XXXX in special populations - the elderly.

@entity1 @entity137 @entity64 @entity303 @entity1245 @entity751 @entity933 @entity2718
The International Conference on Harmonization considers older @entity1 a 'special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to @entity137 ( @entity137 ). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older @entity1 or those with multiple morbidities. This presents a challenge caring for older @entity1 , as drug doses in trials may not be achievable in real world @entity1 and risks of @entity137 are underestimated in clinical trial populations. The majority of @entity137 in older @entity1 are Type A, potentially avoidable and associated with commonly prescribed medications. Several @entity137 are particularly associated with major adverse consequences in the elderly and their reduction is therefore a clinical priority. Falls are strongly associated with @entity1245 , neuroleptics, antidepressants and antihypertensives. There is good evidence for medication review as part of a multifactorial intervention to reduce falls risk in community dwelling elderly. Multiple medications also contribute to @entity933 , another @entity751 resulting in excess mortality particularly in frail older @entity1 . @entity2718 associated with use of broad spectrum antibiotics mainly affects frail older @entity1 and results in prolonged hospital stay with substantial morbidity and mortality. Antipsychotics increase the risk of @entity64 by more than three-fold in @entity1 with @entity303 . Inappropriate prescribing can be reduced by adherence to prescribing guidelines, suitable monitoring and regular medication review. Given the heterogeneity within the older population, providing individualized care is pivotal to preventing @entity137 .
