Eric L. Knight, MD, MPH; Jerry Avorn, MD
Grant Support: By a contract from Pfizer Inc. to RAND.
Requests for Single Reprints: Jerry Avorn, MD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115.
Current Author Addresses: Dr. Knight: Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.
Dr. Avorn: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115.
Knight EL, Avorn J. Quality Indicators for Appropriate Medication Use in Vulnerable Elders. Ann Intern Med. 2001;135:703-710. doi: 10.7326/0003-4819-135-8_Part_2-200110161-00009
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Published: Ann Intern Med. 2001;135(8_Part_2):703-710.
Medications are a centrally important aspect of the care of elderly patients, especially vulnerable elders, and are the final common pathway for most therapeutic decisions. While they make up only 14% of the U.S. population, persons 65 years of age and older consume more than 30% of all prescription drugs (1). Because they more often experience acute and chronic illnesses, elders are particularly likely to benefit from the therapeutic and preventive effects of pharmaceutical therapy. However, aspects of the aging process that occur in healthy elders and that are considerably magnified in vulnerable elderly patients increase their risk for drug side effects (2). These include impaired renal function in clearing drugs that are primarily excreted by the kidney; reduction in hepatic blood flow, liver size, and phase I degradative metabolic processes; increased body fat at the expense of lean body mass, which increases the volume of distribution for lipid-soluble drugs and extends their half-life; and aging-induced changes in receptor sensitivity, which can further complicate the prediction and assessment of drug effects.
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Cardiology, Geriatric Medicine, Nephrology, Hypertension, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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