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The ambiguous relation between aging and adverse drug reactions.
1Program for the Analysis of Clinical Strategies, Beth Israel Hospital, Boston, Massachusetts.
Annals of Internal Medicine
|June 1, 1991
Summary
Advancing patient age does not definitively increase adverse drug reactions (ADRs). Individual patient factors, not just age, are key to predicting drug responses and outcomes in geriatric medicine.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Clinical Research
Background:
- Conventional wisdom suggests increased adverse drug reactions (ADRs) with advancing patient age.
- Geriatric medicine often assumes age is a primary risk factor for ADRs.
Purpose of the Study:
- To critically examine the scientific evidence linking patient age to the risk of adverse drug reactions.
- To evaluate the validity of the 'truism' that aging inherently increases ADR risk.
Main Methods:
- Comprehensive literature search of English-language studies (MEDLINE, 1966-1990).
- Screening of studies stratifying ADR data by patient age, regardless of study design.
- Data abstraction from case-control studies, cohort studies, and clinical trials, with discussion of gerontologic issues.
Main Results:
- Most studies fail to differentiate age-related ADRs from those due to comorbidities or polypharmacy in the elderly.
- Exclusion of elderly subjects from clinical trials hinders the assessment of age-specific effects.
- Controlling for clinical differences among age groups is crucial but often lacking.
Conclusions:
- Available data do not confirm that advancing age alone increases the risk of adverse drug reactions.
- Inter-individual variability in aging, including pharmacokinetic and pharmacodynamic changes, complicates the relationship.
- Patient-specific physiological and functional characteristics are more predictive of drug therapy outcomes than chronological age.
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