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 that health care professionals gain knowledge necessary to meeting the needs of this patient group. Despite the availability and benefit of numerous pharmacotherapies to treat their diseases, older patients commonly experience drug-related problems resulting in additional morbidities. Therefore, it is essential for clinicians serving older adults across all health care settings to understand the epidemiology of aging, age-related physiological changes, drug-related problems prevalent in the elderly, comprehensive geriatric assessment, and interprofessional approaches to geriatric care.
EPIDEMIOLOGY AND ETIOLOGY
As humans age, they are at increasing risk of disease, disability, and death for three reasons: (a) genetic predisposition; (b) reduced immunological surveillance; and (c) the accumulated effects of physical, social, environmental, and behavioral exposures over the life course. All elders experience increasing vulnerability (homeostenosis) as they age, resulting in considerable 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 all clinicians to better understand the epidemiology of aging to comprehensively provide high-value services to optimize functioning and health-related quality of life of older adults.1
KEY CONCEPT Our population is rapidly growing older. In 2010, 40.3 million US residents were 65 years and older (13% of the total population), nearly 5.5 million people were 85 years or older (the “oldest-old”), and over 53,000 were centenarians.2 The baby boomers (those born between 1946 and 1964) began turning 65 years in 2011; their numbers will double to 83.7 million in the year 2050, representing over 20% of the total US population.3 In 2010, there were a total of 22.9 million women and 17.4 million men (an average ratio of 100 women to 77.3 men) 65 years and older; this ratio widens as elders age. The oldest-old are projected to increase from 5.3 million in 2006 to nearly 21 million in 2050.3 In addition, minority elders are projected to increase to 12.9 million in 2020.3 Surviving baby boomers will be disproportionally female, more ethnically/racially diverse, better educated, and have more financial resources than were elders in previous generations.
More elders are enjoying higher economic prosperity than ever before, although major inequalities persist, with older blacks and those without high school diplomas reporting fewer financial resources.4 Considerable disparities exist, and may prevent less advantaged elders from ...