Drug Usage in Elderly Persons

  • Richard A. Marottoli
  • Marla J. Campbell
  • Roshini C. Pinto Powell


Although elderly persons tend to be more sensitive to the effects and side effects of medications, most drugs are well tolerated if used judiciously. This chapter reviews some of the factors that contribute to this sensitivity, general approaches to prescribing, signs and symptoms to monitor, and highlights of certain drug categories that are commonly used or have substantial potential to cause side effects.


Elderly Person Tardive Dyskinesia Side Effect Profile Maximum Daily Dose National High Blood Pressure 
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  1. 1.
    Shock NW, Watkin DM, Yiengst MJ, et al. Age differences in the water content of the body as related to basal oxygen consumption in males. J Gerontol 1963;18:1–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Forbes GB, Reina JC. Adult lean body mass declines with age: some longitudinal observations. Metabolism 1970;19: 653–663.PubMedCrossRefGoogle Scholar
  3. 3.
    Mayersohn MB. Special pharmacokinetic considerations in the elderly. In: Evans WE, Schentag JJ, Jusko WJ (eds) Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring, 3rd ed. Vancouver, WA: Applied Therapeutics, 1992.Google Scholar
  4. 4.
    Greenblatt DJ., Sellers EM, Shader RI. Drug disposition in old age. N Engl J Med 1982;306:1081–1088.PubMedCrossRefGoogle Scholar
  5. 5.
    Tozer TN, Winter ME. Phenytoin. In: Evans WE, Schentag JJ, Jusko WJ (eds) Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring, 3rd ed. Vancouver, WA: Applied Therapeutics, 1992.Google Scholar
  6. 6.
    Paxton JW, Briant RH. Alpha one-acid glycoprotein concentrations and propranolol binding in elderly patients with acute illness. Br J Clin Pharmacol 1984;18:806–810.PubMedCrossRefGoogle Scholar
  7. 7.
    Robertson DRC, Wood ND, Everest H, et al. The effect of age on the pharmacokinetics of levodopa administered alone and in the presence of carbidopa. Br J Clin Pharmacol 1989;28:61–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Castleden CM, George CF. The effect of ageing on the hepatic clearance of propranolol. Br J Clin Pharmacol 1979;7:49–54.PubMedCrossRefGoogle Scholar
  9. 9.
    Cusack B, O’Malley K, Lavan J, et al. Protein binding and disposition of lignocaine in the elderly. Eur J Clin Pharmacol 1985;29:323–329.PubMedCrossRefGoogle Scholar
  10. 10.
    Jaillon P, Gardin ME, Lecocq B, et al. Pharmacokinetics of nalbuphine in infants, young healthy volunteers, and elderly patients. Clin Pharmacol Ther 1989:46:226–233.PubMedCrossRefGoogle Scholar
  11. 11.
    Greenblatt DJ, Shader RI, Harmatz JS. Implications of altered drug disposition in the elderly: studies of benzodiazepines. J Clin Pharmacol 1989;29:866–872.PubMedCrossRefGoogle Scholar
  12. 12.
    Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations. Part I. Clin Pharmacokinet 1991;21:165–177.PubMedCrossRefGoogle Scholar
  13. 13.
    Rowe JW, Andres R, Tobin JD, et al. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 1976;31:155–163.PubMedCrossRefGoogle Scholar
  14. 14.
    Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985;33:278–275.PubMedGoogle Scholar
  15. 15.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Hanlon JT, Weinberger M, Samsa GP, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve prescribing in elderly outpatients with polypharmacy. Am J Med 1996;100:428–137.PubMedCrossRefGoogle Scholar
  17. 17.
    Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med 1990;113:941–948.PubMedCrossRefGoogle Scholar
  18. 18.
    Inouye SK, Viscoli CM, Horwitz RI, et al. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993;119: 474–481.PubMedCrossRefGoogle Scholar
  19. 19.
    Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275:852–857.PubMedCrossRefGoogle Scholar
  20. 20.
    Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA 1994;272:1518–1522.PubMedCrossRefGoogle Scholar
  21. 21.
    Jenike MA. Psychoactive drugs in the elderly: antipsychotics and anxiolytics. Geriatrics 1988;43(9):53–65.PubMedGoogle Scholar
  22. 22.
    Task Force on Late Neurological Effects of Antipsychotic Drugs. Tardive dyskinesia: summary of a task force report of the American Psychiatric Association. Am J Psychiatry 1980;137:1163–1172.Google Scholar
  23. 23.
    Smith JM, Baldessarini RJ. Changes in prevalence, severity, and recovery in tardive dyskinesia with age. Arch Gen Psychiatry 1980;37:1368–1373.PubMedCrossRefGoogle Scholar
  24. 24.
    Jenike MA. Psychoactive drugs in the elderly: antidepressants. Geriatrics 1988;43(ll):43–57.PubMedGoogle Scholar
  25. 25.
    Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37–49.CrossRefGoogle Scholar
  26. 26.
    Stimmel GL, Gutierrez MA. Psychiatric disorders. In: Dela-fuente JC, Stewart RB (eds) Therapeutics in the Elderly, 2nd ed. Cincinnati: Harvey Whitney Books, 1995:324–343.Google Scholar
  27. 27.
    Tourigny-Rivard MF. Pharmacotherapy of affective disorders in old age. Can J Psychiatry 1997;42(suppl 1):10S-18S.Google Scholar
  28. 28.
    Perry PJ, Pfohl BM, Holstad SG. The relationship between antidepressant response and tricyclic antidepressant plasma concentrations: a retrospective analysis of the literature using logistic regression analysis. Clin Pharmacokinet 1987;13:381–392.PubMedCrossRefGoogle Scholar
  29. 29.
    Gitlin MJ. Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. J Clin Psychiatry 1994;55:406–113.PubMedGoogle Scholar
  30. 30.
    Wallace AE, Kofoed LL, West AN. Double-blind, placebo-controlled trial of methylphenidate in older, depressed, medically ill patients. Am J Psychiatry 1995;152:929–931.PubMedGoogle Scholar
  31. 31.
    Schneider LS. Overview of generalized anxiety disorder in the elderly. J Clin Psychiatry 1996; 57(suppl 7):34–45. 183PubMedGoogle Scholar
  32. 32.
    Shuckit MA. Current therapeutic options in the management of typical anxiety. J Clin Psychiatry 1981;42(11, sect 2):15–26.Google Scholar
  33. 33.
    Ramer HE. Sleep problems. Med J Aust 1995;162:603–607.Google Scholar
  34. 34.
    Greenblatt DJ, Harmatz JS, Shapiro L, et al. Sensitivity to triazolam in the elderly. N Engl J Med 1991;324:1691–1698.PubMedCrossRefGoogle Scholar
  35. 35.
    Roger M, Attali P, Coquelin JP. Multicenter, double-blind, controlled comparison of Zolpidem and triazolam in elderly patients with insomnia. Clin Ther 1993;15:127–136.PubMedGoogle Scholar
  36. 36.
    Fairweather DB, Kerr JS, Hindmarch I. The effects of acute and repeated doses of Zolpidem on subjective sleep, psychomotor performance and cognitive function in elderly volunteers. Eur J Clin Pharmacol 1992;43:597–601.PubMedCrossRefGoogle Scholar
  37. 37.
    Herr KA, Mobily PR. Pain assessment in the elderly: clinical considerations. J Gerontol Nurs 1991;17(4):12–19.PubMedGoogle Scholar
  38. 38.
    Ferrell BA. Pain management in elderly people. J Am Geriatr Soc 1991;39:64–73.PubMedGoogle Scholar
  39. 39.
    Ferrell BA. Pain evaluation and management in the nursing home. Ann Intern Med 1995;123:681–687.PubMedCrossRefGoogle Scholar
  40. 40.
    Barrett BJ. Acetaminophen and adverse chronic renal outcomes: an appraisal of the epidemiologic evidence. Am J Kidney Dis 1996;28(suppl 1):S14–S19.CrossRefGoogle Scholar
  41. 41.
    Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413–2446.Google Scholar
  42. 42.
    Messerli FH, Schmieder RE, Weir MR. Salt: a perpetrator of hypertensive target organ disease? Arch Intern Med 1997;157:2449–2452.PubMedCrossRefGoogle Scholar
  43. 43.
    Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA 1996;276:1886–1892.PubMedCrossRefGoogle Scholar
  44. 44.
    Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Lancet 1990;335:827–838.PubMedCrossRefGoogle Scholar
  45. 45.
    Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991;338:1281–1285.PubMedCrossRefGoogle Scholar
  46. 46.
    Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the Hypertension Detection and Follow-up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 1979;242:2562–2571.Google Scholar
  47. 47.
    SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;265:3255–3264.Google Scholar
  48. 48.
    Gueyffier F, Boutitie F, Boissel JP, et al. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men: a meta-analysis of individual patient data from randomized, controlled trials. Ann Intern Med 1997;126:761–767.PubMedCrossRefGoogle Scholar
  49. 49.
    MacMahon S, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. Clin Exp Hyper-tens 1993;15:967–978.CrossRefGoogle Scholar
  50. 50.
    Kaplan NM, Gifford RW. Choice of initial therapy for hypertension. JAMA 1996;275:1577–1580.PubMedCrossRefGoogle Scholar
  51. 51.
    Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985;27:335–371.PubMedCrossRefGoogle Scholar
  52. 52.
    Hennekens CH, Albert CM, Godfried SL, et al. Adjunctive drug therapy of acute myocardial infarction: evidence from clinical trials. N Engl J Med 1996;335:1660–1667.PubMedCrossRefGoogle Scholar
  53. 53.
    Smith SC, Blair SN, Criqui MH, et al. Preventing heart attack and death in patients with coronary disease. J Am Coll Cardiol 1995;26:292–294.PubMedCrossRefGoogle Scholar
  54. 54.
    Gansevoort RT, Sluiter WJ, Hemmelder MH, et al. Antipro-teinuric effect of blood-pressure-lowering agents: a metaanalysis of comparative trials. Nephrol Dial Transplant 1995;10:1963–1974.PubMedGoogle Scholar
  55. 55.
    Ad Hoc Subcommittee of the Liaison Committee of the World Health Organisation and the International Society of Hypertension. Effects of calcium antagonists on the risks of coronary heart disease, cancer and bleeding. J Hypertens 1997;15:105–115.Google Scholar
  56. 56.
    National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on hypertension in the elderly. Hypertension 1994;23:275–285.Google Scholar
  57. 57.
    Du Buske LM. Introduction: risk management in asthma and allergic diseases. J Allergy Clin Immunol 1996;98(6, part 3):S289–S290.CrossRefGoogle Scholar
  58. 58.
    Cantu TG, Korek JS. Central nervous system reactions to histamine-2 receptor blockers. Ann Intern Med 1991;114: 1027–1034.PubMedCrossRefGoogle Scholar
  59. 59.
    Sanford JP, Gilbert DN, Moellering RC, Sande MA (eds). Anti-infective drug-drug interactions. In: The Sanford Guide to Antimicrobial Therapy, 27th ed. Vienna, VA: Antimicrobial Therapy, 1997:123–126.Google Scholar
  60. 60.
    Gleckman RA. Antibiotic concerns in the elderly. Infect Dis Clin North Am 1995;9:575–590.PubMedGoogle Scholar
  61. 61.
    Lesar TS, Lomaestro BM, Pohl H. Medication-prescribing errors in a teaching hospital: a 9-year experience. Arch Intern Med 1997;157:1569–1576.PubMedCrossRefGoogle Scholar
  62. 62.
    Gilbert DN, Bennett WM. Use of antimicrobial agents in renal failure. Infect Dis Clin North Am 1989;3:517–531.PubMedGoogle Scholar
  63. 63.
    McCue JD. Antimicrobial therapy. Clin Geriatr Med 1992;8:925–945.PubMedGoogle Scholar
  64. 64.
    Sanford JP, Gilbert DN, Moellering RC, Sande MA (eds). Dosage of antimicrobial drugs in adult patients with renal impairment. In: The Sanford Guide to Antimicrobial Therapy, 27th ed. Vienna, VA: Antimicrobial Therapy, 1997:116–120.Google Scholar
  65. 65.
    Posner JD. Particular problems of antibiotic use in the elderly. Geriatrics 1982;37(8):49–54.PubMedGoogle Scholar
  66. 66.
    Tablan OC, Reyes MP, Rintelmann WF, et al. Renal and auditory toxicity of high-dose, prolonged therapy with gen-tamicin and tobramycin in Pseudomonas endocarditis. J Infect Dis 1984;149:257–263.PubMedCrossRefGoogle Scholar
  67. 67.
    Moore RD, Smith CR, Lietman PS. Risk factors for the development of auditory toxicity in patients receiving aminoglycosides. J Infect Dis 1984;149:23–30.PubMedCrossRefGoogle Scholar
  68. 68.
    Marra F, Partovi N, Jewesson P. Aminoglycoside administration as a single daily dose. Drugs 1996;52:344–370.PubMedCrossRefGoogle Scholar
  69. 69.
    Barza M, Ioannidis JPA, Cappelleri JC, et al. Single or multiple daily doses of aminoglycosides: a meta-analysis. BMJ 1996;312:338–345.PubMedCrossRefGoogle Scholar
  70. 70.
    Hatala R, Dinh T, Cook DJ. Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Ann Intern Med 1996;124:717–725.PubMedCrossRefGoogle Scholar
  71. 71.
    Van den Brande P, van Steenbergen W, Vervoort G, et al. Aging and hepatotoxicity of isoniazid and rifampin in pulmonary tuberculosis. Am J Respir Crit Care Med 1995; 152:1705–1708.PubMedCrossRefGoogle Scholar
  72. 72.
    Mandell LA, Bergeron MG, Ronald AR, et al. Once-daily therapy with ceftriaxone compared with daily multiple-dose therapy with cefotaxime for serious bacterial infections: a randomized, double-blind study. J Infect Dis 1989;160:433–441.PubMedCrossRefGoogle Scholar
  73. 73.
    Barriere SL, Flaherty JF. Third-generation cephalosporins: a critical evaluation. Clin Pharm 1984;3:351–373.PubMedGoogle Scholar
  74. 74.
    Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease: incidence, etiology and management. Drug Saf 1992;7:32–45.PubMedCrossRefGoogle Scholar
  75. 75.
    Brogden RN, Carmine A, Heel RC, et al. Cefoperazone: a review of its in vitro antimicrobial activity, pharmacological properties and therapeutic efficacy. Drugs 1981;22:423–460.PubMedCrossRefGoogle Scholar
  76. 76.
    Rockoff SD, Blumenfrucht MJ, Irwin RJ, et al. Vitamin K supplementation during prophylactic use of cefoperazone in urologie surgery. Infection 1992;20:146–148.PubMedCrossRefGoogle Scholar
  77. 77.
    Goss TF, Walawander CA, Grasela TH, et al. Prospective evaluation of risk factors for antibiotic-associated bleeding in critically ill patients. Pharmacotherapy 1992;12:283–291.PubMedGoogle Scholar
  78. 78.
    Grasela TH, Walawander CA, Welage LS, et al. Prospective surveillance of antibiotic-associated coagulopathy in 970 patients. Pharmacotherapy 1989;9:158–164.PubMedGoogle Scholar
  79. 79.
    Schentag JJ, Welage LS, Williams JS, et al. Kinetics and action of N-methylthiotetrazole in volunteers and patients: population-based clinical comparisons of antibiotics with and without this moiety Am J Surg 1988;155(5A):40–44.PubMedCrossRefGoogle Scholar
  80. 80.
    MacGregor RR, Gibson G A, Bland JA. Imipenem pharmacokinetics and body fluid concentrations in patients receiving high-dose treatment for serious infections. Antimicrob Agents Chemother 1986;29:188–192.PubMedCrossRefGoogle Scholar
  81. 81.
    Neu HC. Aztreonam activity, pharmacology, and clinical uses. Am J Med 1990;88(suppl 3C):2S–6S.CrossRefGoogle Scholar
  82. 82.
    Fillastre JP, Leroy A, Baudoin C, et al. Pharmacokinetics of aztreonam in patients with chronic renal failure. Clin Phar-macokinet 1985;10:91–100.CrossRefGoogle Scholar
  83. 83.
    Davies BI, Maesen FPV Drug interactions with quinolones. Rev Infect Dis 1989:11 (suppl 5):S1083–S1090.CrossRefGoogle Scholar
  84. 84.
    Norrby SR, Ljungberg B. Pharmacokinetics of fluorinated 4-quinolones in the aged. Rev Infect Dis 1989; 11 (suppl 5)S1102–S1106.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Richard A. Marottoli
  • Marla J. Campbell
  • Roshini C. Pinto Powell

There are no affiliations available

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