Aging And Drug Therapy

One of the greatest advances in Geriatric Medicine during the last quarter of a century has been the increased realization of the possibilities of treatment for elderly patients. Neglect has been replaced by a more optimistic therapeutic endeavour and countless old people have benefitted from this approach. But there is also a drawback, and this is the risk of hazardous side effects of medication which are often directly proportional to the biological potency of the drug and may be unpredictably increased due to changes in the senile organism. In fact the anatomical and biological changes in old age alter both the kinetics of most drugs and the receptor response. On account of these changes the individual tolerance of aged patients to drug therapy may be quite different from that of younger subjects. Thus for a variety of reasons elderly patients receive more drugs, but they are at a higher risk of encountering adverse reactions, which often show atypical clinical features. We can therefore speak of "geriatric iatrogenic disorders" and point out that some of these side effects are determined by a complex pathogenesis due to the particular pathophysiological condition in the elderly. It is important to encourage the habit of individ ually evaluating potential risk versus expected advantages of drugs in keeping with the same principles adopted in the evaluation of cost/benefit ratio.

One of the greatest advances in Geriatric Medicine during the last quarter of a century has been the increased realization of the possibilities of treatment for elderly patients. Neglect has been replaced by a more optimistic therapeutic endeavour and countless old people have benefitted from this approach. But there is also a drawback, and this is the risk of hazardous side effects of medication which are often directly proportional to the biological potency of the drug and may be unpredictably increased due to changes in the senile organism. In fact the anatomical and biological changes in old age alter both the kinetics of most drugs and the receptor response. On account of these changes the individual tolerance of aged patients to drug therapy may be quite different from that of younger subjects. Thus for a variety of reasons elderly patients receive more drugs, but they are at a higher risk of encountering adverse reactions, which often show atypical clinical features. We can therefore speak of "geriatric iatrogenic disorders" and point out that some of these side effects are determined by a complex pathogenesis due to the particular pathophysiological condition in the elderly. It is important to encourage the habit of individ ually evaluating potential risk versus expected advantages of drugs in keeping with the same principles adopted in the evaluation of cost/benefit ratio.

With people aged 65 years and older currently making up the fastest growing age group throughout the world, the demographic revolution of an aging society will inevitably lead to increased pressure to develop a rationalistic and age-tailored process of diagnosis and treatment among the elderly. As aging people often suffer from several chronic diseases and are being treated with multiple medications concurrently, unwanted drug interactions occur more frequently. Whereas recent approaches have recommended to remove particular drugs from the medication regimen to avoid adverse effects, Drug Therapy for the Elderly underlines both indispensable and dispensable elements of drug treatment in order to provide an overall assessment of drugs suitable for the aged. In view of the multimorbidity and polypharmacy situations experienced by elderly patients, this book takes into account the special needs and requirements shown by this group, thus serving as a timely reference for physicians who treat the elderly.

Experimental gerontological research is necessary to obtain optimal information and thus ensure proper drug therapy for the elderly. Most older persons acquire multiple diseases, first of all chronic diseases. They involve complex problems of a physical, social, and psychological nature. The multimorbidity of the elderly raises many questions in drug therapy. By contrast with our extensive knowledge of pharmacokinetics and pharmacodynamics in younger age groups, few facts are available in respect of the elderly. A variety of factors may influence drug therapy. Physiological and pathological age-related changes of molecules, cells, organs, and the total organism may interact to enhance or inhibit drug therapy in higher age groups. It is well known that elderly patients are overmedicated and therefore the incidence of adverse drug reactions increases with age. Elderly patients with multimorbidity often have a diminished body clearance of drugs; age-related changes of the kidney seems to be one of the most important factors in this regard. Far less important than the elimination of drugs through the kidney is their excretion in the bile. So far results have disclosed that oxidative steps in drug clearance are more likely to be disturbed than phase II reactions. Furthermore; changes in distribution volume and age-related alterations in receptor sensitivity also influence the clearance of drugs in the elderly.

Drug-related problems in the elderly is intended to serve as a source of information and clinical support in geriatric pharmacotherapy for students as well as all health care professionals, e.g. physicians, nurses and pharmacists. Pharmacotherapy is of great importance to all mankind. Drugs are however powerful and must be handled appropriately. This is especially important for elderly patients. Drug-related problem is not a major subject in most university programmes in medicine or pharmacy. When there is no speci c course, there is often no book covering the topic. In our view, as teachers at various university courses, there has been a shortage of literature that re ects the most important aspects of drug-related problems in the elderly. Medical practitioners, nurses and pharmacists, need to have this knowledge to be able to serve their patients in the best way. This book covers most aspects of drug-related problems in the elderly. With b- ter knowledge of drug-related dif culties and risks we hope that elderly will have fewer drug-related problems and bene t more from their pharmacotherapy.

This open access book provides a comprehensive perspective on the concept of ageism, its origins, the manifestation and consequences of ageism, as well as ways to respond to and research ageism. The book represents a collaborative effort of researchers from over 20 countries and a variety of disciplines, including, psychology, sociology, gerontology, geriatrics, pharmacology, law, geography, design, engineering, policy and media studies. The contributors have collaborated to produce a truly stimulating and educating book on ageism which brings a clear overview of the state of the art in the field. The book serves as a catalyst to generate research, policy and public interest in the field of ageism and to reconstruct the image of old age and will be of interest to researchers and students in gerontology and geriatrics.