Medication for The Elderly; Helpful or Harmful?

Many times, it is difficult to confidently choose a therapy for our elderly patients.  This is due to the fact that very rarely, do any large, evidence-based studies include patients > 65 years of age, and many do not include patients ≥ 75 years old.  Cardiovascular Disease (CVD) prevalence increases with age.  Patients ≥ 65 years old account for more than half of ALL CV hospitalizations and procedures.

Demographics and Their Implication

Approximately 6% of the total population is ≥ 75 years old, but > 50% of CV deaths occur in this group of patients. This burden will only increase as patients are living longer, and men and women ≥ 80 years old account for a disproportionate number of deaths from CVD.2 Due to age related CV structure and function, and added age related changes in kidney, liver, brain, skeletal systems, etc. Our elderly are more vulnerable to the negative effects of both nonpharmacological and pharmacological treatments normally used in younger populations.3,4

 As pharmacists, it can be a struggle to know the best practice guidelines when it comes to the elderly.  Current guidelines suffer from large gaps in the management of older patients with CVD, because most of the patients would not have been eligible for participation in the studies that have been done.

What can be agreed upon is that there is a critical need for large population-based studies and clinical trials that include a large range of the elderly population that is a representation of those seen in clinical practice.5

 In the meantime, what do current guidelines state about the elderly and CVD treatment?  The following pages are a summary of the current guidelines for specific CV issues you might see.  Some of these are very broad, as there are just no specific treatment guidelines available.  My advice for any and all therapies is to “START LOW AND GO SLOW” when dosing patients 65 years and older.  This will help to decrease unwanted side effects and will take into account potential organ system changes that may be present.