Drug poisoning in older patients. Preventative and management strategies

Children under 6 years of age are involved in the majority of poisonings. However, the elderly are more likely to require hospitalisation and to die from poisonings compared with younger individuals. Drugs play an important role in the poisoning exposures of older patients. Analgesics, cardiovascular medications, theophylline preparations and antidepressants and other psychotropic medications are most commonly implicated in drug poisoning fatalities in elderly Americans. Careful review of information which characterises drug poisonings in the elderly is essential to the development of effective preventative strategies. Most poison centre calls for elderly patients involve accidental exposures. The ingestion of extra doses of medications because of forgetfulness, mistaken identity of medications, incorrect route of administration, and improper storage of medications are among the the primary reasons for unintentional drug poisonings in older patients. A model for injury control composed of 3 phases can be applied to poison exposures in the elderly: activities in the pre-event phase focus on prevention; it should occur; the post-event phase is directed at appropriate management to reduce the consequence of injury from poison exposure once it occurs. The general management of drug poisonings is similar in older and younger patients. However, management in the elderly is complicated by difficulties in the diagnosis of drug poisoning, pharmacokinetic and pharmacodynamic changes associated with aging, increased incidence of chronic illness, and increased medication with the potential for clinically significant drug interactions. Aggressive initial treatment is imperative because the elderly are generally more susceptible to the toxic effects of drugs.