15.14 Concluding Remarks

The global elderly population is increasing at a tremendous pace and many elderly

patients require multiple drugs for treating comorbid conditions. Several factors like

declining liver and kidney functions, comorbidity, polypharmacy, and drug

interactions lead to ADRs in the elderly patients. Drug dose adjustments are abso-

lutely necessary, in order to avoid any iatrogenic or drug-induced harmful effects in

the elderly and frail patients. Custom designing of personal therapeutic regimens as

well as precision medications is the need of the hour to suit individual patients.

Hence, it is the professional responsibility of healthcare providers such as

physicians, surgeons, nurses, pharmacist, and para-medical fraternity to change the

current scenario and provide properly suitable medications which would improve the

quality of life of frail and elderly men and women.

Adverse drug reactions, sometimes with life-threatening situations, occur among

elderly patients due to inappropriate drug doses, polypharmacy, comorbid

conditions, dementia, and inability to read drug labelling. Drug doses based on

mg/kg body wt. cannot be applied in frail and elderly patients due to reduction in

body mass and compromised hepatic drug metabolism and renal excretory capacity,

which consequently cause significant alterations in the metabolic disposition of

drugs as opposed to the younger individuals. Overwhelming number of studies

have shown that elderly men and women are the most vulnerable group to iatrogenic

effects due to comorbid conditions, co-medications, and declining functions of the

gastrointestinal-hepatic-renal systems. Age-related debilitating conditions and self-

medication with micronutrients (vitamins, minerals), herbal remedies, and dietary

supplements tend to enhance clinically important ADRs due to drug-herbal-diet

interactions. All these situations make it highly challenging for the physicians,

nurses, pharmacists, and surgeons to make drug dose adjustment decisions for the

geriatric patients.

Systematic research by various scientific groups and pharmaceutical companies

has helped in the computation of drug dose adjustments and decision making easier

for drug administration in elderly and frail patients. Appropriate equations and

formulas are available for calculating drug dosages for elderly patients based on

serum creatinine or cystatin-C clearance as well as some other biomarkers. It is

important that elderly patients should be enrolled in clinical trials for learning more

about the pharmacometabolomics and therapeutically optimal dose levels without

any ADRs. In this review, we have focused on the dose adjustments of psychothera-

peutic drugs because the antidepressant, antianxiety, and insomnia treating

medications are most frequently used by elderly men and women. The prescribers

need

education,

training,

and

motivation

about

reporting

ADRs

and

pharmacovigilance to ensure patient safety.

Conflict of Interest The authors declare no conflict of interest.

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