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Review
. 2023 Nov 1;16(11):1542.
doi: 10.3390/ph16111542.

Insight into Risk Factors, Pharmacogenetics/Genomics, and Management of Adverse Drug Reactions in Elderly: A Narrative Review

Carlo Maria Bellanca  1   2 , Egle Augello  1   2 , Anna Flavia Cantone  1 , Rosaria Di Mauro  3 , Giuseppe Antonino Attaguile  1 , Vincenza Di Giovanni  3 , Guido Attilio Condorelli  1 , Giulia Di Benedetto  1   2 , Giuseppina Cantarella  1 , Renato Bernardini  1   2
Affiliations
Review

Insight into Risk Factors, Pharmacogenetics/Genomics, and Management of Adverse Drug Reactions in Elderly: A Narrative Review

Carlo Maria Bellanca et al. Pharmaceuticals (Basel). .

Abstract

The European Medicine Agency (EMA) has defined Adverse Drug Reactions (ADRs) as "a noxious and unintended response to a medicine", not including poisoning, accidental, or intentional overdoses. The ADR occurrence differs based on the approach adopted for defining and detecting them, the characteristics of the population under study, and the research setting. ADRs have a significant impact on morbidity and mortality, particularly among older adults, and represent a financial burden for health services. Between 30% and 60% of ADRs might be predictable and preventable, emerging as a result of inappropriate prescription, drug chemistry inherent toxicity, cell-specific drug toxicity, age- and sex-related anomalies in drug absorption, distribution, metabolism, and elimination (ADME), and drug-drug interactions (DDIs) in combination therapies or when a patient is treated with different drugs for concomitant disorders. This is particularly important in chronic diseases which require long-term treatments. Rapid developments in pharmacogenetics/genomics have improved the understanding of ADRs accompanied by more accurate prescriptions and reduction in unnecessary costs. To alleviate the burden of ADRs, especially in the elderly, interventions focused on pharmaceutical principles, such as medication review and reconciliation, should be integrated into a broader assessment of patients' characteristics, needs, and health priorities. Digital health interventions could offer valuable solutions to assist healthcare professionals in identifying inappropriate prescriptions and promoting patient adherence to pharmacotherapies.

Keywords: adverse drug reactions; drug interactions; older adults; prescription appropriateness; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Summary of risk factors leading to ADRs in elderly patients. Created with BioRender.com; accessed on 19 October 2023.
Figure 2
Figure 2
Management for prescription appropriateness in elderly patients. Created with BioRender.com; accessed on 10 September 2023.
See this image and copyright information in PMC

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