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Medications and Oral Health: Points to Consider in Older People

  • Mirko PetrovicEmail author
  • Barbara Janssens
Chapter
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Part of the Practical Issues in Geriatrics book series (PIG)

Abstract

This chapter describes the increase of chronic illness, multimorbidity, care dependency, and related polypharmacy as a consequence of ageing. Moreover, a focus has been put on drug-related oral health problems since clear associations have been found between the medication intake and the oral status of older people. Prescribing physicians must be aware of the potential oral complications caused by medications in order to be able to develop an appropriate and tailored treatment plan that also considers oral health-related complications. Approaches to identify potential drug-related problems and to optimize medication use comprise medication reconciliation followed by medication review and criteria to assess quality of prescribing, preferably incorporated in computer-based prescribing systems and as a part of comprehensive geriatric assessment (CGA) and management.

Taking into consideration the differences in life expectancy, and in order to provide an integrated plan for treatment, rehabilitation, support and long-term care, CGA and assessment of multimorbidity are assumed to distinguish between three groups of older patients, i.e. fit, vulnerable, and frail.

Keywords

Older people Multimorbidity Polypharmacy Drug-related oral health problems Comprehensive Geriatric Assessment 

References

  1. 1.
    Stewart R, Cooper J. Polypharmacy in the aged. Practical solutions. Drugs Aging. 1994;4:449–61.PubMedCrossRefGoogle Scholar
  2. 2.
    van den Bemt P, Egberts A, Lenderink A, Verzijl J, Simons K, van der Pol W, et al. Risk factors for the development of adverse drug events in hospitalized patients. Pharm World Sci. 2000;22:62–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Hajjar E, Hanlon J, Artz M, Lindblad C, Pieper C, Sloane R, et al. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother. 2003;1:82–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Field T, Gurwitz J, Avorn J, McCormick D, Jain S, Eckler M, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161:1629–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Field T, Gurwitz J, Harrold L, Rothschild J, Debellis K, Seger A, et al. Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc. 2004;52:1349–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Lund B, Carnahan R, Egge J, Chrischilles E, Kaboli P. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44:957–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Steinman M, Landefeld C, Rosenthal G, Berthenthal D, Sen S, Kaboli P. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54:1516–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Page R, Linnebur S, Bryant L, Ruscin M. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75–87.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Hajjar E, Cafiero A, Hanlon J. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:314–6.CrossRefGoogle Scholar
  10. 10.
    Goldberg R, Mabee J, Chan L, Wong S. Drug-drug and drug disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med. 1996;14:447–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990;150:841–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Petrovic M, Gnjidic D, Tommelein E, Boussery K. Pharmacotherapy. In: Roller-Wirnsberger R, Singler K, Polidori MC, editors. Learning geriatric medicine: a study guide for medical students. Cham: Springer International Publishing AG; 2018. p. 219–35.CrossRefGoogle Scholar
  13. 13.
    Laroche ML, Charmes JP, Marcheix A, Bouthier F, Merle L. Estimation of glomerular filtration rate in the elderly: Cockcroft-Gault formula versus modification of diet in renal disease formula. Pharmacotherapy. 2006;26:1041–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Page R, Linnebur S, Bryant L, et al. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75–87.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Kinirons MT, Crome P. Clinical pharmacokinetic considerations in the elderly: an update. Clin Pharmacokinet. 1997;33:302–12.PubMedCrossRefGoogle Scholar
  16. 16.
    Mayersohn M. Pharmacokinetics in the elderly. Environ Health Perspect. 1994;102(Suppl. 11):119–24.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Klotz U, Avant G, Hoyumpa A, Schenker S, Wilkinson G. The effects of age and liver disease on the disposition and elimination of diazepam in adult man. J Clin Invest. 1975;55:347–59.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Swift C. Pharmacodynamics: changes in homeostatic mechanisms, receptor and target organ sensitivity in the elderly. Br Med Bull. 1990;40:36–52.CrossRefGoogle Scholar
  19. 19.
    Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991;114:956–66.PubMedCrossRefGoogle Scholar
  20. 20.
    Barat I, Andreasen F, Damsgaard EM. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol. 2001;51:615–22.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Lindley C, Tully M, Paramsothy V, Tallis R. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing. 1992;21:294–300.PubMedCrossRefGoogle Scholar
  22. 22.
    Janssens B, Petrovic M, Jacquet W, Schols J, Vanobbergen J, De Visschere L. Medication use and its potential impact on the oral health status of nursing home residents in Flanders (Belgium). J Am Med Dir Assoc. 2017;18:809.e1–8.CrossRefGoogle Scholar
  23. 23.
    Singh M, Papas A. Oral implications of polypharmacy in the elderly. Dent Clin N Am. 2014;58:783–96.PubMedCrossRefGoogle Scholar
  24. 24.
    Xu F, Laguna L, Anwesha S. Aging-related changes in quantity and quality of saliva: where do we stand in our understanding? J Texture Stud. 2019;50:27–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Das P, Challacombe S. Dry mouth and clinical oral dryness scoring systems. Prim Dent J. 2016;5:77–9.PubMedGoogle Scholar
  26. 26.
    Affo R, Foley N, Garrick R, Siqueira W, Martin R. Meta-analysis of salivary flow rates in young and older adults. J Am Geriatr Soc. 2015;63:2142–51.CrossRefGoogle Scholar
  27. 27.
    Navazesh M, Christensen C, Brightman V. Clinical criteria for the diagnosis of salivary gland hypofunction. J Dent Res. 1992;71:1363–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Amerongen AV, Veerman EC. Saliva—the defender of the oral cavity. Oral Dis. 2002;8:12–22.PubMedCrossRefGoogle Scholar
  29. 29.
    Vissink A, Spijkervet FK, Van Nieuw Amerongen A. Aging and saliva: a review of the literature. Spec Care Dentist. 1996;16:95–103.PubMedCrossRefGoogle Scholar
  30. 30.
    Smidt D, Torpet L, Nauntofte B, Heegaard K, Pedersen A. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2011;39:276–88.PubMedCrossRefGoogle Scholar
  31. 31.
    Smidt D, Torpet L, Nauntofte B, Heegaard K, Pedersen A. Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2010;38:422–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Turner M, Ship J. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138(Suppl):15S–20S.PubMedCrossRefGoogle Scholar
  33. 33.
    Balakumar P, Kavitha M, Nanditha S. Cardiovascular drugs-induced Oral toxicities: a murky area to be revisited and illuminated. Pharmacol Res. 2015;102:81–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Yuan A, Woo S. Adverse drug events in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:35–47.PubMedCrossRefGoogle Scholar
  35. 35.
    Boulinguez S, Reix S, Bedane C, Debrock C, Bouyssou-Gauthier ML, Sparsa A, Le Brun V, De Vencay P, Bernard P, Bonnetblanc J. Role of drug exposure in aphthous ulcers: a case-control study. Br J Dermatol. 2000;143:1261–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Siegel M, Balciunas B. Medication can induce severe ulcerations. J Am Dent Assoc. 1991;122:75–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Healy C, Thornhill M. An association between recurrent oro-genital ulceration and non-steroidal anti-inflammatory drugs. J Oral Pathol Med. 1995;24:46–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Goffin E, Pochet J, Lejuste P, De Plaen J. Aphtous ulcers of the mouth associated with losartan. Clin Nephrol. 1998;50:197.PubMedGoogle Scholar
  39. 39.
    Susser W, Whitaker-Worth D, Grant-Kels J. Mucocutaneous reactions to chemotherapy. J Am Acad Dermatol. 1999;40:367–98.PubMedCrossRefGoogle Scholar
  40. 40.
    Logan R, Stringer A, Bowen J, Gibson R, Sonis S, Keefe D. Is the pathobiology of chemotherapy-induced alimentary tract mucositis influenced by the type of mucotoxic drug administered? Cancer Chemother Pharmacol. 2009;63:239–51.PubMedCrossRefGoogle Scholar
  41. 41.
    Sonis S. Regimen-related gastrointestinal toxicities in cancer patients. Curr Opin Support Palliat Care. 2010;4:26–30.PubMedCrossRefGoogle Scholar
  42. 42.
    Ciancio S. Medications’ impact on oral health. J Am Dent Assoc. 2004;135:1440–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Edwards PC, Kelsch R. Oral lichen planus: clinical presentation and management. J Can Dent Assoc. 2002;68:494–9.PubMedGoogle Scholar
  44. 44.
    Lavanya N, Jayanthi P, Rao U, Ranganathan K. Oral lichen planus: an update on pathogenesis and treatment. J Oral Maxillofac Pathol. 2011;15:127–32.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Coulter D. Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of postmarketing surveillance. Br Med J (Clin Res Ed). 1988;296:1086–8.CrossRefGoogle Scholar
  46. 46.
    Boyd I. Captopril-induced taste disturbance. Lancet. 1993;342:304.PubMedCrossRefGoogle Scholar
  47. 47.
    Heeringa M, van Puijenbroek E. Reversible dysgeusia attributed to losartan. Ann Intern Med. 1998;129:72.PubMedCrossRefGoogle Scholar
  48. 48.
    Tsuruoka S, Wakaumi M, Ioka T, Yamamoto H, Ando H, Sugimoto K, Fujimura A. Angiotensin II receptor blocker-induces blunted taste sensitivity: comparison of candesartan and valsartan. Br J Clin Pharmacol. 2005;60:204–7.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Sadasivam B, Jhaj R. Dysgeusia with amlodipine—a case report. Br J Clin Pharmacol. 2007;63:253.PubMedCrossRefGoogle Scholar
  50. 50.
    Ackerman B, Kasbekar N. Disturbances of taste and smell induced by drugs. Pharmacotherapy. 1997;17:482–96.PubMedGoogle Scholar
  51. 51.
    Maier C. Life-threatening postoperative angioedema following treatment with an angiotensin converting enzyme inhibitor. Anaesthesist. 1995;44:875–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Hall R. Angioedema and ACE inhibitors. Periodont Insights. 1998;5:6–7.Google Scholar
  53. 53.
    Israili Z, Hall W. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med. 1992;117:234–42.PubMedCrossRefGoogle Scholar
  54. 54.
    Chin H, Buchan D. Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor. Ann Intern Med. 1990;112:312–3.PubMedCrossRefGoogle Scholar
  55. 55.
    Campbell D, Krum H, Esler M. Losartan increases bradykinin levels in hypertensive humans. Circulation. 2005;111:315–20.PubMedCrossRefGoogle Scholar
  56. 56.
    Lo K. Angioedema associated with candesartan. Pharmacotherapy. 2002;22:1176–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Irons B, Kumar A. Valsartan-induced angioedema. Ann Pharmacother. 2003;37:1024–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Nykamp D, Winter E. Olmesartan medoxomil-induced angioedema. Ann Pharmacother. 2007;41:518–20.PubMedCrossRefGoogle Scholar
  59. 59.
    ONTARGET Investigators, Yusuf S, Teo K, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, Anderson C. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–59.CrossRefGoogle Scholar
  60. 60.
    Jagadeesh G, Balakumar P, Stockbridge N. How well do aliskiren’s purported mechanisms track its effects on cardiovascular and renal disorders? Cell Signal. 2012;24:1583–91.PubMedCrossRefGoogle Scholar
  61. 61.
    Southward J, Irvine E, Rabinovich M. Probable amlodipine-induced angioedema. Ann Pharmacother. 2009;43:772–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Pierce W, Hederman A, Gordon C, Ostrenga A, Herrington B. Angioedema associated with dihydropyridine calcium-channel blockers in a child with Burkitt lymphoma. Am J Health Syst Pharm. 2011;68:402–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Ruscin J, Page R 2nd, Scott J. Hydrochlorothiazide-induced angioedema in a patient allergic to sulphonamide antibiotics: evidence from a case report and a review of the literature. Am J Geriatr Pharmacother. 2006;4:325–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Nisly S, Kara A, Knight T. Simvastatin: a risk factor for angioedema? J Pharm Technol. 2013;29:149–52.CrossRefGoogle Scholar
  65. 65.
    Hampson J, Smith D, Cowell R, Baker A. Hypotension and eosinophilia with atorvastatin. Pharm World Sci. 2005;27:279–80.PubMedCrossRefGoogle Scholar
  66. 66.
    Rees S, Gibson J. Angioedema and swellings of the orofacial region. Oral Dis. 1997;3:39–42.PubMedCrossRefGoogle Scholar
  67. 67.
    Dongari-Bagtzoglou A, Research, Science and Therapy Committee, American Academy of Periodontology. Drug-associated gingival enlargement. J Periodontol. 2004;75:1424–31.PubMedCrossRefGoogle Scholar
  68. 68.
    Sam G, Sebastian S. Nonsurgical management of nifedipine induced gingival overgrowth. Case Rep Dent. 2014;2014:741402.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Bhatia V, Mittal A, Parida A, Talwar R, Kaul U. Amlodipine induced gingival hyperplasia: a rare entity. Int J Cardiol. 2007;122:e23–4.PubMedCrossRefGoogle Scholar
  70. 70.
    Young P, Turiansky G, Sau P, Liebman M, Benson P. Felodipine-induced gingival hyperplasia. Cutis. 1998;62:41–3.PubMedGoogle Scholar
  71. 71.
    Maguin B, Yachouh J, Goudot P. Nicardipine-induced gingival hyperplasia: case report. Rev Stomatol Chir Maxillofac. 2004;105:219–21.PubMedCrossRefGoogle Scholar
  72. 72.
    Brown R, Sein P, Corio R, Bottomley W. Nitrendipine-induced gingival hyperplasia. First case report. Oral Surg Oral Med Oral Pathol. 1990;70:593–6.PubMedCrossRefGoogle Scholar
  73. 73.
    Hall W. Dilantin hyperplasia: a preventable lesion? Compend Suppl. 1990;14:S502–5.Google Scholar
  74. 74.
    Ciancio S, Yaffe S, Catz C. Gingival hyperplasia and diphenylhydantoin. J Periodontol. 1972;43:411–4.PubMedCrossRefGoogle Scholar
  75. 75.
    Nakade O, Baylink D, Lau K. Phenytoin at micromolar concentrations is an osteogenic agent for human-mandible-derived bone cells in vitro. J Dent Res. 1995;74:331–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Ellis J, Seymour R, Steele J, Robertson P, Butler T, Thomason J. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. J Periodontol. 1999;70:63–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Nishikawa S, Tada H, Hamasaki A, Kasahara S, Kido J, Nagata T, Ishida H, Wakano Y. Nifedipine-induced gingival hyperplasia: a clinical and in vitro study. J Periodontol. 1991;62:30–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Seymour R, Smith D. The effect of a plaque control programme on the incidence and severity of cyclosporin-induced gingival changes. J Clin Periodontol. 1991;18:107–10.PubMedCrossRefGoogle Scholar
  79. 79.
    Ortín M, Olalla JI, Muruzábal MJ, Peralta FG, Gutiérrez MA. Miconazole oral gel enhances acenocoumarol anticoagulant activity: a report of three cases. Ann Pharmacother. 1999;33:175–7.PubMedCrossRefGoogle Scholar
  80. 80.
    Sindet-Pedersen S, Ramström G, Bernvil S, Blombäck M. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med. 1989;320:840–3.PubMedCrossRefGoogle Scholar
  81. 81.
    Farhat G, Yamout B, Mikati M, Demirjian S, Sawaya R, El-Hajj Fuleihan G. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology. 2002;58:1348–53.PubMedCrossRefGoogle Scholar
  82. 82.
    Salvatore R, Dodson T, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg. 2014;72:1938–56.CrossRefGoogle Scholar
  83. 83.
    Gaudin E, Seidel L, Bacevic M, Rompen E, Lambert F. Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. J Clin Periodontol. 2012;42:922–32.CrossRefGoogle Scholar
  84. 84.
    Diniz-Freitas M, Limeres J. Prevention of medication-related osteonecrosis of the jaws secondary to tooth extractions. A systematic review. Med Oral Patol Oral Cir Bucal. 2016;21:e250–9.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: a review. J Pharm Bioallied Sci. 2015;7(Suppl 2):S403–8.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Anil Kumar N, Divya P. Adverse drug effects in mouth. Int J Med Appl Sci. 2015;4:82–91.Google Scholar
  87. 87.
    Onder G, van der Cammen T, Petrovic M, Somers A, Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42:284–91.PubMedCrossRefGoogle Scholar
  88. 88.
    Agency for Healthcare Research and Quality U.S. Department of Health and Human Services; 2012. https://www.ahrq.gov/sites/default/files/publications/files/match.pdf. Accessed 8 Dec 2019.
  89. 89.
  90. 90.
    Kaufmann C, Tremp R, Hersberger K, Lampert M. Inappropriate prescribing: a systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014;70:1–11.PubMedCrossRefGoogle Scholar
  91. 91.
    Tommelein E, Petrovic M, Somers A, Mehuys E, van der Cammen T, Boussery K. Older patients’ prescriptions screening in the community pharmacy: development of the Ghent older People’s prescriptions community pharmacy screening (GheOP3S) tool. J Public Health (Oxf). 2016;38:e158–70.CrossRefGoogle Scholar
  92. 92.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor M, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8.PubMedCrossRefGoogle Scholar
  93. 93.
    American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.CrossRefGoogle Scholar
  94. 94.
    Renom Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71:861–75.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Spinewine A, Schmader KE, Barber N, Hughes C, Lapane K, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173–84.PubMedCrossRefGoogle Scholar
  96. 96.
    Beers M, Ouslander J, Rollingher I, Reuben D, Brooks J, Beck J. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825–32.PubMedCrossRefGoogle Scholar
  97. 97.
    American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616–31.CrossRefGoogle Scholar
  98. 98.
    Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.PubMedCrossRefGoogle Scholar
  99. 99.
    Hanlon J, Schmader K, Samsa G, Weinberger M, Uttech K, Lewis I, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045–51.PubMedCrossRefGoogle Scholar
  100. 100.
    Somers A, Mallet L, van der Cammen T, Robays H, Petrovic M. Applicability of an adapted medication appropriateness index for detection of drug-related problems in geriatric inpatients. Am J Geriatr Pharmacother. 2012;10:101–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Vander Walde N, Jagsi R, Dotan E, Baumgartner J, Browner I, Burhenn P, et al. NCCN guidelines insights: older adult oncology, version 2.2013. J Natl Cancer Netw. 2016;14:1357–70.CrossRefGoogle Scholar
  102. 102.
    Stauder R. The challenge of individualised risk assessment and therapy planning in elderly high-risk myelodysplastic syndromes (MDS) patients. Ann Hematol. 2012;91:1333–43.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5:224–37.PubMedCrossRefGoogle Scholar
  104. 104.
    Geriatric Medicine Research, Dalhousie University, Halifax. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html. Accessed 8 Dec 2019.
  105. 105.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173:489–95.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  2. 2.Department of Oral Health Sciences, Special Needs in Oral Health, Gerodontology, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium

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