pharmacological treatment of the elderly

Over the past 25 years, there has been a significant increase in the elderly population.

The increase in life expectancy is related to the great progress that has been made in recent years in medicine and
in particular in geriatrics.

In the elderly, chronic diseases occur more often, which not infrequently coexist: arthritis, chronic lung diseases,
diabetes, hypertension, cardiovascular diseases and malignant tumors.

This requires prescribing several drugs at the same time, which can be justified on the one hand, but on the other
hand, it increases the frequency of side effects developed as a result of drugs or their interactions.

In addition to prescription drugs, older adults often take over-the-counter drugs that are considered safe for the
younger population. For the body of the elderly, these drugs can be a serious threat.
 Recommendations for improving the effectiveness of treatment for the elderly

1. Information about the purpose of prescribing the drug and the dosage regimen should be provided to the patient as
comprehensively as possible and in a form that is understandable to him:
A. Dosing of the drug should be as convenient as possible (eg, 1 or 2 times a day, if possible);
b. The time of taking the medicine should be determined exactly

2. The patient's family members or caregiver should be informed about the dosage of the medicine.

3. The doctor must make sure that the patient can independently go to the pharmacy to buy medicine, open the medicine
bottle and drink it. Otherwise, he should talk to the patient's family members or caregivers about buying and giving medicine to
the patient.

4. Use of aids (special boxes for storing medicines, so-called medicine calendars) that make it easier for the elderly to take
medicine on time.

5. To take home the drug card for the patient to be filled.

 Medications that are not recommended for the elderly
Analgesics
• narcotic drugs
• Meperidine
• Pentazocine
• Propoxyphene

Nonsteroidal anti-inflammatory drugs

• Indomethacin
• Phenylbutazone

Cardiovascular and cerebrovascular means

• Cyclandelate
• dipyridamole
• Disopyramide
• Methyldopa
• Reserpine
• Ticlopidine
 Prevention of adverse drug reactions in the elderly

• Make a diagnosis before starting treatment. Medical treatment is considered optimal for a certain period of time or for the
purpose of removing a specific symptom. As much as possible, avoid prescribing medicines for a long time.

• When prescribing medical treatment for elderly patients, it is necessary to frequently check and update the prescription, as well
as to determine whether the patient is also taking drugs prescribed by another doctor.

• Try to prescribe the minimum number of drugs. Discuss the pharmacological interaction of prescribed drugs and their inactivation
and elimination ways. Use the lowest effective dose. It is recommended to reduce the maintenance dose in case of impaired drug
elimination due to age changes.

• If you have symptoms associated with the aging process (eg, memory loss, weakness, depression, anorexia, impaired
consciousness), determine whether the prescribed drug or combination of drugs is contributing to or exacerbating these
symptoms. This circumstance should be taken into account especially when the patient is taking psychotropic, sedative, sleeping,
heart or kidney drugs.
 Age changes affecting the pharmacological characteristics of the drug

Pharmacological parameter age changes

Absorption Reduction of absorption surface, deterioration of mesenteric blood circulation,

Increasing the pH of gastric juice, disrupting gastrointestinal peristalsis.

Distribution body water volume reduction, body mass reduction, aluminum in the blood
Decreasing the level, disrupting the ability to bind to proteins.

Metabolism Reduction of blood circulation in the liver, decrease in the activity of enzymes, enzymes
inducibility.

Excretion Decreased blood circulation in the kidneys, decreased glomerular filtration,

Inhibition of tubular secretion.

Tissue sensitivity to the drug Reduction in the number of receptors, receptor affinity
Impairment, dysfunction of secondary messengers, cellular and
Decrease in nuclear reactivity.
Distribution

In contrast to absorption, significant changes in drug distribution in the body are observed in old age

It is known that the content of albumin in the blood serum (to which the drug usually binds) decreases with age, especially in hospitalized
patients.

Accordingly, the amount of freely circulating drug increases.

This fact should be taken into account in relation to those drugs that are closely related to albumin.

When administered at the same time, such drugs compete with each other for protein binding.

Age-related changes in body components directly affect the volume of drug distribution, due to the fact that water and muscle mass in the
body decreases with age.

Drugs that fall mainly into these sectors (most antibiotics, digoxin, lithium, alcohol) are characterized by lower Volume distribution.
Accordingly, their concentration will be higher than expected.

On the other hand, if fat content increases with age, drugs that are predominantly fat soluble (most psychotropic drugs) will have an elevated
Volume distribution.

As a result, the half-life of such drugs is prolonged.

 Pharmacological characteristics of some drugs in old age
Medicine The main route Other Side effects
Medicine The main route of Other Side effects of elimination pharmacologica
elimination pharmacological l properties
properties
erythromycin liver
Aspirin kidney tightly bound to The appointment
plasma proteins; of coated tablets
In large doses, is indicated; In
the half-life is large doses, it penicillins Kidney, liver The half-life is causes sodium
prolonged exhibits longer in the overload
ulcerogenic elderly
properties
Closely binds to
plasma
Naproxen kidney Closely binds to In large doses, it proteins
Ibuprofen plasma proteins exhibits
ulcerogenic
properties sulfonamides kidney Closely binds to They enhance
plasma the effect of
Aminoglycosides kidney The half-life is Nephrotoxicity proteins warfarin
longer in the and ototoxicity
elderly
Carbidopa- Liver Toxic effect on
Levodopa the
Cephalosporins kidney The half-life is Nephrotoxicity cardiovascular
longer in the requires system
elderly monitoring of
drug plasma Lidocaine Liver Increased requires
concentration volume of monitoring of
distribution, drug plasma
Clindamycin Liver prolongation of concentration
half-life,
 Prescribing painkillers in the elderly

To assess the degree of pain in elderly patients, a scale showing different facial expressions in
response to pain is often used

1 2 3 4 5

• 0 - no pain
• 1 - asymptomatic pain
• 2 - mild pain
• 3 - average pain
• 4 - severe pain
• 5 - unbearable pain
 Treatment of various types of pain
type of pain
Somatic (arthritis, postoperative, Tissue damage (eg, bone,
fracture, bone metastases)
Visceral (kidney, intestinal
obstruction, etc.).
neuropathic (lumbar sciatica,
trigeminal neuralgia, diabetic
neuropathy, etc.).
Unclear (myofascial pain,
somatoform pain)
cause of pain Description of pain
Localized, persistent, gnawing,
muscle, joint) explosive
Internal organs Diffuse, poorly localized, long-
term, paroxysmal, mesenteric,
deaf, acute; It is often
accompanied by nausea and
vomiting.
Peripheral and central nervous Long, constant, may be
system paroxysmal, acute, burning,
throbbing, pressing. It can be
accompanied by paresthesias,
hyperalgesia, impaired motor
function, atrophy, deep
abnormal reflexes.
It is difficult to specify "Pain of the whole body",
weakness, binding, etc
treatment
Non-opioids, non-steroidal anti-
inflammatory drugs,
physiotherapy
Non-opioids, non-steroidal anti-
inflammatory drugs,
physiotherapy
Tricyclic antidepressants, local
anesthetics, physiotherapy
Antidepressants, anti-anxiety
drugs (anxiolytics),
physiotherapy
 Pain medication management chart

1. Oral medicine should be prescribed first, because it is effective in most cases and it is more convenient to take;

2. If it is not possible to relieve pain, it is necessary to quickly climb to the next step of the ladder (the patient's pain should not last
long);

3. Opiates work best for pain of a nociceptive and neuropathic nature (eg, herpes, postoperative, pressure on a nerve, brachial
plexopathy);

4. Analgesic drugs should be prescribed taking into account the time interval of 24 hours. Once a stable dose of a short-acting oral
opiate has been established, a longer-acting drug can be switched;

5. In the period between switching from one opiate to another or when changing the route of administration, special care is needed to
ensure that analgesia is not intermittent;

6. A general rule of thumb for the elderly is to start treatment with a low dose and then gradually increase the dose. In case of
increasing the dose, it is necessary to increase the total daily dose by 25-30% (while in young patients the dose increase reaches 40-
50%). There are exceptions to this rule: if the patient still suffers from pain, the dose may be increased more quickly.