Meeting Commentary-“Medicines for Older Adults: Learning from practice to develop patient centric drug products” (original) (raw)
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British Journal of Clinical Pharmacology, 2022
Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper ‘Pharmaceutical development of medicines for use in the older population’, which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Top...
Geriatric drug therapy: Neglecting the inevitable majority
Ageing Research Reviews, 2010
Demographic evolution will considerably increase the number of people aged 65 years and beyond in the coming decades. The elderly not only represent the most heterogeneous population, but also are a major user group for prescribed medicines, a predominance that will continue to further increase. Medicines and medication management are much more complex and challenging in the elderly and can only be addressed through a multidisciplinary approach.
Public engagement workshop: How to improve medicines for older people?
International Journal of Pharmaceutics, 2014
Public engagement in medication management has become more and more important in promoting population health. A public engagement workshop attended by 78 members of the geriatric community, family carers as well as professionals from academic research, industry and regulatory agencies entitled 'How to improve medicines for older people?' took place on the 2nd July 2013 at the University College London (UCL) School of Pharmacy. The main aim of the event was to provide a dynamic environment for information exchange and to identify ways of improving current and future geriatric drug therapy. The day opened with presentations from UCL School of Pharmacy researchers on the use of medicines at home, formulations, administration devices and multi-component compliance aids (MCAs) whilst a representative from UCL Interaction Centre gave an insightful presentation on human errors and resilience strategies regarding medication use. These opening presentations encouraged participants to share their own experiences as well as initiating a lively debate. Following the plenary presentations, the workshop was divided into 8 groups for parallel discussion session. These opinion sharing sessions witnessed fruitful discussions between patients, carers and researchers. The day closed with a panel session of representatives from the European Medicines Agency (EMA), the Medicines and Healthcare products Regulatory Agency (MHRA), the Geriatric Medicines Society and Guy's and St. Thomas' NHS Foundation Trust (GSTT). Participants were encouraged to voice their questions, concerns and recommendations about medications. The main concern expressed by both patients and carers from the workshop were (but are not limited to) formulation changes, MCA accessibility difficulties, interactions of different medicines, carers' concerns with the administration of medicines and not having enough knowledge of services provided by community pharmacists i.e. medicines use reviews (MURs) or new medicine service (NMS). Overall, this workshop created a useful forum for members of the geriatric community, their carers as well as research and industrial professionals to have an input in the improvement and management of geriatric drug therapy and this event also provided an excellent opportunity for the researchers to share the latest research innovations with attendees.
Drug treatment in an ageing population: Practical implications
Maturitas, 2010
The population of the industrialised nations is ageing. By 2020 those of 65 years and older will constitute nearly 17% of the US population; it is predicted that the proportion of the population aged 80 years and over will then range from 3.5 to 6.5%, around the world [1]. Those over 65, due to age-related chronic disease and more prophylactic prescribing, receive a disproportionate number of drugs; in the UK for example, 45% of the total prescriptions dispensed [2]. Older patients may benefit from prophylactic treatments to a greater extent than younger people because of a higher absolute risk of disease and it is therefore important that they are not inappropriately denied these. However, it is also important that, as each additional drug prescribed brings an increased risk of an adverse drug effect, prescribers have enough knowledge of pharmacological issues in old age to enable them to weigh up these conflicting pressures to arrive at good prescribing decisions.
Medication Management in Older Adults
Springer eBooks, 2010
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Pharmaceutics
A meeting organised by the Academy of Pharmaceutical Sciences focussed on the challenges of developing medicines for older adults. International experts discussed the complexity introduced by polypharmacy and multiple morbidities and how the risk–benefit ratio of a medicine changes as an individual ages. The way in which regulatory authorities are encouraging the development of age-appropriate medicines was highlighted. Examples were provided of the difficulties faced by the older population with some medicinal products and suggestions given as to how the pharmaceutical scientist can build the requirements of the older population into their development of new medicines, as well as improvements to existing ones.
Australian family physician, 2004
Prescribing medications to older people is difficult due to comorbidity, limited evidence for efficacy, increased risk of adverse drug reactions, polypharmacy, and altered pharmacokinetics. This article describes the principles underlying clinical geriatric pharmacology including approaches to evaluating the evidence for risk and benefit, and adjusting dose for age related pharmacokinetic changes. The challenge for the general practitioner is to balance an incomplete evidence base for efficacy in frail, older people against the problems related to adverse drug reactions without denying older people potentially valuable pharmacotherapeutic interventions.
BMJ, 2008
About a fifth of the population in the United Kingdom is 60 years or older, 1 yet people in this age group receive 59% of dispensed prescriptions and account for more than half of NHS drug costs. 2 Older people often have several coexisting medical problems and take multiple drugs. Increasing age is associated with changes in pharmacokinetics and pharmacodynamics, so prescribing in this age group can be problematic. 3 Many randomised controlled trials involving older patients focus on managing a single disease state, such as hypertension or osteoporosis, but people in this age group often have many interacting conditions and are taking many drugs, so guidance on their treatment often has to be based on consensus and involves extrapolating data derived from healthier patients. This review highlights some of the difficulties in prescribing in older patients and offers guidance for appropriate prescribing. Sources and selection criteria We searched the National Library for Health, PubMed, and Embase databases using the keywords "elderly" and "prescribing", including synonyms by the MeSH or major descriptor headings. Our search was limited to studies undertaken in humans that were published in English during the past five years. We displayed abstracts of interest using Abstract Plus before obtaining the full text of articles of interest. In addition, we searched the Cochrane Library and our own personal archives of references What physiological changes occur with ageing? Pharmacokinetic and pharmacodynamic changes With age the body undergoes several changes that can affect the distribution, metabolism, and excretion of drugs. These changes included a reduction in renal clearance, liver size, and lean body mass. 4 Hepatic enzyme activity and serum albumin may also be reduced in the presence of chronic disease. The most clinically important of these changes is the reduction in renal clearance, which results in reduced excretion of water soluble drugs. This is especially important for drugs with a narrow therapeutic window (ratio of desired effect to toxic effect), such as digoxin, lithium, and gentamicin. Box 1 Guidelines for good prescribing in elderly patients Carry out a regular medication review and discuss and agree all changes with the patient Stop any current drugs that are not indicated Prescribe new drugs that have a clear indication If possible, avoid drugs that have known deleterious effects in elderly patients, such as benzodiazepines, and recommend dosage reduction when appropriate Use the recommended dosages for elderly patients Use simple drug regimens and appropriate administration systems Consider using once daily or once weekly formulations and using fixed dose combinations when possible Consider non-pharmacological treatments if appropriate Limit the number of people prescribing for each patient if possible Where possible, avoid treating adverse drug reactions with further drugs