Geriatrics

Older people form about 18% of the population and receive about one-third of health service prescriptions in the UK.
• Ageing results in physiological changes that affect the absorption metabolism, distribution and elimination of drugs.
• Alzheimer’s disease and vascular dementia are the most important diseases of cognitive dysfunction in the elderly. Donepezil, rivastigmine and galantamine are inhibitors of acetylcholinesterase and improve cognitive function in Alzheimer’s disease.
• The elderly patient with Parkinson’s disease is more susceptible to the adverse effects of levodopa such as postural hypotension, ventricular dysrhythmias and psychiatric effects.
• Aspirin, clopidogrel and anticoagulants (in patients with atrial fibrillation) reduce the reoccurrence of non-fatal strokes in the elderly.
• Calcium channel blockers (CCBs) are the first-line drugs for the treatment of hypertension in older people. In those intolerant to CCBs and in those who have contraindications, thiazide diuretics should be offered.
• Urinary incontinence can be classified as stress incontinence, overflow incontinence or due to detrusor instability. Commonly used drugs used in detrusor instability include oxybutynin, solifenacin, trospium and tolterodine.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are more likely to cause gastroduodenal ulceration and bleeding in the elderly