Drugs and the elderly patient

The rational use of drugs in older persons is a challenging area of clinical practice. The increased incidence of multiple chronic illnesses contributes to disproportionately high use of prescription and over-the-counter (OTC) medications, which in turn leads to more adverse drug events among the elderly. Inadequate nutrition and poor patient compliance also may contribute to the problem. Drug studies that use young adult subjects cannot be extrapolated accurately to apply to the elderly because physiologic changes that occur with age affect the pharmacokinetics and pharmacodynamics of drugs. In addition, therapeutic target concentrations of drugs are impossible to define due to marked interindividual variation in the elderly population. Drugs should be administered to elderly patients only when absolutely necessary. The dosages should be titrated to a clearly defined clinical response and dentists should avoid drugs that are known to be problematic for older adults.