0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

The Ambiguous Relation between Aging and Adverse Drug Reactions

Jerry H. Gurwitz, MD; and Jerry Avorn, MD
[+] Article and Author Information

Grant Support: In part by grants from the Medications and Aging Program of the John A. Hartford Foundation and the National Institute on Aging (AG-08812). Dr. Gurwitz is a Merck Fellow in Geriatric Clinical Pharmacology.

Requests for Reprints: Jerry H. Gurwitz, MD, Program for the Analysis of Clinical Strategies, 333 Longwood Avenue, Boston, MA 02115.

Current Author Addresses: Drs. Gurwitz and Avorn: Program for the Analysis of Clinical Strategies, 333 Longwood Avenue, Boston, MA 02115.


©1991 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1991;114(11):956-966. doi:10.7326/0003-4819-114-11-956
Text Size: A A A

Purpose: To examine the evidence for a relation between advancing patient age and the risk for adverse drug reactions.

Data Sources: A computer-assisted search of the English-language literature (MEDLINE, 1966 to 1990) followed by selective review of all pertinent articles.

Study Selection: Studies that stratified data on adverse drug reactions by patient age were screened for review. Article selection was not limited by study design; the relation between age and the occurrence of adverse drug reactions did not have to be a primary focus of the study.

Data Extraction: Pertinent data were abstracted from the results of case-control and cohort studies and from clinical trials. The methodologic strengths and weaknesses of these studies are discussed with particular reference to gerontologic issues.

Results of Data Synthesis: Most studies have neglected the issue of whether the increased frequency of adverse drug reactions in the elderly is attributable to age alone or to the fact that older patients are more likely to have coexisting illnesses and to be taking several medications. Studies that combine all drug exposures for each patient and report the risk for any adverse effect provide little useful information about the risks associated with specific drug therapies in the elderly. The association between age and the risk for adverse drug reactions is best examined for individual pharmacologic agents. However, the exclusion of elderly subjects from clinical trials makes the determination of age effects impossible in many studies. Where subjects do represent an adequate age range, most studies fail to control for important clinical differences among subjects of different ages to distinguish the independent effects of chronologic age.

Conclusion: Conventional clinical wisdom suggests that the risk for adverse drug reactions increases with advancing age, but available data do not confirm this "truism" of geriatric medicine. The inter-individual variability of the aging process, including the non-uniform nature of the pharmacokinetic and pharmacodynamic changes that occur with aging, indicates that clinical reality is far more complex. Patient-specific physiologic and functional characteristics are probably more important than any chronologic measure in predicting both adverse and beneficial outcomes associated with specific drug therapies.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)