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 Neglect has been replaced by a more optimistic therapeutic endeavour and countless old people have benefitted from this approach.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

Inhalt
Pharmacokinetics in Advancing Age.- Brain Receptors and Aging in Relation to Drug Effect.- Clinical Trials in Old Subjects.- General Symptomatology of Pathogenic Drug Usage in Old Patients.- Epidemiological Consideration of Adverse Reactions to Drugs.- Drug Compliance.- The Treatment of Sleep Disorders.- Assessment and Management of Confused Old People in General Hospitals.- Treatment of Depression in the Elderly.- Treatment of Chronic Brain Failure.- Perspective in the Treatment of Dementia.- Physiopathology and Treatment of Transient Ischaemic Attacks.- Psychodynamic Treatment of the Elderly.- Nutrition of Elderly Patients in Long Care Wards.- Disorders of Fluid and Electrolyte Metabolism in the Elderly.- Long Term Treatment with Oral Antidiabetics.- Insufficiency of Haemoactive Principles in the Elderly and its Treatment.- Plasma Lipids and Frequency of Hyperlipidaemia in the Elderly: Indications and Cost/Benefit Ratio of Hypolipidaemic Treatment.- Metabolic Bone Disease and Fracture of the Femoral Neck.- The Prophylaxis of Senile Osteoporosis.- Treatment of Post-Menopausal Osteoporosis.- The Role of the Physician in Femoral Neck Fracture.- Digitalis Metabolism in Aged Patients.- Digitoxin in Elderly Patients with Rapid Atrial Fibrillation.- The Use of the Antiarrythmic Agents in the Elderly.- Diuretic Therapy in Old Patients.- Should Hypertension in the Elderly be Treated?.- Anti-Hypertensive Treatment in the Older Patient.- Treatment of Orthostatic Hypotension.- Treatment of Cardiorespiratory Failure in the Elderly.- Intensive Care of Acute Ischemic Cardiopathy in Old Patients.- Cardiac Rehabilitation in the Elderly.- Pathophysiology of Urinary Incontinence.- The Pharmacology of Urinary Incontinence.- Perspectives on the Prophylaxis and Therapy of Thromboembolism in the Aged.- Thrombolytic Therapy in the Elderly.- Antiplatelet Aggregating Agents.- Endogenous Opiates Regulating Pain Perception in the Aged Rat.- Pathophysiology of Prostaglandins, with Particular Reference to the Elderly.- Pain Treatment in Old Patients.