Therapeutics In The Elderly

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

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 Neglect has been replaced by a more optimistic therapeutic endeavour and countless old people have benefitted from this approach.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 Neglect has been replaced by a more optimistic therapeutic endeavour and countless old people have benefitted from this approach.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.

This book focuses on evidence-based occupational therapy in the care of older adults in different clinical settings, from home to acute hospital, from intensive care unit to rehabilitation centers and nursing homes. Occupational therapy has progressively developed as a new discipline aiming to improve the daily life of individuals of different ages, from children to older adults. The book first reviews the interaction between occupational therapy and geriatrics and then discusses in depth how occupational therapy interventions are applied in the community, in the acute hospital and in the nursing home. It highlights the key role of occupational therapy in the management of frail patients, including critically ill older patients and persons with dementia, and describes in detail how to maintain occupational therapy interventions across different settings to avoid the fragmentation of care. The ageing population requires new innovative approaches to improve the quality of life, and as such this book provides clinicians with handy, key information on how to implement occupational therapy in the daily clinical care of older adults based on the current scientific evidence.

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.