Skip to main content
SpringerLink
Log in

Drug development in the elderly: problems and constraints

  • Chapter
The Focus for Pharmaceutical Knowledge

  • 14 Accesses

Abstract

The pharmacological treatment of the elderly patient represents a therapeutic problem which, over the last decade, has reached a totally unexpected dimension with important social, medical and economic implications [1,2]. A better understanding of various aetiopathogenic factors and the improvement of therapeutic possibilities are factors which have contributed to a better quality of life and an increase in life expectancy. However, at the same time there has been an increase in the ‘institutionalization’ of the elderly, as well as in the use of agents capable not only of curing illnesses but also of modifying behaviour in ways not always acceptable to the family and/or the community.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Reference

  1. World Health Organization. Health care in the elderly: report of the technical group on use of medicaments by the elderly. Drugs 1981; 22: 279–94.

    Article  Google Scholar 

  2. Royal College of Physicians. Medication for the elderly. J R Coll Physicians Lond 1984; 18: 3–10.

    Google Scholar 

  3. Grundy, E. Demography and old age. J Am Geriatr Soc 1984; 31: 325–32.

    Article  Google Scholar 

  4. Butler, R. N. A changing demography. In: Butler R. N., Bearn, A. G., eds. The Ageing Process: Therapeutic Implications. New York: Raven Press, 1984; 5–18.

    Google Scholar 

  5. Haavisto, M., Geiger, U., Mattila, K., Rajala, S. A health survey of the very aged in Tampere, Finland. Age Ageing 1984; 13: 266–72.

    Article  Google Scholar 

  6. Grundy, E., Arie, T. Institutionalization and the elderly: International comparisons. Age Ageing 1984; 13: 129–37.

    Article  Google Scholar 

  7. Jefferys, M. The elderly in society. In: Brocklehurst, J. C., ed. Textbook of Geriatric Medicine and Gerontology, Edinburgh: Churchill Livingstone, 1978; 763–82.

    Google Scholar 

  8. Insee. Recensement général de la population. Structure de la population totale. Insee, 1985; Série D, No 98.

    Google Scholar 

  9. Hale, W. E., Perkins, L. L., May, F. E., Marks, R. G. et al. Symptom prevalence in the elderly. An evaluation of age, sex, disease, and medication use. J Am Geriatr Soc 1986; 34: 333–40.

    Article  Google Scholar 

  10. Kivelä, S. L. Disability among home-nursed patients and home-help clients. Scand J Soc Med 1985; 13: 75–82.

    Google Scholar 

  11. Magni, G., Shifano, F., de Leo, D. Assessment of depression in an elderly medical population. J Affective Disord 1986; 11: 121–4.

    Article  Google Scholar 

  12. Ravizza, L. Diagnostic and therapeutic problems in the psychopharmacological treatment of the elderly patient. Neuropsychobiology 1986; 15: 15–8.

    Article  Google Scholar 

  13. Brooks, P. M., Kean, W. F., Kassam, Y., Buchanan, W. W. Problems of antiarthritic therapy in the elderly. J Am Geriatr Soc 1984; 32: 229–34.

    Article  Google Scholar 

  14. Lamy, P. P. Renal effects of nonsteroidal anti-inflammatory drugs. Heightened risk to the elderly? J Am Geriatr Soc 1986; 34: 361–7.

    Article  Google Scholar 

  15. Patterson, C. Iatrogenic disease in late life. Clinics in Geriatric Medicine 1986; 2: 121–36.

    Google Scholar 

  16. Moir, D. C., Dingwall-Fordyce, I. Drug taking in the elderly at home. J Clin Exptl Gerontol 1980; 2: 329–12.

    Google Scholar 

  17. Lamy, P. P. Patterns of prescribing and drug use. In: Butler, R. N., Bearn, A. G., eds. The Ageing Process: Therapeutic Implications, New York: Raven Press, 1984; 53–82.

    Google Scholar 

  18. Salzman, C. Polypharmacy and drug interaction in the elderly. In: Nandy, ed. Geriatric Psychopharmacology, North Holland: Elsevier, 117–26.

    Google Scholar 

  19. Black, D. Medication for the elderly. In: Butler, R. N., Bearn, A. G., eds. The Aging Process: Therapeutic Implications, New York: Raven Press, 1984; 299–305.

    Google Scholar 

  20. Shimp, L. A., Ascione, F. J., Glazer, H. M., Atwood, B. F. Potential medication-related problems in noninstitutionalized elderly. Drug Intell Clin Pharm 1985; 19: 766–72.

    Google Scholar 

  21. Williamson, J., Chopin, J. M. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing 1980; 9: 73–80.

    Article  Google Scholar 

  22. Davison. W. Adverse drug reactions in the elderly: general considerations. In: Butler, R. N. and Bearn, A. G., eds. The Aging Process: Therapeutic Implications, New York: Raven Press, 1984; 101–11.

    Google Scholar 

  23. Alexander, R. N., Godwin, J. S., Carrie, C. Comparison of admission and discharge medications in two geriatric populations. J Am Geriatr Soc 1985; 32: 827–32.

    Article  Google Scholar 

  24. Freer, C. B. Study of medicine prescribing for elderly patients. Br Med J 1985; 292: 1113–5.

    Article  Google Scholar 

  25. Shapiro, S., Avery, K. T., Carpenter, R. D. Drug utilization by a non-institutionalized ambulatory elderly population. Gerontology 1986; 2: 99–103.

    Google Scholar 

  26. Hurtwitz, N. Predisposing factors in adverse reactions to drugs. Br Med J 1969; 1: 536–9.

    Article  Google Scholar 

  27. Décamps, A., Dumas, R., Dordain, G., Lavarenne, J. Accidents neuropsychiques d’origine médicamenteuse chez les sujets âgés. Thérapie 1984; 39: 39–46.

    Google Scholar 

  28. Klein, U., Klein, M., Sturm, H. Rothenbühler M., et al. The frequency of adverse drug reactions as dependent upon age, sex and duration of hospitalization. Int J Clin Pharmacol 1976; 13: 187–95.

    Google Scholar 

  29. Pickels, H. Prescriptions, adverse reactions and the elderly. Lancet 1986; 8497: 40–1.

    Article  Google Scholar 

  30. Kelsey, F. O. Investigational new drug trials in geriatric subjects. In: Moore, S. Q., Teal, T. W., eds. Geriatric Drug Use—Clinical and Social Perspectives, New York: Pergamon Press, 1985; 177–81.

    Google Scholar 

  31. Temple, R. Guidelines for studying drugs in the elderly. In: Moore, S. R., Teal, T. W., eds. Geriatric Drug Use. Clinical and Social Perspectives, Oxford: Pergamon Press, 1985; 171–6.

    Google Scholar 

  32. Morgan, B. D., Newton, H. M. V., Schorah, C. J., Jewitt, M. A. et al. Abnormal indices of nutrition in the elderly: a study of different clinical groups. Age Ageing 1986; 15: 65–76.

    Article  Google Scholar 

  33. Lindeman, R. D., Tobin, J., Shock, N. W. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985; 33: 278–85.

    Article  Google Scholar 

  34. Rodeheffer, R. J., Gerstenblith, G., Becker, L. C., Fleg, J. L. et al. Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation 1984; 69: 203–13.

    Article  Google Scholar 

  35. Williams, M. E. Clinical implications of aging physiology. Am J Med 1984; 76: 1049–54.

    Article  Google Scholar 

  36. Docherty, J. R. Aging and the cardiovascular system. J Auton Pharmacol 1986; 6: 77–84.

    Article  Google Scholar 

  37. Brockelhurst, J. C. Aging in the autonomic nervous system. Age Ageing 1975; 4: 7–14.

    Google Scholar 

  38. Pack, A. I., Millman, R. P. Changes in control of ventilation, awake and asleep, in the elderly. J Am Geriatr Soc 1986; 34: 533–4.

    Article  Google Scholar 

  39. Westenend, M., Lenders, J., Thien T. The course of blood pressure after a meal: a difference between young and elderly subjects. J Hypertens 1985; 3: S417–9.

    Google Scholar 

  40. Fagan, T., Conrad, K. A., Mar, J. H., Nelson, L. Effects of meals on hemodynamics: implications for antihypertensive drug studies. Clin Pharmacol Ther 1986; 39: 255–60.

    Article  Google Scholar 

  41. Zarit, S. H., Gallagher, D., Kramer, N. Memory training in the community aged: effects on depression, memory complaint, and memory performance. Educational gerontology, an international quarterly 1981; 6: 11–27.

    Article  Google Scholar 

  42. Rowe, J. W. Physiologic changes with age and their clinical relevance. In: Butler, R. N., Bearn, A. G., eds. The Aging Process: Therapeutic Implications, New York, Raven Press, 1984; 41–52.

    Google Scholar 

  43. O’Malley, K., Tudge, T. G., Crooks, J. Geriatric clinical pharmacology and therapeutics. In: Avery, ed. Drug Treatment, Sydney: Adis Press, 1976; 123–42.

    Google Scholar 

  44. Morselli, P. L., Placidi, G. F. Terapia farmacologica nel soggetto anziano: aspetti farmacocinetici. In: Muratrio, A., Maggini, C., Muni, L. eds. Il sonno nell’età senile, Pisa: Pacini Editore, 1977; 161–74.

    Google Scholar 

  45. Greenblatt, D. J., Abernethy, D.R., Shader, R. I. Pharmacokinetic aspects of drug therapy in the elderly. Ther Drug Monit 1986; 8: 249–55.

    Article  Google Scholar 

  46. Guillet, P., Piette, F. Pharmacologie du sujet âgé. Rev Prat 1986; 36: 581–92.

    Google Scholar 

  47. Vestal, R. E., Wood, A. J. J., Shand, D. G. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol Ther 1979; 26: 181–6.

    Google Scholar 

  48. Dillon, N., Chung, S., Kelly, J., O’Malley, K. Age and beta-adrenoceptor mediated function. Clin Pharmacol Ther 1980; 27: 769–72.

    Article  Google Scholar 

  49. Castleden, C. M., George, C. F., Marcer, D., Hallett, C. Increased sensitivity to nitrazepam in old age. Br Med J 1977; 1: 10–2.

    Article  Google Scholar 

  50. Pomara, N., Stanley, B., Block, R. et al. Adverse effects of single therapeutic doses of diazepam on performance in normal geriatric subjects: relationship to plasma concentrations. Psychopharmacology 1984; 84: 342–6.

    Article  Google Scholar 

  51. Moskowitz, H., Burns, M. M. Cognitive performance in geriatric subjects after acute treatment with antidepressants. Neuropsychobiology 1986; 15: 38–43.

    Article  Google Scholar 

  52. Riecken, H. W., Ravich, R. Informed consent to biomedical research in veterans administration hospitals. JAMA 1982; 248: 344–8.

    Article  Google Scholar 

  53. Stanley, B., Guido, J., Stanley, M., Shortell, D. The elderly patient and informed consent. Empirical findings. JAMA 1984; 252: 1302–6.

    Article  Google Scholar 

  54. Denham, M. J. The ethics of research in the elderly. Age Ageing 1984; 13: 321–7.

    Article  Google Scholar 

  55. Berry, G., Fisher, R. H., Lang, S. Detrimental incidents, including falls in elderly institutional population. J Am Geriatr Soc 1981; 29(7): 322–4.

    Article  Google Scholar 

  56. Perri, B. C. Falls among the elderly: a review of the methods and conclusions of epidemiologic studies. J Am Geriatr Soc 1982; 30: 367–71.

    Article  Google Scholar 

  57. Leader, M. A., Neuwirth, E. Clinical research and the noninstitutional elderly: a model for subject recruitment. J Am Geriatr Soc 1978; 26: 27–31.

    Article  Google Scholar 

  58. Sheiner, L. B., Benet, L. Z. Premarketing observational studies of population pharmacokinetics of new drugs. Clin Pharmacol Ther 1985; 38: 481–7.

    Article  Google Scholar 

Download references

Authors
  1. P. L. Morselli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Guillet
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Ciba-Geigy Pharmaceuticals, IFAPP, Wimblehurst Road, Horsham, West Sussex, RH12 4AB, England

    Denis Burley (President) (President)

Copyright information

© 1988 The International Federation of Associations of Pharmaceutical Physicians

About this chapter

Cite this chapter

Morselli, P.L., Guillet, P. (1988). Drug development in the elderly: problems and constraints. In: Burley, D., Haward, C., Mullinger, B. (eds) The Focus for Pharmaceutical Knowledge. Palgrave, London. https://doi.org/10.1007/978-1-349-09571-1_27

Download citation

Publish with us

Policies and ethics

Search

Navigation