One of my favorite areas of medicine is the challenge involved with treating the elderly. While on rotations in school I was fortunate enough to be placed at a site with an all-inclusive care program for the elderly. The program was a mixture of adult daycare and healthcare (physicians, nurse practitioners, physical & occupational therapists, etc. were on site). I LOVED the older patients – they were full of wisdom and had a no holds barred attitude, saying whatever they wanted to say!!!
I quickly learned there is more to treating the elderly than one would think. I assumed you could treat the older patient exactly like a younger adult suffering from the same ailment – Not true!
There are several different challenges to meet when dealing with the elderly and medicine so I’m going to hit on one area at a time – hopefully this keeps the topic from being too overwhelming.
We’ll start with what your body does to drugs after you take it (pharmacokinetics – big word!), which consists of four major areas. Note: this may be a little confusing, but please do not hesitate to contact me with any questions! The major areas are:
1) Absorption – the movement of the drug into the bloodstream
2) Distribution – the movement of the drug between the blood and the different tissues of the body (i.e. muscle, fat, and brain tissue)
3) Metabolism – how your body changes the drug in preparation for elimination
4) Elimination – how the drug is removed from your body
These actions all change as you get older and at some point they will change to a degree in which extra care is needed. Some of the changes in the elderly are as follows:
1) Absorption –
a. Even though the surface area of the small intestine (where most of the drug absorbs) decreases with age, changes in drug absorption tend to be minor and not important in the clinical setting.
2) Distribution
a. An ↑ in levels of fat-soluble drugs because body fat increases with age.
b. A ↓ in levels of water-soluble drugs because the total amount of water in the body decreases.
c. Drugs that bind to proteins in the blood may ↑ or ↓ in levels depending on the type of protein (with aging, one type of protein decreases in number while the other increases!).
3) Metabolism
a. Drugs broken-down by the liver will ↑ in level because your liver doesn’t function as well with age.
4) Elimination
a. Your kidneys will not be able to remove drugs from your body as well so there will be an ↑ amount of the drugs in your bloodstream.
I’m going to stop here so you’ll have some time to digest what I have told you thus far! In my next post related to this topic, I’ll give some examples of common medications that would be relevant to the above information. Until then, please contact me with any questions – I am looking forward to hearing from you!
During my mother’s final 4 years, we had to deal with this problem, and the resultant weird and/or very uncomfortable side effects, several times before we finally found a doctor who understood the problem. Then, whenever a new med was prescribed, my mother was started on a minimal dose which was increased as needed until the optimal dosage for her was determined.
This is a very good article from a pharmacists perspective which shows the way in which medications flow through our systems. This is crucial because Older Adults are often prescribed so many medications.