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[Cardiovascular therapy problems in the elderly patient]
P Carbonin1, R Bernabei, L Carosella
1Cattedra di Gerontologia e Geriatria, Università Cattolica del Sacro Cuore, Roma.
Insights
Managing cardiovascular drugs in elderly patients over 75 requires careful consideration due to increased risks. Evidence-based therapies and individualized dosing are crucial for safe and effective treatment in this population.
Area of Science:
- Geriatric Medicine
- Cardiovascular Pharmacology
Context:
- Elderly patients (over 75) face higher risks of comorbidity and dependence.
- Current clinical trials often exclude this demographic, limiting data on drug efficacy and safety.
- Therapeutic management must prioritize quality of life over single pathology resolution.
Purpose:
- To highlight the critical need for careful therapeutic management in elderly patients over 75.
- To address the lack of specific data on cardiovascular drug efficacy and safety in this age group.
- To provide guidelines for optimizing drug therapy in older adults.
Summary:
- Therapeutic management for patients over 75 demands extreme caution due to increased comorbidity and dependence.
- Multidimensional evaluation, including psychological and social factors, is essential.
- Drug selection should prioritize proven efficacy, with careful dosing based on renal function and body weight, and strict clinical monitoring for adverse reactions.
Impact:
- Informs clinical practice for geriatric cardiovascular care.
- Emphasizes the importance of individualized treatment plans for elderly patients.
- Contributes to safer and more effective medication use in advanced age.
Abstract:
The therapeutic management of elderly patients should be extremely careful, particularly in those over 75 years of age. As a matter of fact, in such patients a steep increase of the risk of comorbidity and of dependence has been evidenced. This implies a more complex therapeutic management, that must be oriented to the amelioration of quality of life more than to the resolution of the single pathologies. However, all the intervention trials so far conducted excluded such patients. Therefore, they cannot be considered representative of the geriatric epidemiological reality. As a result, there is virtually no useful information on the efficacy and safety of cardiovascular drugs in patients over 75 years of age. However, the following items should be pointed out: only drugs whose efficacy has been proved should be used, and only after a thorough diagnosis; a multidimensional evaluation should be performed, also addressing psychological, social, environmental and economical factors that could affect the clinical course; the risks and benefits of any therapy should be considered, particularly in the presence of comorbidity, as the number of assumed drugs directly correlates with the risk of developing adverse reactions; drugs should be dosed according to renal function and body weight, possibly starting with half the dosage of younger patients; after starting the therapy, patients should be kept under strict clinical control, and every new symptom should be considered an adverse reaction, unless it will not disappear after withdrawal of the drug; serum drug concentration should be monitored whenever possible, given its larger variability in advanced age.