Читать книгу Clinical Pharmacology and Therapeutics - Группа авторов - Страница 87

The prescription of multiple drugs can lead to a multitude of problems both for the prescriber and the patient, including poor adherence, drug interactions and adverse reactions. The incidence of adverse reactions has been reported as 4% when taking less than five drugs and increases to 54% when taking over five. When prescribing in the elderly it is important to ensure that both you, as prescriber, and the patient understand the indication for the prescription (i.e. symptomatic and/or prognostic benefit) versus potential for side effects.

There is no evidence that an elderly patient whose mental function is normal is more likely to make mistakes with their medication than a younger patient. However, polypharmacy contributes to poor adherence and safety at all ages. The rate of errors when three drugs are prescribed is approximately 20% but it is close to 100% when 10 drugs are prescribed – and the high rate of prescribing for the elderly results in a greater opportunity to make errors. This is, however, potentially made worse by the prevalence of cognitive impairment, which is as high as 25% in those over the age of 85 years.

Physical disability, such as arthritis can contribute to poor adherence as opening ‘child‐proof’ containers or ‘bubble‐pack’ drugs becomes more difficult. Medication aids such as ‘blister packs’ and non‐childproof containers should be considered in this population.