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Sunday, August 26, 2018

Overprescribing in the Elderly

Melissa Walton-Shirley, MD
DISCLOSURES 
August 26, 2018
At the European Society of Cardiology (ESC) 2018 Congress, the presenters for the session titled "Drug Prescription in the Elderly" threw around words like "sarcopenia" and "frailty." The initials "GFR" (glomerular filtration rate) got some focus by Christian Funck-Brentano of Paris. "Kidney function is key to drug accumulation and side effects," he said. Muscle wasting and the tendency to fall are almost never mentioned in late-breaking clinical trial presentations, but for patients over age 65, sarcopenia, frailty, and GFR are everything. They predict whether our patients will  break a hip, become confused, or even die.
The panelists meant for us to leave convinced that these terms should never be an afterthought but rather a first consideration when sending an e-script. It worked for me.
Claudio Cenconi from Italy made the  point that the prevalence of heart failure soared between 1988 and 2008, in his presentation "Pharmacotherapy in the Elderly." And the proportion of these patients over 80 years of age increased from 13.3% to 22.4%.[1] The mean number of daily meds per patient has increased from 4.1 to 6.4 over this time, coinciding with an increase in patients with five or more chronic comorbidities (from 42% to 58%).[1] Both systolic and diastolic impairment are common, so understanding this basic milieu of our geriatric patients is salient to nearly all prescriptions./.../

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