Optimizing Pharmacotherapy in Older Patients: An Interdisciplinary Approach

Description:

This book summarizes the broad and rapidly evolving field of geriatric pharmacotherapy, which is becoming increasingly relevant for practicing physicians who care and prescribe medications for older patients. Around the globe, ageing populations are associated with an increased prevalence of chronic diseases. Older adults are often affected by multimorbidity, i.e., suffer from more than one chronic disease. The main consequence of multimorbidity is polypharmacy, which is commonly defined as the regular use of five or more medicines. Polypharmacy has now reached epidemic proportions in our societies, and is associated with an increased risk of drug-drug interactions, drug-disease interactions and adverse drug reactions. The management of polypharmacy in older patients with complex multimorbidity poses several challenges and needs to be based on specific knowledge and prescribing expertise.

The aim of this book is to provide a comprehensive update on the field, and to share the expertise needed to optimize the management of pharmacotherapy in older patients.

Foreword

Aging seems to be a longer lasting pandemic than COVID. Older people enjoy living happily despite a rapidly increasing disease burden, and this has to do with the robust and expanding achievements of hygiene and medicine. This may or may not include the most important option for treatment in almost all therapeutic areas, which is the prescription of drugs. Medication can positively contribute to disease prevention and mitigation, but due to inevitable side effects it could also be limiting the enjoyment of life or even end it.

This topic of medication in older people thus is of paramount importance for this steadily growing population part of our industrial societies. The new book on Optimizing pharmacotherapy in older patients is one of the very few attempts to condense our knowledge on this issue and comprehensively detail the dimensions, implications, and technical accommodations for coping with this challenging aspect of medicine. In its 29 chapters, the book deals with the epidemiology of “polypharmacy” (a widely used, but incorrect term which should rather be multimedication), the detrimental impact of some pharmacodynamic and pharmacokinetic features of the aging body on therapeutic outcomes and on instruments, practices, and tools to optimize medication use in older people. Catchwords like “deprescribing” or “potentially inappropriate medications” (PIM) are defined and discussed in the current scientific context. Drug–drug, drug–nutrient, and drug–disease interactions are being exemplified, issues of adherence and the roles of potential networking partners such as pharmacists addressed in chapters by outstanding researchers in the area.

The content of this first section on general issues is applied to geriatric syndromes such as frailty or falls, and to special aspects of medications for frequent diseases in older people (e.g., hypertension or heart failure) in the second main part of the book.

It thus does not only provide the theoretical background but also practical, disease-oriented solutions to medication-related problems in older people.

In its comprehensive approach, this book provides all relevant information for enabling a better and more appropriate medication process in the geriatric population. The book, thus, addresses physicians both in ambulatory and clinical care, pharmacists, nursing staff, and all care providers involved in the complex process of individualized medication in older people. Only few similar books have been published on this important issue to date, but none is comparably actual and comprehensive.

We are convinced that this new book is instructive, helpful, and protective in this context by not only showing the risks, but also the opportunities by the correct application of drugs in older people. It clearly conveys that drugs may harm, but also successfully treat older people if chosen correctly. The current FORTA-list contains 41% of positively labelled drugs. Thus, the right drug for the right patient is still a very good option for older people to live longer and/or better.

In the name of all those patients benefitting from the book, we sincerely thank the editors and authors for the creation of this important work.