Skip to main content
SpringerLink
Log in

Principles of Pharmacology

  • Chapter
Geriatric Medicine

Abstract

The proper use of medications represents one of the most important ways in which the practice of geriatric medicine differs importantly from conventional medical care. Pharmacotherapy is perhaps the single most important medical intervention in the care of elderly patients, and its proper performance requires a special understanding of the unique physiologic properties of drugs in this group, as well as a grasp of the sociocultural and epidemiologic aspects of medication use in aging. The advent of Medicare coverage of some prescription medications taken by elderly persons has focused attention on the special problems and opportunities offered by pharmacotherapy in geriatrics at a time of growing public awareness of the benefits, risks, and costs of prescription drugs. Thus, physicians have both an opportunity and a responsibility to examine this topic in all its aspects, from those as “micro” as receptor physiology and the molecular biology of aging, to those as “macro” as the study of adverse drug effects in large populations and the questions raised by governmental coverage of medication costs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Reidenberg MM, Levy M, Warner H, et al. Relationship between diazepam dose, plasma level, age, and central nervous system depression. Clin Pharmacol Ther 1978; 23: 371–374.

    PubMed  CAS  Google Scholar 

  2. Casteden CM, George CF, Marcer D, et al. Increased sensitivity to nitrazepam in old age. Br Med J 1977; 1: 10–12.

    Article  Google Scholar 

  3. Meyer BR, Lewin M, Dreyer DE, et al. Optimizing metoclopramide control of cisplatin-induced emesis. Ann Intern Med 1984; 100: 393–395.

    PubMed  CAS  Google Scholar 

  4. O’Malley K, Stevenson IH, Ward CA, et al. Determinants of anticoagulant control in patients receiving warfarin. Br J Clin Pharmacol 1977; 4: 309–314.

    Article  PubMed  Google Scholar 

  5. Shephard AMM, Hewick DS, Moreland TA. Age as a determinant of sensitivity to warfarin. Br J Clin Pharmacol 1977; 4: 315–320.

    Article  Google Scholar 

  6. Bellville JW, Forrest WH, Miller E, et al. Influence of age on pain relief from analgesics. JAMA 1971; 217: 1835 1841.

    Google Scholar 

  7. Kaiko RF. Age and morphine analgesia in cancer patients with postoperative pain. Clin Pharmacol Ther 1980; 28: 823–826.

    Article  PubMed  CAS  Google Scholar 

  8. Scott JC, Stanski DR. Decreased fetanyl and alfentanil dose requirements with age: a simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 1987; 240: 159–166.

    PubMed  CAS  Google Scholar 

  9. Vestal RE, Wood AJJ, Shand DG. Reduced betaadrenoreceptor sensitivity in the elderly. Clin Pharmacol Ther 1979; 26: 181–186.

    PubMed  CAS  Google Scholar 

  10. Avorn J, Everitt DE, Weiss S, et al. Increased antidepressant use in patients prescribed beta-blockers. JAMA 1986; 255: 357–360.

    Article  PubMed  CAS  Google Scholar 

  11. Schmucker DL. Aging and drug disposition: an update. Pharmacol Rev 1985; 37: 133–148.

    PubMed  CAS  Google Scholar 

  12. Campion EW, deLabry LO, Glynn RJ. The effect of age on serum albumin in healthy males: report from the Normative Aging Study. J Gerontol 1988; 43: M18 - M20.

    Article  PubMed  CAS  Google Scholar 

  13. MacLennan WJ, Martin P, Mason BJ. Protein intake and serum albumin levels in the elderly. Gerontology 1977; 23: 360–367.

    Article  PubMed  CAS  Google Scholar 

  14. Greenblatt DJ, Sellers EM, Koch-Weser J. Importance of protein binding for the interpretation of serum or plasma drug concentrations. J Clin Pharmacol 1982; 22: 259–263.

    Article  PubMed  CAS  Google Scholar 

  15. Buskirk ER. Health maintenance and longevity: exercise. In: Handbook of the Biology of Aging, 2nd ed. Finch CE, Schneider EL (eds.) New York: Van No-strand Reinhold Company 1985;pp. 898–899.

    Google Scholar 

  16. Mooney H, Roberts R, Cooksley WGE, et al. Alterations in the liver with aging. Clin Gastroenterol 1985; 14: 757–771.

    PubMed  CAS  Google Scholar 

  17. Vestal RE, Norris AH, Tobin JD, et al. Antipyrine metabolism in man: influence of age, alcohol, caffeine, and smoking. Clin Pharmacol Ther 1975; 18: 425–432.

    PubMed  CAS  Google Scholar 

  18. Rowe JW, Andres R, Tobin JD, et al. The effect of age on creatinine clearance in man. J Gerontol 1976; 31: 155163.

    Google Scholar 

  19. Lindeman RD, Tobin JD, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985; 33: 278–285.

    PubMed  CAS  Google Scholar 

  20. Greenblatt DJ, Divoll M, Harmatz JS, et al. Kinetics and clinical effects of flurazepam in young and elderly insomniacs. Clin Pharmacol Ther 1981; 30: 475–486.

    Article  PubMed  CAS  Google Scholar 

  21. Greenblatt DJ, Allen MD, Shader RI. Toxicity of high-dose flurazepam in the elderly. Clin Pharmacol Ther 1977; 21: 355–361.

    PubMed  CAS  Google Scholar 

  22. Larson EB, Kukull WA, Buchner D, et al. Adverse drug reactions associated with global cognitive impairment in elderly persons. Ann Intern Med 1987; 107: 169–173.

    PubMed  CAS  Google Scholar 

  23. Greenblatt DJ, Harmatz JS, Zinny MA, et al. Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. N Engl J Med 1987; 317: 722–728.

    Article  PubMed  CAS  Google Scholar 

  24. Busto U, Sellers EM, Naranjo CA, et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. N Engl J Med 1986; 315: 854–859.

    Article  PubMed  CAS  Google Scholar 

  25. Danielson M, Lundback M. Withdrawal of antihypertensive drugs in mild hypertension. Acta Med Scand 1981;646(suppl 11: 127–131.

    Google Scholar 

  26. Fleg JL, Gottlieb SH, Lakatta EG. Is digoxin really important in treatment of compensated heart failure? a placebo-controlled crossover study in patients with sinus rhythm. Am J Med 1982; 73: 244–250.

    Article  PubMed  CAS  Google Scholar 

  27. Gheorghiade M, Beller GA. Effect of discontinuing maintenance digoxin therapy in patients with ischemic heart disease and congestive heart failure in sinus rhythm. Am J Cardiol 1983; 51: 1243–1250.

    Article  PubMed  CAS  Google Scholar 

  28. Callaghan N, Garrett A, Goggin T. Withdrawal of anti-convulsant drugs in patients free of seizures for two years. N Engl J Med 1988; 318: 942–946.

    Article  PubMed  CAS  Google Scholar 

  29. Sackett DL, Snow JC. The magnitude of compliance and noncompliance. In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care. Baltimore, Md: The Johns Hopkins University Press; 1979, pp. 11–12.

    Google Scholar 

  30. Simonson W. Medications and the Elderly: A Guide for Promoting Proper Use. Rockville, Md: Aspen Systems Corp; 1984.

    Google Scholar 

  31. Ostrom JR, Hammarlund ER, Christensen DB, et al. Medication usage in the elderly population. Med Care 1985; 23: 157–164.

    Article  PubMed  CAS  Google Scholar 

  32. Hammarlund ER, Ostrom JR, Kethley AJ. The effects of drug counseling and other educational strategies on drug utilization of the elderly. Med Care 1985; 23: 165–170.

    Article  PubMed  CAS  Google Scholar 

  33. Darnell JC, Murray MD, Martz BL, et al. Medication use by ambulatory elderly: an in-home survey. J Am Geriatr Soc 1986; 34: 1–4.

    PubMed  CAS  Google Scholar 

  34. German PS, Klein LE, McPhee SJ, et al. Knowledge of and compliance with drug regimens in the elderly. J Am Geriatr Soc 1982; 30: 568–571.

    PubMed  CAS  Google Scholar 

  35. Kendrick R, Bayne JRD. Compliance with prescribed medication by elderly patients. Can Med Assoc J 1982; 127: 961–962.

    PubMed  CAS  Google Scholar 

  36. Mazzullo J. The nonpharmacologic basis of therapeutics. Clin Pharmacol Ther 1972; 13: 157–158.

    PubMed  CAS  Google Scholar 

  37. Trends in Nursing and Related Care Homes and Hospitals: United States, Selected Years 1969–80. National Center for Health Statistics; 1984. US Dept of Health and Human Services publication PHSS 84–1825.

    Google Scholar 

  38. Robers PA. Extent of medication use in U.S. long-term-care facilities. Am J Hosp Pharm 1988; 45: 93–100.

    PubMed  CAS  Google Scholar 

  39. Physicians’ Drug Prescribing Patterns in Skilled Nursing Facilities. Office of Long Term Care; 1976. US Dept of Health, Education, and Welfare publication OS 7650050.

    Google Scholar 

  40. Ray WA, Federspiel CF, Schaffner W. A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse. Am J Public Health 1980; 70: 485–491.

    Article  PubMed  CAS  Google Scholar 

  41. Ingman SR, Lawson IR, Pierpaoli PG, et al. A survey of the prescribing and administration of drugs in a longterm care institution for the elderly. J Am Geriatr Soc 1975; 23: 309–316.

    PubMed  CAS  Google Scholar 

  42. Beers M, Avorn J, Soumerai SB, et al. Psychoactive medication use in intermediate-care facility. DAMA. 1988; 260: 3016–3020.

    Article  CAS  Google Scholar 

  43. Buck JA. Psychotropic drug practice in nursing homes. J Am Geriatr Soc 1988; 36: 409–418.

    PubMed  CAS  Google Scholar 

  44. Institute of Medicine Committee on Nursing Home Regulation. Improving the Quality of Care in Nursing Homes. Washington, DC: National Academy Press; 1986: 378–379.

    Google Scholar 

  45. Sherman DS, Avorn J, Campion EW. Cimetidine use in nursing homes: prolonged therapy and excessive doses. J Am Geriatr Soc 1987; 35: 1023–1027.

    PubMed  CAS  Google Scholar 

  46. Dall JLC. Maintenance digoxin in elderly patients. Br Med J 1970; 2: 705–706.

    Article  PubMed  CAS  Google Scholar 

  47. Fonrose HA, Ahlbaum N, Bugatch E, et al. The efficacy of digitalis withdrawal in an institutionalized aged population. J Am Geriatr Soc 1974; 2: 208–211.

    Google Scholar 

  48. Hull SM, Mackintosh A. Discontinuation of maintenance digoxin therapy in general practice. Lancet 1977; 2: 1054–1055.

    Article  PubMed  CAS  Google Scholar 

  49. Wilkins CE, Khurana MS. Digitalis withdrawal in elderly nursing home patients. J Am Geriatr Soc 1985; 33: 850851.

    Google Scholar 

  50. Garibaldi RA, Brodine S, Matsumiya. Infections among patients in nursing homes: policies, prevalence and problems. N Engl J Med 1981; 305: 731–735.

    Article  PubMed  CAS  Google Scholar 

  51. Zimmer JG, Bentley DW, Valenti WM. Systemic antibiotic use in nursing homes: A quality assessment. J Am Geriatr Soc 1986; 34: 703–710.

    PubMed  CAS  Google Scholar 

  52. Crossley K, Henry K, Irvine P, et al. Antibiotic use in nursing homes: prevalence, cost, and utilization review. Bull NY Acad Med 1987; 63: 510–518.

    CAS  Google Scholar 

  53. Zimmer JG, Bentley DW, Valenti WM. Systemic antibiotic use in nursing homes: a quality assessment. J Am Geriatr Soc 1986; 34: 703–710.

    PubMed  CAS  Google Scholar 

  54. Nolan L, O’Malley K. Prescribing for the elderly, I: sensitivity of the elderly to adverse drug reactions. 1988; 36: 142–149.

    CAS  Google Scholar 

  55. Seidl CG, Thornton GF, Smith JW, et al. Studies on the epidemiology of adverse drug reactions, III: reactions in patients on a general medical service. Bull Johns Hopkins Hosp 1966; 119: 299–315.

    Google Scholar 

  56. Granck E, Baker SP, Abbey H, et al. Medications and diagnoses in relation to falls in a long-term care facility. J Am Geriatr Soc 1987; 35: 503–511.

    Google Scholar 

  57. Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly, institutionalized population: prevalence, incidence, and associated risk. Q J Med 1985; 55: 45–54.

    PubMed  CAS  Google Scholar 

  58. Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Aging 1981; 10: 14 1146.

    Google Scholar 

  59. Sobel KG, McCart GM. Drug use and accidental falls in an intermediate care facility. Drug Intel! Clin Pharm 1983; 17: 539–542.

    CAS  Google Scholar 

  60. Wells BG, Middleton B, Lawrence G, et al. Factors associated with the elderly falling in intermediate care facilities. Drug Intel! Clin Pharm 1985; 19: 142–145.

    CAS  Google Scholar 

  61. Stephen PJ, Williamson J. Drug-induced parkinsonism in the elderly. Lancet 1984; 2: 1082–1083.

    Article  PubMed  CAS  Google Scholar 

  62. Ray WA, Griffin MR, Schaffner W. Psychotropic drug use and the risk of hip fracture. N Engl J Med 1987; 316: 363–369.

    Article  PubMed  CAS  Google Scholar 

  63. MacDonald JB, MacDonald ET. Nocturnal femoral fracture and continuing widespread use of barbiturate hypnotics. Br Med J 1977; 2: 483–485.

    Article  PubMed  CAS  Google Scholar 

  64. Avorn J, Everitt DE, Weiss S, et al. Increased antidepressant use in patients prescribed beta-blockers. JAMA 1986; 255: 357–360.

    Article  PubMed  CAS  Google Scholar 

  65. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on quality of life. N Engl J Med 1986; 314: 1657–1664.

    Article  PubMed  CAS  Google Scholar 

  66. Resnick NM. Urinary incontinence in the elderly. Med Grand Rounds 1984; 3: 281–290.

    Google Scholar 

  67. Katz PR. Training internists for a role in long-term care. J Gen Intern Med 1987; 2: 450–452.

    Article  PubMed  CAS  Google Scholar 

  68. Mitchell JB. Physician visits to nursing homes. Gerontologist 1982; 22: 45–48.

    Article  PubMed  CAS  Google Scholar 

  69. Waxman HM, Klein M, Carver EA. Drug misuse in nursing homes: an institutional addiction. Hosp Community Psychiatry 1985; 36: 886–887.

    PubMed  CAS  Google Scholar 

  70. Taggart HM, Alderdice JM. Fatal cholestatic jaundice in elderly patients taking benoxaprofen. Br Med J Clin Res 1982; 284: 1372.

    Article  CAS  Google Scholar 

  71. Temple R. FDA Discussion Paper on Testing of Drugs in the Elderly. Washington DC: Food and Drug Administration; 1983.

    Google Scholar 

Download references

Authors
  1. Jerry Avorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jerry Gurwitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Section of General Internal Medicine, The University of Chicago Medical Center, 60637, Chicago, Illinois, USA

    Christine K. Cassel M.D. (Chief) (Chief)

  2. Journal of the American Medical Association, 60610, Chicago, Illinois, USA

    Donald E. Riesenberg M.D. (Senior Editor, Clinical Associate Professor of Medicine) (Senior Editor, Clinical Associate Professor of Medicine)

  3. Pritzker School of Medicine, University of Chicago, 60637, Chicago, Illinois, USA

    Donald E. Riesenberg M.D. (Senior Editor, Clinical Associate Professor of Medicine) (Senior Editor, Clinical Associate Professor of Medicine)

  4. Department of Medicine, Pritzker School of Medicine, University of Chicago, 60637, Chicago, Illinois, USA

    Leif B. Sorensen M.D., Ph.D. (Associate Chief) (Associate Chief)

  5. Geriatric Medicine, Portland V.A. Medical Center, 97207, Portland, Oregon, USA

    John R. Walsh M.D. (Chief) (Chief)

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer Science+Business Media New York

About this chapter

Cite this chapter

Avorn, J., Gurwitz, J. (1990). Principles of Pharmacology. In: Cassel, C.K., Riesenberg, D.E., Sorensen, L.B., Walsh, J.R. (eds) Geriatric Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-2093-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-2093-8_7

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-2095-2

  • Online ISBN: 978-1-4757-2093-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation