Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment

Authors

  • Andrew J. McLachlan,

    Corresponding author
    1. Faculty of Pharmacy, The University of Sydney, Sydney, NSW 2006
    2. Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW 2139
    Search for more papers by this author
  • Sally Bath,

    1. Faculty of Pharmacy, The University of Sydney, Sydney, NSW 2006
    Search for more papers by this author
  • Vasi Naganathan,

    1. Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW 2139
    2. Faculty of Medicine, The University of Sydney, Sydney, NSW 2006
    Search for more papers by this author
  • Sarah N. Hilmer,

    1. Faculty of Medicine, The University of Sydney, Sydney, NSW 2006
    2. Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, NSW
    Search for more papers by this author
  • David G. Le Couteur,

    1. Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW 2139
    2. Faculty of Medicine, The University of Sydney, Sydney, NSW 2006
    Search for more papers by this author
  • Stephen J. Gibson,

    1. National Ageing Research Institute Inc, 34-54 Poplar Road, Parkville, Vic. 3052, Australia
    Search for more papers by this author
  • Fiona M. Blyth

    1. Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW 2139
    Search for more papers by this author

Professor Andrew J. McLachlan, Faculty of Pharmacy, University of Sydney, A15 Science Rd, Sydney, NSW 2006, Australia. Tel.: + 61 2 9767 7373 Fax: + 61 2 9767 7826 E-mail: andrew.mclachlan@sydney.edu.au

Abstract

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.

Ancillary