Quiz 21: Drugs for the Older Adult Patient

Medicine

The phenomenon of aging causes some structural and physiological changes in the human body that impact the functioning of different systems. Some of the major changes that take place are described below. Skin The subcutaneous fat reduces, and the skin becomes thin and fragile. It can bruise easily. Skin remains dry due to reduced secretion of natural oils. Wrinkles and skin tags (small growths) are commonly seen on the skin. Heart The blood vessels become stiffer with age. This causes the heart to pump blood more forcefully. Overtime the efficiency of heart decreases. The pulse rate increases. Collagen As body ages, the connective tissue becomes stiffer and more collagen accumulates. This is more evident in the lungs where the elasticity of the alveoli is affected. Thus, lungs cannot expand to full capacity. Consequently, to draw in more air, breathing rate increases and breath is shallow. Brain The brain loses cells as the body ages. Loss of cells results in loss of memory. Reflexes slow down. Senses Senses of sight and hearing are affected the most, due to which presbyopia and presbycusis, respectively are more common. Also, with regards to sight, there is a decline in tolerance of glares, and ability to perform activity in low-contrast conditions and discriminate colors. High tones in speech may not be audible to the ear, thus making it difficult for the ear to discern consonants. Taste of salty diminishes, that for bitter increases, and for sweet is not altered. Salivary glands too secrete less saliva. All this combined with the loss of teeth, makes the person less inclined to eating. Hyposmia may be seen due to olfactory losses. Skin changes, reduced circulation and loss of brain cells also contribute to the diminishes sense of touch. Digestive tract The peristalsis is not as efficient as it was when the individual was young. Digestion occurs slowly. Constipation is prevalent in most aged individuals. Kidneys The reduction in renal functioning is down by a predictable 50% in the case of the older individuals. Thus, the excretion time is increased as compared to that in someone of younger age. Endocrine glands Hormone receptors become less receptive and hormone production of most of the hormones decreases. The thyroid produces less of the thyroid hormones. This reduces the basal metabolic rate, which in turn, causes increased body fat and reduced production of heat in the body. However, production of parathyroid hormone increases. This combined with the loss of calcium, also a feature of ageing, brings about demineralization of bones causing osteoporosis. Menopause is also an outcome of reduce hormonal activity. Menstruation Secretion of hormones decreases with age, periods become shorter and infrequent and finally cease. Muscles The muscle mass declines, muscles loss flexibility and become weaker. This forces restricted mobility. Bones The bone mass decreases due to demineralization. Bones become fragile. Also, the cartilages lose their elasticity due to the stiffening of the connective tissue. This leads to frequent fractures.

"Geriatrics" is the branch of medicine that helps in pertaining to the diseases and disorders of people whose age is 65 years or older. It is the study of diseases of the aged people like in an aging condition where the body loses its ability to cope with stress and make it harder for the older adult to bounce back after diseases. So, the geriatrics branch helps in understanding the type of diseases and thereby administering medications accordingly. Geriatrics medicine is also different from normal medication care as it is dependent upon the physiological alteration in advancing age, multiple diseases, environmental factors and genetic variations which may not be there when treating young individuals. Aging brings changes in patterns of daily living in an individual. Without fully and proper knowledge of the disease, it is not possible to adjust the appropriate dosage and routes. Therefore, geriatrics help in the effective treatment of old aged individuals.

The reasons why treatment is individualized according to each person's needs are stated below. 1. Most of the elderly patients are suffering from multiple chronic diseases. For example, one in every four elderly suffers from arthritis and another serious ailment such diabetes or cardiovascular disease. Thus, individualized treatment needs to be given so that there is no interaction between the combination of drugs prescribed to remedy the respective ailment. 2. Variation in the action of drugs across individuals is more as compared to the younger age group, requiring individualized treatment for each patient.