Abstract
Many more elderly individuals will present for treatment in acute care now than in the past as the proportion of patients in the geriatric age group increases. Physiological changes in the elderly affect the way their bodies handle and react to various drugs, and this needs to be kept in mind during the management of these patients in acute care. Some pharmacological changes can be predicted while many others remain unknown simply because large randomized controlled trials are difficult to perform in this age group. Many who present in the acute setting may already have medical co-morbidities and be on multiple medications which will increase their risks for drug-drug interactions and associated adverse effects. The pharmacokinetic changes associated with ageing include changes in absorption due to decreased blood flow, altered volume of distribution depending on lipid solubility or water solubility, decreased metabolism and excretion. It is imperative that drug administration in this category of patients is titrated to meet the patients’ needs.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Further Reading
Greenblatt DJ, von Moltke LL, Harmatz JS, et al. Pharmacokinetics, pharmacodynamics, and drug disposition. In: Davis KL, Charney D, Coyle JT, et al., editors. Neuropsychopharmacology: the fifth generation of progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 507–24.
Handel J. Anaesthesia for the elderly. In: Allman KG, Wilson IH, editors. Oxford handbook of anaesthesia. 2nd ed. New York: Oxford University Press; 2006.
Hutchison LC, O’Brien CE. Changes in pharmacokinetics and pharmacodynamics in the elderly patient. J Pharm Prac. 2007;20:4–12.
Kirby BS, Crecelius AR, Voyles WF, Dinenno FA. Impaired skeletal muscle blood flow control with advancing age in humans: attenuated ATP release and local vasodilation during erythrocyte deoxygenation. Circ Res. 2012;111(2):220–30. doi:10.1161/CIRCRESAHA.112.269571.
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.
Mendes-Nett RS, Silva CQ, Oliveira Filho AD, et al. Assessment of drug interactions in elderly patients of a family health care unit in Aracaju (Brazil): a pilot study. Afr J Pharm Pharmacol. 2011;5:812–18.
Miller SW. Therapeutic drug monitoring in the geriatric patient. In: Murphy JE, editor. Clinical pharmacokinetics. 4th ed. Bethesda: American Society of Health-System Pharmacists; 2007.
Routledge PA, O’Mahony MS. Woodhouse KW Adverse drug reactions in elderly patients. Br J Clin Pharmacol. 2004;57:121–6.
US Department of Health and Human Services. Elderly at risk of hospitalizations from key medications: promoting safe use of blood thinners and diabetes medications can protect patients. CDC Online Newsroom (US). 2011 Nov. Available from: www.cdc.gov/media/releases/2011/p1123_elderly_risk.html. Last accessed 15 June 2014.
Wooten JM. Pharmacology considerations in elderly adults. South Med J [Internet]. 2012;105(8):437–45. Available from: http://www.medscape.com/viewarticle/769412_2. Last accessed 15 June 2014.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Loh, P.S. (2015). The Elderly Patient. In: Chan, Y., Ng, K., Sim, D. (eds) Pharmacological Basis of Acute Care. Springer, Cham. https://doi.org/10.1007/978-3-319-10386-0_21
Download citation
DOI: https://doi.org/10.1007/978-3-319-10386-0_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-10385-3
Online ISBN: 978-3-319-10386-0
eBook Packages: MedicineMedicine (R0)