Pharmacoepidemiology in older people: Purposes and future directions - 22/03/19

Doi : 10.1016/j.therap.2018.10.006

Marie-Laure Laroche ^a,^b,^⁎ , Caroline Sirois ^c,^d, Emily Reeve ^e,^f,^g,^h, Danijela Gnjidic ⁱ, Lucas Morin ^j
^a Centre de pharmacovigilance, de pharmacoépidemiologie et d’information sur les médicaments, CHU de Limoges, 97042 Limoges, France
^b Inserm 1248, faculté de médecine de Limoges, 87042 Limoges, France
^c Centre d’excellence sur le vieillissement de Québec, centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, G1S 4L8 Québec, Canada
^d Département de médecine sociale et préventive, université Laval, G1V 0A6 Québec, Canada
^e NHMRC-Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Sydney Medical School, University of Sydney, NSW 2065 Saint-Leonard, Australia
^f Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, NS B3H 2Y9 Halifax, Canada
^g College of Pharmacy, Faculty of Health, Dalhousie University, B3H 4R2 Nova Scotia, Canada
^h College of Medicine, University of Saskatchewan, SK S7N 5C9 Saskatoon, Canada
ⁱ Sydney Pharmacy School and Charles Perkins Centre, University of Sydney, NSW 2006 Sydney, Australia
^j Aging Research Center, Karolinska Institutet, SE-171 77 Stockholm, Sweden

^⁎Corresponding author. Centre de pharmacovigilance, de pharmacoépidémiologie et d’information sur les médicaments, centre hospitalier universitaire de Limoges, 87042 Limoges cedex, France.Centre de pharmacovigilance, de pharmacoépidémiologie et d’information sur les médicaments, centre hospitalier universitaire de LimogesLimoges cedex87042France

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Summary

Knowledge of the benefit/risk ratio of drugs in older adults is essential to optimise medication use. While randomised controlled trials are fundamental to the process of drug development and bringing new drugs to the market, they often exclude older adults, especially those suffering from frailty, multimorbidity and/or receiving polypharmacy. Therefore, it is generally unknown whether the benefits and harms of drugs established through pre-marketing clinical trials are translatable to the real-word population of older adults. Pharmacoepidemiology can provide real-world data on drug utilisation and drug effects in older people with multiple comorbidities and polypharmacy and can greatly contribute towards the goal of high quality use of drugs and well-being in older adults. A wide variety of pharmacoepidemiology studies can be used and exciting progress is being made with the use of novel and advanced statistical methods to improve the robustness of data. Coordinated and strategic initiatives are required internationally in order for this field to reach its full potential of optimising drug use in older adults so as to improve health care outcomes.

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Keywords : Pharmacoepidemiology, Aged 80 and over, Pharmacovigilance, Drug utilization, Polypharmacy