Foreword

Excerpt

The use of polypharmacy is a widely observed finding in older persons with multiple comorbidities. Disease-specific clinical practice guidelines often contribute to polypharmacy by suggesting a two or three-drug approach for the treatment of each single disease, without providing any additional information about the presence of multiple chronic conditions and the associated risk of drug–drug and drug–disease interactions.[1,2] In persons over the age of 75 years, approximately 60–80% take one or more drugs and 10% take five or more drugs. The more commonly prescribed drugs in older persons include those for hypertension and cardiovascular disease followed by analgesics, sedatives and gastrointestinal drugs, such as laxatives and gastroprotectors. However, the simultaneous use of many drugs is associated with an increased risk of adverse drug reactions (ADRs), which represent serious healthcare problems in Italy as well as other industrialized countries. In particular, ADRs are responsible for 3–5% of all hospital admissions and contribute from 5% to 10% of total hospital admission costs in elderly persons. Furthermore, ADRs are also associated with an increased risk of morbidity and mortality in older persons. The increased risk of ADRs in older persons is mainly explained by the pathophysiological changes in drug pharmacokinetics and pharmacodynamics over the aging process. Considering that a large number of diverse drugs are available for chronic conditions in older persons, such as type 2 diabetes mellitus, cardiovascular disease and chronic pain, the decision on drug administration is becoming an extremely challenging issue for physicians. Indeed, inappropriate drug prescription in older persons is under constant evaluation. In addition, it is important to underline the difficulties faced by physicians according to patient settings (acute care or long-term care) in which the prescription of a new drug regimen is crucially important in order to avoid ADRs. …