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Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment
Author(s) -
McLachlan Andrew J.,
Bath Sally,
Naganathan Vasi,
Hilmer Sarah N.,
Le Couteur David G.,
Gibson Stephen J.,
Blyth Fiona M.
Publication year - 2011
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2010.03847.x
Subject(s) - polypharmacy , analgesic , medicine , dementia , pharmacodynamics , geriatrics , drug , population , cognition , chronic pain , clinical pharmacology , older people , alzheimer's disease , disease , intensive care medicine , physical therapy , psychiatry , gerontology , pharmacology , pharmacokinetics , environmental health
Pain is highly prevalent in frail older people who often have multiple co‐morbidities and multiple medicines. Rational prescribing of analgesics in frail older people is complex due to heterogeneity in drug disposition, comorbid medical conditions, polypharmacy and variability in analgesic response in this population. A critical issue in managing older people with pain is the need for judicious choice of analgesics based on a comprehensive medical and medication history. Care is needed in the selection of analgesic medicine to avoid drug–drug or drug–disease interactions. People living with dementia and cognitive impairment have suboptimal pain relief which in part may be related to altered pharmacodynamics of analgesics and challenges in the systematic assessment of pain intensity in this patient group. In the absence of rigorously controlled trials in frail older people and those with cognitive impairment a pharmacologically‐guided approach can be used to optimize pain management which requires a systematic understanding of the pharmacokinetics and pharmacodynamics of analgesics in frail older people with or without changes in cognition.

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