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Upon completion of the chapter, the reader will be able to:
Explain changing aging population demographics.
Discuss age-related pharmacokinetic and pharmacodynamic changes.
Identify drug-related problems and associated morbidities commonly experienced by older adults.
Describe major components of geriatric assessment.
Recognize interprofessional patient care functions in various geriatric practice settings.
The growth of the aging population and increasing lifespan require healthcare professionals to gain knowledge necessary to meet the needs of this patient group. Despite the availability and benefit of numerous pharmacotherapies, older patients commonly experience drug-related problems, resulting in additional morbidities. Therefore, it is essential for clinicians serving older adults across all healthcare settings to understand the epidemiology of aging, age-related physiological changes, drug-related problems prevalent in elders, comprehensive geriatric assessment, and interprofessional approaches to care.
EPIDEMIOLOGY AND ETIOLOGY
As humans age, they are at increasing risk of disease, disability, and death for three reasons: genetic predisposition; reduced immunological surveillance; and the accumulated effects of physical, social, environmental, and behavioral exposures over the life course. Elders experience variably increasing vulnerability (homeostenosis) as they age, resulting in heterogeneity in health states and care requirements. While resilient elders can maintain high levels of physical and cognitive functioning, others suffer functional decline, frailty, disability, or premature death. There is an urgent need for clinicians to better understand the epidemiology of aging to comprehensively provide high-value services to optimize the function and health-related quality of life of older adults.1
The population is rapidly growing older. In 2020, 56.1 million US residents were 65 years and older, with projections to increase to 94.7 million by 2060.2 Almost 6.7 million people were 85 years or older (the “oldest-old”), and 100 thousand persons were aged 100 or older.2 Those 85+ years individuals are projected to grow from 6.4 million in 2016 to 14.4 million in 2040 and further increase to 19 million by 2060.2 In 2020, older women aged 65 years and above (31 million) outnumbered older men (25 million), with a ratio of 100 to 81; this ratio widens as elders age.2 Additionally, minority elders are projected to increase to 21.1 million in 2020.3 With changing aging population demographics, surviving baby boomers will be disproportionally female, more ethnically/racially diverse, better educated, live alone, and have more financial resources than elders in previous generations.
More elders have higher economic prosperity than ever before. In 2017 only 9.2% of Americans of 65 years and older and 11.6% of 80 ...