Roberts J, Tumer N
Department of Pharmacology, Medical College of Pennsylvania, Philadephia.
Clin Geriatr Med. 1988 Feb;4(1):127-49.
The elderly have the highest incidence of medical and psychiatric disorders. These conditions frequently occur simultaneously and are often chronic, lasting the lifetime of the individual. Consequently, the elderly require more medications than do younger patients. Consumption of over-the-counter drugs is considerable among the aged. There is considerable evidence that the elderly patient in most cases responds differently to drugs than do young adults. Many factors contribute to these differences. Among them are reduced protein binding, reduced biotransformation, diminished renal elimination, changes in receptor density or affinity, or both, diminished receptor adaptability, changes in the coupling between receptors and effector systems, impairment of responding organs resulting from the pathologic state, reduction in the reactivity of homeostatic mechanisms, and the aging process itself. These components may have different weight, depending on the drug and the individual considered. Because of the physiologic age-related changes in the distribution and elimination of drugs and in the sensitivity to medications, adverse side effects develop frequently in the elderly. Accordingly, dosages and dosage intervals must be adjusted carefully. In addition, since the elderly often take multiple medications, they frequently experience ADRs. Psychotropic drugs are often involved in such interactions and cause twice the incidence of side effects in elderly patients as they do in younger patients. Drug-nutrient and drug-drug interactions, programs to enhance patient compliance, and sociogenic factors should be taken into account in any well-designed dose regimen for the elderly. Physician awareness of problems that exist in the elderly population's use of drugs is essential if rational drug therapy for the aged is to evolve. The proper use of drugs in the elderly largely depends on taking into account both the pharmacokinetic and the pharmacodynamic properties of the drug and how these parameters are altered with age; such information can be obtained only by investigating drug action in older people.
老年人患医学和精神疾病的发病率最高。这些疾病常常同时出现，且往往是慢性的，会伴随个体一生。因此，老年人比年轻患者需要更多的药物。老年人非处方药的消费量相当可观。有大量证据表明，在大多数情况下，老年患者对药物的反应与年轻人不同。许多因素导致了这些差异。其中包括蛋白质结合减少、生物转化减少、肾脏排泄减少、受体密度或亲和力的变化或两者兼有、受体适应性降低、受体与效应系统之间偶联的变化、病理状态导致的反应器官受损、体内稳态机制反应性降低以及衰老过程本身。根据所考虑的药物和个体不同，这些因素的影响程度可能有所不同。由于与年龄相关的生理变化会影响药物的分布、消除以及对药物的敏感性，老年人经常会出现药物不良反应。因此，必须仔细调整剂量和给药间隔。此外，由于老年人经常服用多种药物，他们经常会经历药物不良反应。精神药物常常参与此类相互作用，并且在老年患者中引起的副作用发生率是年轻患者的两倍。在为老年人精心设计的任何给药方案中，都应考虑药物 - 营养和药物 - 药物相互作用、提高患者依从性的方案以及社会因素。如果要发展针对老年人的合理药物治疗，医生了解老年人群用药中存在的问题至关重要。老年人正确用药很大程度上取决于同时考虑药物的药代动力学和药效学特性以及这些参数如何随年龄变化；只有通过研究老年人的药物作用才能获得此类信息。
