such as prescribing cascades, drug interactions and potentially IP have been discussed respectively. Consecutively, identifying DRPs and optimizing of IP, including drug reconciliation, application of criteria for identifying and preventing IP, implementation of computer-based prescribing systems, and comprehensive geriatric assessment and management have been elaborated as well. One of the main challenges regarding appropriate and tailored prescribing in older people is to evaluate whether the expected benefits of pharmacotherapy are bigger than the risks in a population with multimorbidity, decreased tolerance to vulnerability and limited life expectancy. Comprehensive geriatric assessment enables informed prescribing decisions in the context of such variables. A challenge for future research is how to integrate important clinical information obtained by existing methods into a comprehensive and wide-reaching approach targeting all potential factors involved in causing DRPs. Good prescribing in late life accommodates the needs of older patients with multimorbidity. Individualized, interactive, multidisciplinary, and multifaceted approach to geriatric pharmacotherapy should be promoted and encouraged. How to optimize pharmacological prescription in complex older patients is a major legacy of geriatrics to contemporary medicine/medical practice.
随着人口老龄化，老年人的数量不断增加，这导致了更多患有多种疾病和相关多种药物治疗的人。多种药物治疗反过来又导致了老年人的药物相关问题 (DRPs) 和潜在不适当的处方 (IP)。在这篇评论中，分别讨论了老年人由于药代动力学和药效学变化、多名处方医生、对患者特征考虑不足、多种药物治疗及其后果（如处方级联、药物相互作用和潜在的 IP）而容易发生 DRPs。接着，还详细阐述了识别 DRPs 和优化 IP，包括药物重整、应用识别和预防 IP 的标准、实施基于计算机的处方系统，以及全面的老年评估和管理。在老年人中进行适当和量身定制的处方的主要挑战之一是评估药物治疗的预期益处是否大于患有多种疾病、对脆弱性的耐受性降低和预期寿命有限的人群中的风险。全面的老年评估使我们能够在这些变量的背景下做出明智的处方决策。未来研究的挑战之一是如何将现有方法获得的重要临床信息整合到针对导致 DRPs 的所有潜在因素的综合广泛方法中。在生命晚期进行良好的处方可以满足患有多种疾病的老年患者的需求。应提倡和鼓励针对老年药理学治疗的个体化、互动式、多学科和多方面的方法。如何优化复杂老年患者的药物处方是老年医学对当代医学/医疗实践的主要贡献。
