Journal of Pharmacy Practice

The elderly patient is not simply an older adult and needs to have drug therapy applied with caution with regard to the physiologic changes associated with aging that impact the pharmacology and pharmacokinetics of medicinals used in this population. The elderly patient has a number of physiologic changes with age that affect metabolism, distribution, and excretion. In addition, there exists information that demonstrates changes in the pharmacodynamics of drug therapy commonly used in the elderly. This article reviews these changes.

Type 2 diabetes is prevalent in the elderly population. In the past five years, there has been an increased number of drugs with unique mechanisms of action which have become available for the treatment of type 2 diabetes. Recent studies have shown that attaining optimal glycemic control in patients with type 2 diabetes will prevent or delay the complications associated with this disease. This article will review the management of type 2 diabetes.

Overactive bladder (OB), formerly known as urge incontinence, is the most common type of urinary incontinence. The appropnate management of OB is more important than ever since the number of persons with OB is expected to increase with the growing elderly population, the group at highest risk for OB. At the same time new drugs are available that are generally as effective and better tolerated than the current "gold standard" drug therapy. To facilitate the selection of optimum pharmacotherapy for OB, the important distinguishing properties of the traditional and new drug therapies for OB will be reviewed.

Corrosive esophagitis is caused by the ingestion of caustic agents. The elderly consume a large number of medications that potentially could cause Drug-Induced Esophagitis (DIE). This article reviews the signs and symptoms, diagnosis, prognosis, and epidemiology of DIE. Drugs reported to cause DIE are reviewed, including alendronate, potassium chloride, antibiotics known to cause DIE, as well as others. Illustrative cases are presented.

Elderly are at increased risk for developing pulmonary disease over time. There has been an increase in the prevalence of and mortality from COPD and asthma in the industrialized world. In addition to the increase in these pulmonary diseases there are changes in the pulmonary function of the elderly due to structural changes with age, changes in gas exchange and changes in ventilatory response. This article reviews the epidemiology, diagnosis, prognosis, and therapy of asthma and briefly discusses the epidemiology and therapy of COPD with the emphasis on our elderly population.

Dementia is often accompanied by disturbances in behavior which require treatment with medications. Traditionally, antipsychotics and benzodiazepines have been used. Their modest beneficial effects must be balanced against toxicities such as drug-induced parkinsonism which leads to falls, and worsened cognitive function. Anticonvulsant medications have been used in the past to treat agitated and aggressive behaviors from various conditions. Recent reports attest to their usefulness in treating behavioral problems secondary to dementia. Carbamazepine and divalproex sodium have proven effective in treatment while newer agents like gabapentin may be useful as well. These agents may be preferable because they target a broad variety of symptoms and diseases, are less likely to induce extrapyramidal reactions and some have a low drug interaction profile.

Insomnia is a common complaint in the geriatric population with studies indicating that 23-34% of elderly report symptoms of insomnia. Age-related changes in sleep physiology, diseases common in the elderly, and drug therapies common in the treatment of these diseases may result in difficulties with sleep. Managing these complaints requires a thorough evaluation to determine the etiology of insomnia since it is a symptom and not a disease. Additionally, when treating insomnia, non-pharmacologic issues need consideration before initiating drug therapy. A variety of pharmacologic agents are available to treat insomnia short term. Recently, two new novel agents have been added to the armamentarium of drugs that have some advantages over older, traditional agents.