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. 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 all clinicians to better understand the epidemiology of aging in order to comprehensively provide high value services to optimize the function and health-related quality of life of older adults.1
Our population is rapidly growing older. In 2015, 47.8 million US residents were 65 years and older (nearly 15% of the total population), with projections to more than double to 98 million by 2060.2 Almost 6.3 million people were 85 years or older (the “oldest-old”), and nearly 77 thousand persons were aged 100 or older.3 Those 85+ years individuals are projected to triple from 6.3 million in 2015 to over 14.6 million in 2040.3 In 2015, older women aged 65 years and above (26.7 million) outnumbered older men (21.1 million), with a ratio of 100 women to 79 men; this ratio widens as elders age. In addition, 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 were elders in previous generations.
More elders are enjoying higher economic prosperity than ever before, with only 10% living below the poverty line.4 However, 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 ...