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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Antihistamines are a class of drugs widely used to alleviate the symptoms of allergies, such as sneezing, itching, and nasal congestion. They work by inhibiting the actions of histamine, which is released by immune cells in response to allergenic substances or tissue injuries.
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Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
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Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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First-Generation Antihistamine Use in Geriatric Emergency Department Patients: Retrospective Review.

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First-generation antihistamines are often used in the emergency department for older adults, but carry risks. Most uses were inappropriate, and adverse drug effects like delirium occurred, particularly in those over 85 or with cognitive impairment.

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Area of Science:

  • Geriatric Emergency Medicine
  • Pharmacology
  • Patient Safety

Background:

  • First-generation antihistamines are common in emergency departments (EDs) but carry risks for older adults.
  • Limited ED-specific data exist on adverse drug effects (ADEs) and risks of single-dose administration in this population.
  • This study assessed the use, ADEs, and indications of first-generation antihistamines in older adults during ED visits.

Purpose of the Study:

  • To evaluate the frequency of first-generation antihistamine use in older adults in the ED.
  • To identify the incidence and types of adverse drug effects associated with their use.
  • To determine the appropriateness of indications for antihistamine administration in this demographic.

Main Methods:

  • Retrospective cohort study of adults aged 65+ receiving first-generation antihistamines in an urban academic medical center ED.
  • Chart review by blinded abstractors to identify indications and adverse effects.
  • Regression analysis to assess factors associated with adverse drug effects, including age (≥85), cognitive impairment, and multiple doses.

Main Results:

  • First-generation antihistamines were used in 3% of geriatric ED encounters.
  • Adverse drug effects occurred in 15% of encounters, with delirium and urinary retention being most common.
  • Age ≥85, prior cognitive impairment, and multiple doses significantly increased ADE risk (RR 5.5, 3.1, and 1.9, respectively).
  • 92% of indications were potentially inappropriate, including diphenhydramine for headache or contrast media reactions and hydroxyzine for anxiety.

Conclusions:

  • Emergency department use of first-generation antihistamines in older adults is associated with clinically significant harm, particularly in those ≥85 or with cognitive impairment.
  • The majority of antihistamine administrations in this cohort were for potentially inappropriate indications.
  • Diphenhydramine use for prophylaxis against contrast media reactions is a common, potentially inappropriate indication.