神经系统疾病

Critical Illness and the Aging Population: Clinical Implications and Pharmacotherapy Challenges

Abstract

Catherine K. Floroff, Patricia W. Slattum and Gretchen M. Brophy

The rate of critically ill older patients being admitted to intensive care units (ICU) continues to rise. Multiple factors influence the complexity of treatment strategies and create challenges for optimizing patient care while avoiding unwanted adverse effects. These factors include Pharmacokinetic (PK) and Pharmacodynamics (PD) changes that are compounded by both age and critical illnesses and may heighten the risk of suboptimal treatment strategies and adverse drug events, including neurotoxicity, to the patient. Medications that increase the risk for adverse drug events, drug-drug interactions, and drug-disease interactions may be classified as a potentially inappropriate medications based on risk versus benefit of use in older adults. However, many times these agents are needed for treatment of critically ill patients and must be dosed and monitored appropriately to avoid complications, such as delirium, which is associated with increased morbidity and mortality in the older population. Unfortunately, clinical pharmacotherapy and outcome studies with extreme age considerations for pharmacotherapy are lacking. This article reviews the pharmacotherapy challenges in older critically ill patients, and provides medication considerations for avoiding adverse drug events that may complicate patient care.