review · Clinical Pharmacokinetics
Ageing brings a decline in regulatory processes that maintain physiological homeostasis during stress. This deterioration contributes to wide individual variability in older adults, alongside cognitive and functional difficulties that increase the likelihood of medication errors and poor adherence. Consequently, geriatric patients face risks of prolonged hospital stays, increased illness, reduced quality of life, and mortality. Physiological changes also modify how drugs move through and affect the body. Pharmacokinetic alterations include reduced clearance by the kidneys and liver, as well as an increased volume of distribution for lipid-soluble drugs, which prolongs their elimination half-life. Concurrently, pharmacodynamic changes heighten sensitivity to specific drug classes, notably antidiabetic agents, anticoagulants, and psychotropic medications. Understanding these combined mechanisms is necessary to address the complex pharmacological challenges associated with chronic medication management in older populations.
Older adults frequently experience altered reactions to standard drug treatments due to bodily changes in organ function and drug processing. When physiological decline leads to heightened drug sensitivity and slower clearance, standard regimens can increase medication errors, hospitalisation, and mortality. Recognising these pharmacodynamic and pharmacokinetic differences helps healthcare providers better understand treatment outcomes and safety risks in ageing populations.
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As people age, the efficiency of various regulatory processes that ensure proper communication between cells and organs tends to decline. This deterioration can lead to difficulties in maintaining homeostasis during physiological stress. This includes but is not limited to cognitive impairments, functional difficulties, and issues related to caregivers which contribute significantly to medication errors and non-adherence. These factors can lead to higher morbidity, extended hospital stays, reduced quality of life, and even mortality. The decrease in homeostatic capacity varies among individuals, contributing to the greater variability observed in geriatric populations. Significant pharmacokinetic and pharmacodynamic alterations accompany ageing. Pharmacokinetic changes include decreased renal and hepatic clearance and an increased volume of distribution for lipid-soluble drugs, which prolong their elimination half-life. Pharmacodynamic changes typically involve increased sensitivity to various drug classes, such as anticoagulants, antidiabetic and psychotropic medications. This review examines the primary age-related physiological changes in geriatrics and their impact on the pharmacokinetics and pharmacodynamics of medications.
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DOI: 10.1007/s40262-024-01466-0
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