Elderly Patients

Elderly patients often experience multiple co-morbidities and prescribed number of medications thereby increases the risk of adverse events (AEs), drug-disease and drug-drug interaction. This risk is more by age-related physiological changes, which influence ADME and pharmacodynamics. Particular drugs shows additional risks to elderly patients as a result of these changes, e.g. increased risk of upper GIT bleeding with NSAIDs and increased risk of falls and prolonged sedation with long-acting benzodiazepines or Prescription of such drugs is potentially inappropriate to use when safer alternative drugs are exist. Some studies by using Beers' criteria are controversial. There is disagreement for certain drugs as inap¬propriate, e.g. nitrofurantoin

In these patients, the risk of Adverse drug reactions (ADRs) increases in proportion to the no. of simultaneous prescribed medications. Poor choice of medication by the physician is undoubtedly a major cause of ADRs in older citizens. Another scale and severity of the problem globally, there is little agreement about how best to prevent Inappropriateness in older people. Regular review of medications in older citizens seems a logical way of minimizing Inappropriateness and associated adverse drug reactions (ADRs). There is a need for the task to be carried out in an orderly, systematic way.
Several factors contribute to greater propensity of ADRs in the elderly citizens, including use of potentially inappropriate medication (PIM). Elderly citizens are prescribed potentially inappropriate medication (PIM) in an ambulatory setting and during hospitalization. About one-third of the adverse outcomes in elderly citizens are estimated to be due to the use of

Therefore, every criteria having questionnaire was evaluated according to the Likert scale of which is having (1) to (5) points, where (1) signifies that total agreement with inadequacy and (5) signifies that total disagreement with inadequacy. Items which score (1) and (2) were kept in list, while items (4) and (5) need to exclude from list; items with scores of (3) of uncertain opinion were presented to the experts again at another time. Questionnaire consisted of two categories, drugs should be avoided in elderly citizens as they were not effective or induces some type of risk factors and drugs to be used in specific medical conditions. The French list identified 34 medication products were inappropriate for elderly citizens >75 years of age, because at this age, pharmacokinetic and dynamic changes are more often likely to alter the response to medication than in younger ages. Among the medications which has found 25 were deemed unsuitable due to unfavorable benefit/risk, one was considered as questionable efficacy and other eight were classify as having both questionable efficacy and unfavorable risk/benefit. Among all medications or classes of medications in French list, just a few also proposed in the Beers criteria list, since those not available in France or considered harmful were excluded