Optimal therapy for the geriatric patient: the challenge to clinical pharmacology

The elderly are an increasing proportion of the population. Their median life span should rise to 85 years, although in later life organs of drug distribution and elimination may deteriorate in function and 100 years will remain the general maximum. Progressive containment of chronic diseases will still leave them at lethal risk from acute infectious diseases because of depleted homeostatic reserves of vital systems (cardiovascular, hepatic, immunological and renal). A decline in chronic disease should lengthen the period of well-being and reduce medical needs and perhaps drug needs of older persons. To estimate further therapeutic requirements of the elderly, information is needed on the epidemiology of drug use and rates of efficacy and toxicity in the elderly. Implicit in the data gathering is a true need for systematic post-marketing surveillance (PMS) of drugs with particular respect to drug efficacy and unanticipated adverse or beneficial reactions in this age group. Observational, non-experimental techniques can be devised and should be tested as appropriate methods of establishing the rates of anticipated efficacy and unwanted effects of drugs. The application of such techniques may be one of the only feasible ways to establish utility functions for drugs used in the elderly.