[Geriatric pharmacology. Pharmacokinetics and pharmacodynamics in the elderly. Problems with geriatric and nootropic...

The reasons for the increased frequency of adverse drug reactions in the elderly are a decrease in drug elimination, primarily via the kidneys, on the one hand and a decrease in adaptive counterregulatory mechanisms on the other hand that attenuate drug effects in younger subjects. Because of the decreased functional reserve in the aged drugs may adversely affect preexisting chronic diseases. Generally, the possibility that clinical symptoms in the elderly are drug-related has to be considered. Abrupt changes in dosage should be avoided. The indication of drug therapy should be reevaluated periodically. However, advanced age is no reason to withhold necessary medication. The compliance with or adherence to drug therapy may be improved by giving clear, written instructions, simplifying the dosage schedule and reducing the number of drugs, for instance by using combination drugs. Elderly patients are particularly vulnerable to the sedative effects of psychotropic drugs, resulting in cognitive impairment and motor incoordination with an increased risk of falls and hip fracture. There is no rational basis for the use of geriatric drugs that claim to stop or slow the aging process. Also the available evidence does not support the therapeutic value of so-called nootropic or cerebroactive drugs to improve mental function in the elderly.