Key Points

Absorption generally does not change.

Longer half-life of lipophilic drugs.

Increased amount of water soluble and free (active) drug.

Decreased excretion.

• Adverse drug events result in significant morbidity and a high rate of hospital admissions.

• Medications should be adjusted for the individual patient's renal function.

• Medication lists of elderly patients should be periodically reviewed, focusing on indications and side effects.

• One drug should not be used to treat the side effects of another medication.

• Pharmacists' recommendations should be incorporated in a rational drug-prescribing plan.

The primary care physician plays an important role in addressing an array of pharmaceutical issues and concerns for elderly patients, including polypharmacy, adverse drug reactions, adherence, and undertreatment of certain conditions.

Medication use is common in the elderly population and increases with age. A population-based survey showed that 44% of men and 57% of women over age 65 used five or more medications weekly (Kaufmann et al., 2002). Although persons over 65 represent only 13% of the general population, they account for more than 30% of U.S. drug expenditures, totaling over $73 billion in 2006 (MEPS, 2006). Polyphar-macy is a major risk factor for adverse drug events (ADEs). Up to 10% of emergency department visits and 10% to 17% of hospital admissions are the result of ADEs (Hayes et al., 2007).

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