Chapter 20.Psychopharmacology
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Pharmacological intervention in late life requires special care. Older patients are more susceptible to drug-induced adverse events. Several psychotropic medications and classes have been associated with serious adverse events (Pollock et al. 2009), including increased mortality risk (Ballard and Corbett 2020; Kripke et al. 2012; Langballe et al. 2014; Lao et al. 2020; Moreno et al. 2018; Weich et al. 2014; Xu et al. 2020). Older adults are more likely to experience these events, including cardiac effects (e.g., prolonged QTc, arrhythmias, sudden death) (Beach et al. 2018), peripheral and central anticholinergic effects (e.g., constipation, urinary retention, delirium, cognitive dysfunction) (Pasina et al. 2019; Tsoutsoulas et al. 2017), antihistaminergic effects (e.g., sedation), and antiadrenergic effects (e.g., postural hypotension) that not only interfere with basic activities but also lead to falls and fractures. Other possible adverse effects in this population include hyponatremia, bleeding, and altered bone metabolism. Older patients’ increased susceptibility to these adverse events may be due to the pharmacokinetic and pharmacodynamic changes associated with aging, such as diminished glomerular filtration, changes in the density and activity of target receptors, reduced liver size and hepatic blood flow, and decreased cardiac output (Pollock 2019; Reuben et al. 2019; Uchida et al. 2009) (Table 20–1).
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