Arthritis drugs and the older patient

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Information from the CDC...
Since 1901, the life expectancy of an American has increased from less than 50 years to more than 76 years.

Between the years 1960 and 2000, the number of people aged 65 and older has doubled. By the year 2030, this number is expected to reach more than 70 million... approximately 20 per cent of the population.

It is this age group that is most prone to developing adverse drug events. Adverse drug events occur as a result of four major factors:

• Drug interaction

• Interaction between drugs and nutritional supplements

• Functional changes associated with aging

• Age-related disease

The use of multiple medications increases the risk of ADEs. Many older individuals are on multiple medications. This is referred to as "polypharmacy."

Medications are handled less efficiently by the body as a person ages. Alterations occur in drug absorption, distribution in the body, metabolism, and excretion.

Among the many metabolic changes that occur in the body are an increase in body fat, decrease in lean body mass, and decrease in total body water.

As patients get older, declines in liver and kidney function occur. It becomes more difficult for the body to eliminate drugs that are normally excreted by the kidneys or metabolized by the liver.

Liver capacity and blood flow also decrease. This can lead to greater drug effect if metabolism of the drug is delayed.

Changes in drug receptors also can lead to increased drug effect and potential side effects.

For patients who take medicines for arthritis, particularly non- steroidal anti- inflammatory drugs (NSAIDS), this can be be a real issue. Age is a major risk factor for the development of kidney failure, gastrointestinal bleeding, high blood pressure, and congestive heart failure.

Muscle relaxants sometimes prescribed for muscle strain can cause excessive side effects as well. Slower metabolism means the drug tends to hang around in the system more. This can lead to unintended falls.

The bottom line is to use the least amount and the least number of medicines needed to manage the problem. And in patients taking multiple medications, the caution required for monitoring is increased. Another very important issue is to stress to the patient that herbal supplements are also capable of producing side effects and drug interaction.

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