PMID- 21542661
OWN - NLM
STAT- MEDLINE
DCOM- 20111111
LR  - 20211020
IS  - 1179-1969 (Electronic)
IS  - 1170-229X (Linking)
VI  - 28
IP  - 5
DP  - 2011 May 1
TI  - Criteria for drug selection in frail elderly persons.
PG  - 391-402
LID - 10.2165/11587200-000000000-00000 [doi]
AB  - BACKGROUND: Elderly patients with multiple morbidities and polypharmacy are at an 
      increased risk of adverse drug events (ADEs). Appropriate prescribing, preserving 
      the balance between drug effectiveness and safety, and treatment adherence may 
      prevent these ADEs. In this study, we investigated which drug properties, such as 
      effectiveness, safety, clinical experience and convenience, are relevant to the 
      choice of medicine most appropriate for frail elderly patients. OBJECTIVES: The 
      primary aim of this study was to develop a set of criteria to assist in the 
      selection of the most appropriate drug within a drug class for the treatment of 
      frail elderly patients. A secondary goal was to test the usefulness of the set of 
      criteria in the prescription of antipsychotics for delirium and behavioural and 
      psychological symptoms of dementia (BPSD). METHODS: Thirty-one criteria 
      potentially relevant to the choice of appropriate drugs for frail elderly 
      patients were selected on the basis of a literature search in MEDLINE 
      (1966-2008), EMBASE (1947-2008) and the Cochrane Library (1993-2008). This list 
      was reviewed by 46 experts (24 physicians, 22 pharmacists), who scored each item 
      for relevance in clinical practice on a scale from 1 to 10 (where 1 is not 
      important and 10 is very important). By consensus, the authors selected the most 
      relevant criteria for the final set of criteria. The usefulness of the final set 
      of criteria was assessed with regard to the prescription of antipsychotics for 
      delirium and BPSD. RESULTS: The final set of 23 items consisted of 3 items on 
      effectiveness, 14 on safety, including pharmacokinetic and pharmacodynamic 
      criteria, 3 on clinical experience and 3 on convenience. Assessment using these 
      criteria of the appropriateness of antipsychotics prescribed for delirium and 
      BPSD revealed that certain drugs should be prescribed with caution to patients 
      with Parkinson's disease and Lewy body dementia. CONCLUSIONS: The criteria 
      identified in this study, selected on the basis of a literature review and 
      clinical expert opinion, represent a promising approach for determining the 
      appropriateness of a drug for use in frail elderly individuals relative to 
      alternative drugs for the same indication or from the same class.
FAU - Huisman-Baron, Marieke
AU  - Huisman-Baron M
AD  - Department of Geriatrics, University Medical Centre, Utrecht, The Netherlands.
FAU - van der Veen, Lucia
AU  - van der Veen L
FAU - Jansen, Paul A F
AU  - Jansen PA
FAU - van Roon, Eric N
AU  - van Roon EN
FAU - Brouwers, Jacobus R B J
AU  - Brouwers JR
FAU - van Marum, Rob J
AU  - van Marum RJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Drugs Aging
JT  - Drugs & aging
JID - 9102074
RN  - 0 (Antipsychotic Agents)
SB  - IM
EIN - Drugs Aging. 2014 Sep;147(5):318
MH  - Aged
MH  - Aged, 80 and over
MH  - Antipsychotic Agents/adverse effects/therapeutic use
MH  - Behavioral Symptoms/complications/drug therapy
MH  - Delirium/drug therapy
MH  - Dementia/complications/drug therapy
MH  - Drug Prescriptions/standards
MH  - Drug-Related Side Effects and Adverse Reactions/*prevention & control
MH  - *Frail Elderly
MH  - Humans
MH  - Male
MH  - Practice Guidelines as Topic
EDAT- 2011/05/06 06:00
MHDA- 2011/11/15 06:00
CRDT- 2011/05/06 06:00
PHST- 2011/05/06 06:00 [entrez]
PHST- 2011/05/06 06:00 [pubmed]
PHST- 2011/11/15 06:00 [medline]
AID - 5 [pii]
AID - 10.2165/11587200-000000000-00000 [doi]
PST - ppublish
SO  - Drugs Aging. 2011 May 1;28(5):391-402. doi: 10.2165/11587200-000000000-00000.