Appendix 2: Geriatric Assessment and Pharmacotherapy

Balance and gait

↓ Stride length and slower gait

↓ Arm swing

↑ Body sway when standing

Body composition

↓ Total body water

↓ Lean body mass

↑ Body fat

↔ or ↓ Serum albumin

↑ α₁-Acid glycoprotein (↔ or ↑ by several disease states)

Cardiovascular

↓ Cardiovascular response to stress

↓ Baroreceptor activity leading to ↑ orthostatic hypotension

↓ Cardiac output

↑ Systemic vascular resistance with loss of arterial elasticity and dysfunction of systems maintaining vascular tone

↑ Afterload

↓ Coronary perfusion

Central nervous system

↓ Size of the hippocampus and frontal and temporal lobes

↓ Number of receptors of all types and ↑ sensitivity of remaining receptors

↓ Short-term memory, coding and retrieval, and executive function

Altered sleep patterns

Endocrine

↓ Estrogen, testosterone, thyroid-stimulating hormone, and DHEA-S levels

Altered insulin signaling

Gastrointestinal

↓ Motility of the large intestine

↓ Vitamin absorption by active transport mechanisms

↓ Splanchnic blood flow

↓ Bowel surface area

Genitourinary

Atrophy of the vagina with decreased estrogen

Prostatic hypertrophy with androgenic hormonal changes

Detrusor hyperactivity may predispose to incontinence

Hepatic

↓ Hepatic size

↓ Hepatic blood flow

↓ Phase I (oxidation, reduction, hydrolysis) metabolism

Immune

↓ Antibody production in response to antigen

↑ Autoimmunity

Oral

Altered dentition

↓ Ability to taste salt, bitter, sweet, and sour

Pulmonary

↓ Respiratory muscle strength

↓ Chest wall compliance

↓ Arterial oxygenation and impaired carbon dioxide elimination

↓ Vital capacity

↓ Maximal breathing capacity

↑ Residual volume

Renal

↓ Glomerular filtration rate

↓ Renal blood flow

↓ Filtration fraction

↓ Tubular secretory function

↓ Renal mass

Sensory

Presbyopia (diminished ability to focus on near objects)

↓ Night vision

Presbycusis (high-pitch, high-frequency hearing loss)

↓ Sensation of smell and taste

Skeletal

↓ Skeletal bone mass (osteopenia)

Joint stiffening due to reduced water content in tendons, ligaments, and cartilage

Skin/Hair

Thinning of stratum corneum

↓ Langerhans cells, melanocytes, and mast cells

↓ Depth and extent of the subcutaneous fat layer

Thinning and graying of hair due to more hairs in the resting

phase and shortening of the growth phase as well as changes in follicular melanocytes

Gastrointestinal absorption

Unchanged passive diffusion and no change in bioavailability for most drugs

↓ Active transport and ↓ bioavailability for some drugs

↓ First-pass metabolism, ↑ bioavailability for some drugs, and ↓ bioavailability for some prodrugs

Distribution

↓ Volume of distribution and ↑ plasma concentration of water-soluble drugs

↑ Volume of distribution and ↑ terminal disposition half-life (t_1/2) for lipid-soluble ...