27.8. Drug use in elderly persons: Inappropriate medication and drug interactions

Public examination of a doctoral dissertation in the field of social pharmacy

Doctoral candidate: MSc (Pharm) Jouni Ahonen

Time and venue: Saturday 27.8.2011 at 12 noon, Mediteknia Auditorium, Kuopio Campus

Finns are living longer and longer. During the next 20 years, the over 75-year-old population will almost double from the current 440,000 to about 850,000. By the year 2040, their number will be about a million. Morbidity will remain high, which entails increased medicine consumption. This sets growing challenges for health care and requires that, in the minimum, annual assessment of the medication of the elderly must become an integral part of health care services. Checking for medication that must be avoided by the elderly and for harmful interactions must be considered, not only in the assessments, but in the prescription and provision of drugs as well.

The present study examined the use of inappropriate medications and the incidence of potentially clinically relevant drug interactions among residents of Kuopio 77-years of age and above. The work is based on the health and medication data obtained as part of the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GEMS) study in 2006.

According to this study, one in four (28%) of the patients were using medication that should be avoided by the elderly, and one in five (19%) were exposed to potentially clinically significant drug interactions. The amount of inappropriate drugs used and their interactions were associated with general amount of drugs used by the patients and their diseases. Every second incidence of inappropriate drug use and drug interaction was associated with symptoms identified in the subjects. The patients with the poorest physical mobility and functional capacity used the greatest number of medication whose use should be avoided in the elderly, and they were also subjected to the most interactions. The use of inappropriate medication and potentially clinically significant drug interactions were not associated with the deterioration of physical activity and functional capacity.

Half of the observed drug interactions were a pharmacodynamic interaction. They often involved several parallel pharmaceutical ingredients and overlapping drugs, whichmay increase the response and possible side effects.

The use of medication that should be avoided by the elderly and their interactions caused the elderly preventable adverse effects, which should not be treated symptomatically with another drug. The medication of the elderly should be assessed at least once per year and whenever substantial changes occur in their state of health. Nationwide guidelines must be created for medication assessment. Medication assessments should utilize more multi-professional and interdisciplinary cooperation for the best interest of the patient. Medication assessments require the knowledge and expertise of doctors, nurses and pharmacists, and good collaboration with patients.

The doctoral dissertation of Master of Science (Pharmacy) Jouni Ahonen, entitled Drug use in elderly persons: Inappropriate medication and drug interactions will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Jaakko Valvanne of the University of Tampere and the custos will be Professor Sirpa Hartikainen of the University of Eastern Finland.

Photo available for download at http://www.uef.fi/vaitoskuvat

Contact: MSc (Pharm) Jouni Ahonen, GSM 044 5261334, laakekoulutus@gmail.com

Publishing year: 2011

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