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Prescription, Nonprescription and Herbal Medicines
Prescription, Non-prescription and Herbal Medications: Exploring Interactions in the Geriatric Population
Geriatric medicine, generally referred to as just "geriatrics" is a branch of internal medicine and health care that focuses primarily on the diagnoses, prevention, care and treatment of disease and disability in elderly patients. Elderly patients involve those senior members of the population that develop a disability, or are suffering from a disease that is a resultant of old age or is a prompt symptom of old age. Geriatrics commonly involves treatment of these old age symptoms and disabilities such as deteriorated memory, immobility, impaired vision and hearing etc. Geriatrics, in modern times, is quite advanced. Specialized services such as psycho-geriatrics, where expert psychologists focus on treating old age related depression, memory loss and other psychological conditions that occur in the elderly population, along with development of physical therapy centers whose prime focus is the rehabilitation of diseased and discomfited patients of old age. The main aim of geriatric medicine is to relieve the senior population of the discomforts that old age brings and to promote the general good health of the elderly.
The demographics of the world are changing. For example, currently, with reference to the 2012 demographic, the United States of America consists of an aging population. That is, there is an increasing elder patient base (Population Reference Bureau, 2012). According to a report by the United States Department of Health and Human Services, between 2010 and 2030, there will be an increase in the senior population by approximately 73% (Administration on Aging, U.S. Department of Health and Human Services, 2004). Hence, in a span of 30-40 years, the world's youthful countries shall experience a need in geriatric services.
However, it should be borne in mind that as the demand for geriatrics rises all over the globe, there will be a race to develop new medicines and methods in order to cope up with old age diseases and disabilities, new and old, but not all will benefit the elderly as senior population has certain limitations and can develop reactions to certain drugs.
As a human being continues to age, there are changes in all of his/her organ systems. Such physiological changes limit the activity of the individual and cause them to suffer, sometimes vivid, reactions from drugs that were meant to ease their discomfort, and would've worked had their organ systems been young and thriving. Not only are there internal but there are external consequences of aging as well. Skin, being a living organ, visibly deteriorates with age, losing its tone and elasticity due to the changes in the elastic and collagen in the epidermis, transforming the outer layer of the human body into a sagging, papery thin sheath. Internal physiological changes that are resultant of old age tend to affect an individual's lifestyle more, however.
There are numerous internal changes that occur in each organ system of the human body. These include degenerative changes that inhibit locomotion by loss of muscle mass and weakening the joints. Even the cardiac muscle functions at an inhibited pace causing high blood pressure and other heart related diseases such as, for example, blocked coronary arteries (Kannel & Gordon, 1978) . As a result of this lower heart function, the lungs display impaired functionality in terms of inspiration and expiration of gases. The impaired functionality extends to the liver, kidneys and the digestive system as well. These include consistent rise in the blood glucose levels, osteoporosis, atrophic gastritis, urinary incontinence, reduction in the size and mass of kidneys, and decrease in intestinal motility, to name a few. In women, the occurrence of menopause is compulsory. All such changes lead to the alteration of metabolism of an elderly individual. As a result, the response of an individual to a specific drug and/or a dosage of changes with his/her age. Thus, it is important for geriatric medicine practitioners to instigate appropriate dosages of medicine, in accordance to each senior individual specific history and current reaction to different drugs.
Due to such physiological changes, the manner in which the body of an elderly human being responds to drugs is different to that of a young, healthy individual. There is also a difference in the metabolism rates of elderly patients of different sexes. That is, the metabolic rate of an elderly female will be lower than that of an elderly male (O'Malley, Crooks, Duke, & Stevenson, 1971). Another factor is the diet of the geriatric population. It is often different to that of young individuals due to reduced functioning of the intestines with age along with old-age prone diseases high blood pressure, diabetes and high cholesterol restricts the types of food intake for the elderly.
With age, the entire process of what happens to medicinal drugs after they are ingested evolves. Since old age invites multiple chronic diseases, variant diet schedules and other functional defects in the human body, how it responds to different sorts of drugs and medicines also changes. As mentioned earlier, the function of the intestines is slows down as age increases. As with rest of the body, there is a lower level of blood flowing through the intestines. The intestinal cells display decreased capacity for absorption of drugs, decline in the secretion of intestinal fluids, and it takes a greater amount of time for the compound to pass through the intestinal tract (Aschenbrenner & Venable, 2009). There is a decline in the secretion of the mucus lining the walls of the intestines that contain enzymes to catalyze and absorb the drugs. This leads to lowering rates of absorption of drugs through the intestines as a person ages. So, the process of the absorption of the drugs into the blood tissue is a slower and lengthier process in an elderly person than in a young and healthy one.
The distribution (medical term for absorption in to the tissues and cells of the body) of the drug begins after it has been absorbed into the blood stream via the intestines. This again is affected by the composition of various body fluids and tissues, and how it changes with old age. The composition of blood primarily consists of a protein known as plasma. The alterations (shrinking) in the plasma with age can highly influence the movement of the drugs through the intercellular spaces into the body tissue and various organs. Since aging leads to muscle loss, there are less amounts of fatty tissue available for fat-soluble drugs to diffuse through in to the tissues. There is also a drop in the total of the water content in the body, leading to lower levels of distribution of the water-soluble drugs in to the body organs and tissues. As the body of an elderly individual goes through these changes, it is necessary to alter the dosage of the drugs and medications accordingly so that there aren't high levels of insoluble drug particles in the blood circularization of the individuals, as it may lead to severely adverse effects for the concerned senior person. Research and other studies have shown that there is some-what of a "brain-barrier" present in the drug distribution old age individuals. In this case, specifically in elderly persons, drugs are delivered to the brain in a higher concentration (Alavijeh, Chishty, Qaisar, & Palmer, 2005 October). Hence, the normal dosage of drugs needs to be lowered in very old people. There are also several drugs on the market to control such behavior of the blood tissues in the elderly persons.
The organs that play a fundamental role in the metabolism of drugs are the kidneys and the liver. These are the organs that decide how long the drugs that have entered the body remain in the blood circulation. Given that in the elderly blood circulation is lower, the renal and hepatic blood flow, as a result, is lower than in younger individuals. The senior population tends to have restricted liver function due to decrease in the liver mass due to the effects of aging. As age increases, the capacity of the liver to eliminate the toxicity of the drug reduces. The reduced blood flow in the hepatic blood system results in reduced metabolic activity of the drugs that takes place in the liver. This means, the metabolic reactions that occurred in the liver such as dealkylation (removal of alkyl groups from food/drug compounds), hydrolysis (breakdown of food/drug compounds with water), hydroxylation (neutralization of acidic food/drug compounds) and nitro reduction (the enzyme catalyzed process of breaking down the amino acids into simpler compounds for absorption). The enzymes that are responsible for catalyzing drugs, known as Cytochromes (made up of subunits of proteins), decrease in content as well (George, Byth, & Farrell, 1990). As a result of this lowered activity of the liver enzymes, there is a lot of unwanted medication residue build-up in the liver that can lead to side-effects that may be damaging for the concerned person's health. Again, it is stressed that the dosage in which the medicines and…[continue]
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