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Special Aspects of Geriatric Pharmacology
Bertram G. Katzung, MD, PhD
A 77-year-old man comes to your office at his wife’s insistence. He has had documented moderate hypertension for 18 years but does not like to take his medications. He says he has no real complaints, but his wife remarks that he has become much more forgetful lately and has almost stopped reading the newspaper and watching television. A Mini-Mental State Examination reveals that he is oriented as to name and place but is unable to give the month or year.
Society has traditionally classified everyone over 65 as “elderly,” but most authorities consider the field of geriatrics to apply to persons over 75—even though this too is an arbitrary definition. Furthermore, chronologic age is only one determinant of the changes pertinent to drug therapy that occur in older people. In addition to the chronic diseases of adulthood, the elderly have an increased incidence of many conditions, including Alzheimer’s disease, Parkinson’s disease, and vascular dementia; stroke; visual impairment, especially cataracts and macular degeneration; atherosclerosis, coronary and peripheral vascular disease, and heart failure; diabetes; arthritis, osteoporosis, and fractures; cancer; and incontinence. As a result, the need for drug treatment is great in this age group. And as the average life span approaches (and in some countries, already exceeds) 80, this need will increase dramatically.
When all confounders are accounted for, age itself is still the strongest risk factor for cardiovascular and neurodegenerative diseases and most forms of cancer. Research into the molecular basis of aging has answered a few questions and opened many more. It has long been known that caloric restriction alone can prolong the life span of animals, including mammals. Some evidence suggests
He cannot remember the names of his three adult children or three random words (eg, tree, flag, chair) for more than 2 minutes. No cataracts are visible, but he is unable to read standard newsprint without a powerful magnifier. Why doesn’t he take his antihypertensive medications? What therapeutic measures are available for the treatment of Alzheimer’s disease? How might macular degeneration be treated?