Adverse Consequences of Drug Use in the Elderly

Although drug therapy often results in beneficial effects and improves functional status, adverse consequences of pharmacotherapy are a major patient safety concern, especially in the growing older population '.In the well-known report 'To err is human: building a safer health care system'', it was brought forward that a substantial number of patients is harmed by adverse drug events in medical care. This report placed patient safety and drug safety on the international agenda and was the basis for many policy and health care initiatives to make health care safer. Apart from the vulnerability of a patient to develop an adverse drug reaction, drug safety has several aspects, among which are deficient product quality, quality of prescribing and administration, and patient compliance. In this thesis, we focus on the quality of prescribing and on adverse consequences of pharmacotherapy in the elderly, because in the aging western countries this is a vulnerable patient group of increasing importance. In view of multiple co-morbidity, changes in pharmacokinetics and pharmacodynamics and concomitant use of several drugs simultaneously (polypharmacy), elderly people are at increased risk of drug-related problems. Moreover, several studies on drug utilisation and quality of prescribing in elderly patients have demonstrated high levels of drug use and a considerable number of patients receiving inappropriate medications. lnappropriate medication use for older adults can be defined as medication use for which the potential harm outweighs the potential benefit and for which a good alternative is available. This alternative could be the prescribing of an other (safer) drug or prescribing a drug in a lower (geriatric) dose, in order to decrease the risk of adverse drug events in this vulnerable group.

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