General medical and ethical problems of drug treatment in the elderly

Drug treatment of the elderly raises important concerns regarding medical and ethical issues. Medical problems may arise from age-related changes in social and economic conditions. Furthermore, there is a complexity of influences on the physical and mental state by polymorbidity and polypharmacy, and by alterations in pharmacokinetics and pharmacodynamics. Ethical problems may arise from a conflict of interests between different parties, e.g., between the patient's goal to get the best available treatment and the physican's goal to improve medical knowledge about a certain drug. A central problem in medical ethics is the conflict between two ethical principles: e.g., the principle of respect for the patient's autonomy and the principle of beneficence. The usual solution to this ethical dilemma is to make use of the concept of competence, but it is debatable whether competence is a binary or graded concept. The model of informed consent is based on the patient's competence. But for the purpose of drug treatment of mentally impaired subjects a proxy consent of a legally authorized representative was claimed.