Age Effects on Patient Drug Attribution Judgments

Data were obtained on patients' attribution of symptoms using two different post-marketing surveillance methods. In the patient-initiated method, outpatients were randomly assigned to have a printed notice conspicuously attached to the outside of their medication bags; the "outsert" requested the patients to monitor themselves during the next 2 weeks and to report via a toll-free telephone number any new or unusual symptoms. In the staff-initiated method, other patients filling the same target drug prescriptions did not receive any outsert but were identified at the pharmacy for a telephone interview 10 to 14 days later. The target drugs were chosen from two classes for which the major adverse drug reactions (ADRs) are well identified: oral antibiotics and tricyclic antidepressants. During the interview, for each reported symptom the patient was asked whether it might have been caused by the target drug. Results indicated that older patients, irrespective of the surveillance method or the drug class, appear to be capable of discriminating probable ADRs at least as well as or possibly better than younger patients.

Overmedication of the low-weight elderly

This study analyzes age, weight, and drug doses using cimetidine hydrochloride, flurazepam hydrochloride, and digoxin as tracers. Data were obtained for 1797 patients (mean age, 72 years) filling consecutive prescriptions from a national pharmacy service. With all three drugs, patients with lower weight received substantially higher doses with correlations of weight vs dose, based on milligrams per kilogram of body weight, ranging from -0.34 to -0.40. Because body weight declines with increasing age, lower-weight patients are also older and at greatest risk for drug toxicity. Patients weighing 50 kg or less (n = 155) received milligram-per-kilogram doses that were 31% to 46% higher than the group mean and 70% to 88% higher than patients weighing more than 90 kg. For all three study drugs, as patient weight declines, the mean milligram-per-kilogram dose rose sharply. There was no trend seen toward reducing doses for older patients. Low body weight, in addition to advanced age, is a major risk factor for overmedication. Physicians must recognize the need to reduce drug doses for their low-weight elderly patients.

Utility of drug leaflets for elderly consumers

A mail survey of 1,650 elderly consumers evaluated prescription drug leaflets for antihypertensives, tranquilizers, and arthritis medicines. Of those who said they received the leaflet, 95 per cent read it, 76 per cent kept it, and 56 per cent discussed it with another person. Respondents taking antihypertensive medicine were more apt to keep the leaflet and say they learned new information from it. Those taking tranquilizers were less likely to say the leaflet made them feel better about using the drug.