Pharmacological Concepts:

Geriatric Considerations
Margarita Blajeva
(Group 35, 2010)

Objectives
1. Describe the main physiological changes that occur with
aging
2. Identify factors affecting absorption and distribution with
the geriatric client
3. Describe how drugs are metabolized and excreted in the
elderly
4. Examine the issues related to drug compliance in the
elderly population

Demographics
Geriatric population
largest consumers of Rx medications
the higher the age, the higher the number of Rx drugs a person takes
average usage ~ 3-4 drugs per senior (not uncommon to have 10+
Rx)
nature and frequency of adverse drug reactions increase with age

Concerns with Geriatric Pharmacology

changes in body metabolism

drug interactions
disease processes
changes in lifestyle

Aging
Estimated that after 25-30 years of age, CO by 1% a
year
Most body organs in size with age fewer cells to carry
out organ functions
Changes the way in which body will cope with metabolic
processes particularly important for pharmacology
Pharmacological changes:

Drug absorption
Drug distribution
Drug metabolism
Drug excretion

Drug Absorption
Changes to intestinal tract:

decreased blood flow

reduced absorptive surface area
decreased gastric secretions
decreased motility

Result:
SLOWED rate of drug absorption
SLOWED rate of drug action

Peak drug level:

tends to decrease with age
same amount of drug will be absorbed but over a longer period of time

Drug Distribution
Changes in body composition:
Lean body mass (muscle) % decreases
Body water % decreases
Body fat increases

(memory helper: people get weaker, fatter and dryer)

Because body fat increases with age

Lipid soluble drugs = wider distribution

Lipid soluble drugs:

Organs with greater fat (adipose tissue/muscle) will get more than younger adults
Organs with lower fat content (liver/kidney) will get less than younger adults
liver & kidney do most of the metabolism and excretion so

= SLOWED elimination
= GREATER half life
= GREATER duration of action

Drug Distribution
Body water change = more drug in less fluid
GREATER concentration of drug
HIGHER concentration of drug in elderly patient

Water soluble drugs:

Less bodily fluid to dissolve in
Less distribution to organs with high adipose content
GREATER concentration of drug in certain organs
GREATER pharmacological effects

Drug Metabolism
In general
RATE of drug metabolism decreases with age
but there is much variability

Why?
Decreased blood flow to liver (less coming in/fewer resources
available)
Decreased production of liver enzymes

Mixed-function oxidase system

Enzymes responsible for oxidizing drugs
Tend to be strongly affected by the aging process
Drugs that are oxidized (eg. Benzodiazepines) will be metabolized
slower
longer duration of drug action

Drug Excretion
Main routes of elimination:
Renal & Gastrointestinal
Enterohepatic cycling
Some drugs also are eliminated by travelling through the liver,
biliary tract, then intestinal tract
Some of these drugs, which undergo enterohepatic cycling, will not
be eliminated at a final step but will re-enter circulation
increased half-life & duration

Drug Excretion
Renal excretion
One of the most greatly impacted systems by aging process
Renal function decreases across the board:
glomerular filtration rate (GFR)
creatine clearance

What this means for medications that are primarily excreted

by renal system:
duration of action
plasma drug concentration
pharmacological action

Therefore dosage must be reduced accordingly.

Drug Compliance
Extremely important issue in elderly
Challenges with elderly compliance
Complicated dosing regimens
Confusion

age related memory loss

pathologic processes (Alzheimers, dementia, etc.)
live alone
lack of instructions for drug taking procedures
confusion tends to be directly proportional to number of Rx
medications taken

Presence of unpleasant side effects of drug discourages use

Polypharmacy = multiple drug prescriptions

Drug Compliance
Other considerations:

Understanding and training compliance may be increased

dramatically with thorough instructions about the uses and
methodology involved with a given medication

Form patients may have difficulty with certain forms of medications

(e.g. swallowing large capsules)

Container may be difficult to open, or difficult to read and understand

Helping compliance:

Understanding of the how and why: this should be done by physician

but often is not

Developing easy to follow schedule

e.g. Pill A after lunch/ Pill B before bed

Drug Compliance
BLISTER PACK!!!

Summary
Demographics & Aging
Drug Absorption
Drug Distribution
Drug Metabolism
Drug Excretion
Compliance

THE END