In the elderly, particularly the frail-old or old-old, sociogenic factors combine with the effects of primary (biologic) and secondary (pathologic) aging to produce, at times, a complex clinical picture. The elderly also face a high level of psychosocial and physical stress. In addition, the clinical presentation may be complex and difficult to diagnose, as many of the classical signs and symptoms may be absent or exacerbated. Many of the diagnostic norms may not apply to the elderly, as the concept of being well differs when comparing young with older people. Drug effects in the elderly fluctuate and are much more unpredictable. The elderly patient may present in a confusional state caused by unexplained drug effects. For varying reasons, elders suffer from unwanted drug effects more frequently than do younger adult patients.
Assessment of the health status of the elderly must be based on the understanding that problems of living, general health factors, diseases of adaptation, and a decrease in the efficiency of several organ systems combine to determine that status.
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References
1.
AbelinT.1976“Selbstverantwortung fuer die Gesundheit,”Geneva, Sandoz Institut.
2.
AndresR.1971“Aging and Diabetes,”Medicine Clinics North America, 55, 835.
3.
AydF. J.Jr., 1961“A Survey of Drug-Induced Extrapyramidal Reactions,”Journal American Medical Association, 175, 1054.
4.
BaisdenR.1978“Hematologic Problems of the Elderly,”Hospital Practice, 13 (1), 93.
5.
BalackiJ. A.DobbinsW. O.1974“Maldigestion and Malabsorption: Making up for most Nutrients”Geriatrics, 29157.
6.
BalterM. B.1975“Coping with Illness: Choices, Alternatives, and Consequences,” In HelmsR. B. (Ed) Drug Development and Marketing, Washington, D.C., The American Enterprise Institute for Public Policy Research.
7.
BangsC. C.HanletM. P.MillsW. J.1977“Help for the Victims of Hypothermia,”Patient Care, 11 (21), 46.
8.
BakerL. R.1977“Hypertension in the Elderly,”Paper presented at the Fifth Annual Symposium on Geriatric Medicine, Baltimore, Md., Baltimore City Hospitals.
9.
BergmanH. D.1975“Prescribing of Drugs in a Nursing Home,”Drug Intelligence Clinical Pharmacy, 9, 365.
10.
BlackwellB.1973“Psychotropic Drugs in Use Today,”Journal American Medical Association, 225, 1637.
11.
BlockL. H.1977“Drug Interactions and the Elderly,”U.S. Pharmacist, 2 (10), 46.
12.
BoykinS. P.BurkhartV. P.LamyP. P.1978“Drug Use in a Day Treatment Center,”American Journal Hospital Pharmacy, 35, 155.
13.
BrandF. N.SmithR. T.BrandP. A.1977“Effect of Economic Barriers to Medical Care and Patients' Noncompliance,”Public Health Report, 92, 72.
14.
BriantR. H.1977“Drug Treatment in the Elderly: Problems and Prescribing Rules,”Drugs, 13, 225.
15.
ButlerR. N.1976“Medicine and Aging,”Washington, D.C., National Institute on Aging.
16.
ButlerR. N.1977“Energy and Aging,”Washington, D.C., National Institute on Aging.
17.
ButlerR. N.LewisM. I.1973“Aging and Mental Health: Positive Psychosocial Approaches”St. Louis, C. V. Mosby, pp. 123–142.
18.
ButterworthC. E.1974“Iartrogenic Malnutrition: The Skeleton in the Hospital Closet,”Nutrition Today, 9, 4.
19.
CaranasosG. J.StewartR. B.CluffL. E.1974“Drug-Induced Illness Leading to Hospitalization,”Journal American Medical Association, 228, 713.
20.
Central Maryland Health Systems Agency1978“Health Systems Plan and Annual Implementation Plan,”Baltimore, Md.
21.
CluffL. E.CaranasosG. J.StewartR. B.1975“Clinical Problems with Drugs” In SmithL. H. (Ed), Major Problems in Internal Medicine, Philadelphia, W. B. Saunders Co., Vol. 5.
22.
CrooksJ.O'MalleyK.StevensonI. H.1976“Pharmacokinetecs in the Elderly,”Clinical Pharmacokinetics, 1, 280.
23.
CrouthamelW. G.1976“New Areas of Research” In BenetL. Z. (Ed), The Effect of Disease States on Drug Pharmacokinetics, Washington, D.C., American Pharmaceutical Association.
24.
DiamondM. C.1978“The Aging Brain: Some Enlightening and Optimistic Results,”American Scientist, 66, 66.
25.
DubosR.1961“Mirage of Health,”New York, Doubleday & Co.
26.
EisenbergL.1977“The Perils of Prevention: A Cautionary Note,”New England Journal Medicine, 22, 1230.
27.
EngelG. L.1977“The Need for a New Medical Model: A Challenge for Biomedicine:, Science, 196, 132.
28.
Federal Register197338, 8719.
29.
Garcia-CastineirasS.DillonJ.SpectorA.1978“Detection of Bityrosine in Cataractous Human Lens Protein,”Science, 199, 897.
30.
GoldbergR. S.ThorntonW. E.1978“Combined Tricyclic-MAOI Therapy for Refractory Depression: A Review, with Guidelines for Appropriate Usage,”Journal Clinical Pharmacology, 18, 143.
31.
GuthrieH. A.BlackK.MaddenJ. P.1972“Nutritional Practices of Elderly Citizens in Rural Pennsylvania,”Gerontologist, 27, 330.
32.
GuttmannD.1977“A Survey of Drug Taking Behavior of the Elderly,”Washington, D.C., The Catholic University of America.
33.
HallM. R. P.1972“Drugs and the Elderly,”Adverse Drug Reaction Bulletin, 35, 108.
34.
HogartyG. E.GoldbergS. C.1973“Drugs and Sociotherapy in the Aftercare of Schizoprenic Patients,”Archives General Psychiatry, 28, 54.
35.
HurwitzA.1977“Antacid Therapy and Drug Kinetics,”Clinical Pharmacokinetics, 2, 269.
36.
JacksonG.MahonW.PierscianowskiT. A.CondonJ.1976“Inappropriate Antihypertensive Therapy in the Elderly,”The Lancet, 2, 1317.
37.
KlineN. S.1974“Antidepressant Medications,”Journal American Medical Association, 227, 1158.
KovarM. G.1977“Health of the Elderly and Use of Health Services,”Public Health Reports, 92, 9.
40.
KramerJ. C.KleinD. F.FinkM.1961“Withdrawal Symptoms Following Discontinuation of Imipramine Therapy,”American Journal Psychiatry, 118, 549.
41.
LamyP. P.1978“Therapeutics and the Elderly,”Addictive Diseases: An International Journal, 3 (3), 311, 1978.
42.
LamyP. P.1974“Geriatric Drug Therapy,”Clinical Medicine, 91, (5), 52.
43.
LamyP. P.KitlerM. E.1971“Drugs and the Geriatric Patient,”Journal American Geriatrics Society19, 23.
44.
LamyP. P.VestalR. E.1976“Drug Prescribing for the Elderly,”Hospital Practice, 11 (11), 111.
45.
LaslettP.1977“The Aged,”New Society, Oct. 27, p. 171.
46.
LaventurierM. F.TalleyR. B.1977“The Incidence of Drug-Drug Interactions in a Medical Population,”California Pharmacist, 20, 18.
47.
LawR.ChalmersC.1976“Medicines and Elderly People: A General Practice Survey,”British Medical Journal, 1, 565.
48.
LearoydB. M.1972“Psychotropic Drugs and the Elderly Patient,”Medical Journal Australia1, 1131.
49.
LewisC. E.LewisM. A.1977“The Potential Impact of Sexual Equality on Health,”New England Journal Medicine, 297, 863.
50.
LoeligerE. A.1968“Side Effects of Drugs” In MaylerL.HerxheimerA. (eds) Drug-Induced Diseases, Amsterdam, Excerpta Medica Foundation, p. 460.
51.
McWhinneyI. R.1972“Beyond Diagnosis: An Approach to the Integration of Behavioral Science and Clinical Medicine,”New England Journal Medicine, 287, 384.
52.
MelmonK. L.1978“The Challenge to Widen the Therapeutic Index of Hazardous Drugs,”Hospital Formulary, 13 (1), 33.
53.
MillerR. R.1974“Hospital Admissions due to Adverse Drug Reactions”, Archives Internal Medicine, 132, 219.
54.
National Center for Health Statistics1975a“Prevalence of Selected Impairments, US 1971,”Rockville, Maryland, DHEW Publ. No. (HRA) 75–1526.
55.
National Center for Health Statistics1975b“Persons with Impaired Hearing, US 1971,”Rockville, Md., DHEW Publ. No. (HRA) 76–1528.
56.
National Commission on the Cost of Medical Care1977“Summary Report”American Medical Association, Chicago, Ill.
57.
National Institute on Aging1977“Special Report on Aging: 1977: Washington, D.C., HEW Publ. No. (NIH) 77–1121.
58.
NeugartenB.1974“Age Groups in American Society and the Rise of the Young-Old” In EiseleF. (Ed) Political Consequences of Aging, Annals American Academy Political Social Science, 415, 187.
59.
NiesA.RobinsonD. S.FriedmanM. J.GreenR.CooperT. B.RavarisC. L.IvesJ. O.1977“Relationship Between Age and Tricyclic Antidepressant Plasma Levels,”American Journal Psychiatry, 134, 790.
60.
Office of Nursing Home Affairs1975“Long Term Care Facility Improvement Study, Introductory Report,”Rockville, Md.
61.
PalmoreE.1977“Facts on Aging,”The Gerontologist,”17, 315.
62.
PetersenD. M.ThomasC. W.1975“Acute Drug Reactions Among the Elderly,”Journal Gerontology, 5, 522.
63.
PhilipsonR.1976“Drugs and the Aged: Policy Issues and Utilization of Research Findings,”Paper presented at the Annual Meeting, American Association for the Advancement of Science, Boston, Mass.
64.
ProkschR. A.LamyP. P.1977“Sex Variation and Drug Therapy,”Drug Intelligence Clinical Pharmacy, 11, 398.
65.
U'PrichardD. C.GreenbergD. A.SheehanP. P.SnyderS. H.1978“Tricyclic Antidepressants: Therapeutic Properties and Affinity for alpha-Noradrenergic Receptor Binding Sites in the Brain,”Science, 199, 197.
66.
RawsonI.G.WeinbergE. I.HeroldJ. A.HoltzJ.1978“Nutrition of Rural Elderly in Southwestern Pennsylvania,”Gerontologist, 18, 24.
67.
RoeD. A.1976“Drug-Induced Nutritional Deficiencies,”Westport, Conn., The AVI Publishing Company, Inc.
68.
RosenowIIIEdwardC.1978“Drugs That May Induce Pulmonary Disease”, Geriatrics, 33, 64.
69.
SeidlL. G.ThorntonG. F.CluffL. E.1965“Epidemiological Studies of Adverse Drug Reactions,”American Journal Public Health, 55, 1170.
70.
ShepherdA. M. A.HewickD. S.MorelandT. A.StevensonI. H.1977“Age as a Determinant of Sensitivity to Warfarin,”British Journal Clinical Pharmacology, 4, 315.
71.
SmithM. C.1977“Drug Product Advertising and Prescribing: A Review of the Evidence,”American Journal Hospital Pharmacy, 34, 1208.
72.
StevensonJ. S.1977“Issues and Crises During Middlescence,”New York, Appleton, Century, Crofts.
73.
ToynbeeP.1977“Patients,”New York, Harcourt Brace Jovanovich.
74.
WaldronI.1978“Why do Women Live Longer than Men?,”New England Journal Medicine, 298, 57.
75.
WilkinsonG. R.1976“Pharmacokinetics in Disease States,” In BenetL. Z. (Ed) The Effect of Disease States on Drug Pharmacokinetics, Washington, D.C., American Pharmaceutical Association.
76.
ZieglerV. E.BiggsJ. T.1977“Tricyclic Plasma Levels. Effect of Age, Race, Sex, and Smoking,”Journal American Medical Association, 238, 2167.
