Pharmacologic considerations in the geriatric patient

A physician has the primary responsibility of first causing no harm. Unfortunately, the myriad of pharmacologic agents available to the clinician at times may make this directive difficult. When the variable of age-related changes is introduced, the clinician's task may seem almost impossible. The most important aspect of gerontology is that there are no constants. Age-related changes are inconsistent. Although liver function may vary little among the general population, virtually every other system is affected by the aging process. Additional factors that complicate treatment of the geriatric patient are multiple organ diseases, the intervention of multiple practitioners, and nutritional variation. Multiple diseases require polypharmacy with its greater tendency for drug-drug interaction and iatrogenic disease exacerbation. Multiple clinician involvement frequently lacks appropriate communication between the various specialties. Aging is commonly associated with drastic changes in dietary habits. An older person living alone may tend to miss more meals than other groups. Meals that are consumed may be inadequate and lack proper balance, especially adequate amounts of protein. Mineral and vitamin depletion are additional problems, especially with patients on diuretics and chronic anti-infective therapy. In this article an attempt has been made to stimulate thought and generate an awareness in the podiatric practitioner of the considerations necessary when contemplating drug therapy in the geriatric population. Long lists of specific agents and recommended dosages, which quickly become outdated as newer drugs are introduced into the clinical arena, were intentionally not presented in this article. The author hopes that this article will generate interest in conducting additional research in podiatric applications of drugs.