An Approach to Drug-Induced Liver Injury from the Geriatric Perspective

Area of Science:

• Hepatology
• Geriatric Medicine
• Clinical Pharmacology

Background:

• Drug-induced liver injury (DILI) is a complex condition with variable presentation and severity.
• The geriatric population faces unique challenges with DILI due to age-related liver changes and polypharmacy.
• Herbal and dietary supplement (HDS)-related DILI is a growing concern, contributing to acute liver failure.

Purpose of the Study:

• To highlight the specific challenges and considerations of DILI in the geriatric population.
• To emphasize the need for increased recognition and prompt management of DILI in elderly patients.
• To guide healthcare providers in diagnosing and intervening early in DILI cases among older adults.

Main Methods:

• Review of current literature on DILI, with a focus on geriatric-specific aspects.
• Analysis of the impact of age-related physiological changes and polypharmacy on DILI presentation.
• Examination of the role of herbal and dietary supplements in DILI within the elderly population.

Main Results:

• DILI presentation and severity are highly variable, particularly in the elderly.
• Herbal and dietary supplement use is a significant factor in DILI among older adults, complicating management.
• Early N-acetylcysteine may benefit non-acetaminophen DILI; personalized medicine via genomic signatures is a future possibility.

Conclusions:

• DILI in the elderly requires heightened provider awareness due to complex presentations.
• Thorough patient history, including HDS use, and early intervention are paramount for managing DILI in older adults.
• Prompt diagnosis and management are essential to prevent progression to liver failure and mortality in geriatric DILI cases.