Drug Therapy in Elderly

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With altered organ-functions, the effects and efficient removal of

drugs is affected in elderly. Elderly are more likely to experience

adverse effects of drugs. They may not be able to tolerate full doses

of drugs. Medicines may exhibit abnormal responses in the elder age

group. For example, epam (a sedating drug) may cause prolonged

sleep and behavioural problems.

Generally metabolism of drugs

and excretion by kidneys is reduced due to age resultant reductions in

their function and hence dose adjustments are needed for several drugs.

Liver blood flow is also decreased. Elderly have low total body water

so drug distribution is affected. Serum albumen levels (which allows

binding of drug) decrease and total body fat increases with age.

Distribution of fat is on abdomen and there is thinning of legs and

arms. These changes result in altered drug metabolism.

Finally,

elderly people suffer from a number of diseases at a time and hence

they take many drugs which interact (adversely) with each other. Older

patients are likely to caUSe dosage errors due to forgetfulness, poor

vision and hearing problems. These aspects need to be addressed by a

conscientious prescriber.

Note: It is important to understand

that a healthy old person is different from diseased old person. Drug

related changes are minimal in the former gruop.

Precautions

Always try non-drug treatments methods for trivial ailments.

Treatment should be started with lower than adult doses. Dose increments should

be gradual.

As far as possible number of medicines be kept minimal. This improves

compliance.