Geriatric Pharmacology

Drugs are one of the main therapeutic tools available to modern medicine along with surgery, rehabilitation and other therapies. The objectives of a correct use of pharmacological therapy, at any age and at any time, are the cure or prevention of diseases, the relief or reduction of symptoms and the improvement of the functionality of individuals. Older people have special characteristics that make the handling of medications in them different than in younger adults. First of all, the biological changes that occur over time must be taken into account:

• It decreases the function of renal filtering and the ability of the liver to metabolize substances, which means that drugs take longer to be eliminated from the body, their effect being much longer, or changes in their activation occur.
• Decrease in the amount of lean mass in the body, or what is the same, the lower amount of protein, both in the muscles and in the blood serum, which causes the work of the drugs that bind to proteins to be altered, either by excess or by default.
• Decrease in body water and increase in fat mass, which varies the distribution of drugs that bind to fats (accumulate more than expected).
• Decreased peristaltic movements of the digestive system and the absorption capacity of certain substances, which causes a delay in the arrival of certain drugs administered orally to the bloodstream and from there to the target organ where they act.

Second, the elderly suffer from various diseases and chronic processes simultaneously, that is, what is known as multiple pathologies. This implies that there are multiple simultaneous pharmacological treatments, which is called polypharmacy. Polypharmacy (by convention, geriatrics speak of its presence from 4 drugs) entails an increase in drug interactions, so that its effects may be enhanced or hampered, or new and unexpected effects may occur. However, many patients benefit from the use of multiple medications, which is why polypharmacy is currently being redefined as the administration of more medication than is clinically indicated (in excess or unnecessary).

However, this is not the only problem that occurs with the use of drugs; It is also worth mentioning the incorrect use of drugs, usually the administration of drugs that have been shown to worsen the functionality of the elderly and increase the presence of geriatric syndromes, as well as the underuse of drugs that have been shown to be useful, but that they are not administered or are given at lower doses for fear or ignorance of their usefulness, even in older people. The sum of these factors can facilitate the appearance of Adverse Drug Reactions (ADRs). These are defined as the unexpected, unintended, unwanted, or excessive response to a drug that causes treatment to be suspended or its dose modified, which can be the cause of hospitalization and which in any case complicates the diagnosis and prognosis of the patient. . ADRs are the cause of approximately 30% of hospital admissions of people of geriatric age and can be related to problems such as falls, depression, constipation, confusion and others closely related to dependency in the elderly. In many cases, these adverse reactions can be avoided, if a history of similar reactions is taken into account, the drugs administered are controlled or monitored correctly, drugs with little therapeutic value or those contraindicated in older people are avoided, and appropriate dosage guidelines are used. to the characteristics of the patients and always with after correctly evaluating the global situation.