Experimental gerontological research is necessary to obtain optimal information and thus ensure proper drug therapy for the elderly. Most older persons acquire multiple diseases, first of all chronic diseases. They involve complex problems of a physical, social, and psychological nature. The multimorbidity of the elderly raises many questions in drug therapy. By contrast with our extensive knowledge of pharmacokinetics and pharmacodynamics in younger age groups, few facts are available in respect of the elderly. A variety of factors may influence drug therapy. Physiological and pathological age-related changes of molecules, cells, organs, and the total organism may interact to enhance or inhibit drug therapy in higher age groups. It is well known that elderly patients are overmedicated and therefore the incidence of adverse drug reactions increases with age. Elderly patients with multimorbidity often have a diminished body clearance of drugs; age-related changes of the kidney seems to be one of the most important factors in this regard. Far less important than the elimination of drugs through the kidney is their excretion in the bile. So far results have disclosed that oxidative steps in drug clearance are more likely to be disturbed than phase II reactions. Furthermore; changes in distribution volume and age-related alterations in receptor sensitivity also influence the clearance of drugs in the elderly.

At the beginning of the century the average life span in developed societies was less than 50 years. It is now more than 70 years and will continue to increase in the near future. Aging is a challenge to science and society. There are several theories of aging. The programmed aging hypothesis suggests that aging cannot be altered by any external influence, that aging is programmed from the beginning of life until the end of senescence. Another theory is based on genetic instability, with repair processes correcting errors in the cells that cause aging. Aging processes manifest themselves at the molecular and cellular level, in different organs, and in the whole organism. Most older persons acquire multiple diseases, primarily chronic ones. The multimorbidity of the elderly raises many questions as to nutrition, metabolism, immunity, drug therapy, and rehabilitation. Nutrition may be able to intervene in the aging process. Aging is associated with dec lining immunity and reduced resistance to many diseases, and it is pos sible that nutritional changes in old age contribute to the declining immunity in the elderly. The elderly take 40% of the prescription drugs in Germany and adverse drug reactions are more frequent in geriatric patients. There are not only problems in drug therapy for elderly pa tients, but also in their rehabilitation. The aim of rehabilitation is the restoration of geriatric patients to their former functional and environ mental status."

Im h|heren Lebensalter nimmt die Zahl der Erkrankungen zu. Oft m}ssen mehrere Medikamente gleichzeitig eingesetzt werden. Durch die altersbedingten Organver{nderungen wird jedoch die Wirkung der Medikamente beeinflu~t. Die vorliegende 2. }berarbeitete und durch drei neue Kapitel (Therapie arterieller Durchblutungsst|rungen; Therapie der koronaren Herzkrankheit; Therapie von Schilddr}senerkrankungen) erweiterte Auflage beschreibt die besonderen Probleme und die sinnvolle Anwendung der Pharmakotherapie bei {lteren Patienten. Nach einleitenden Ausf}hrungen }ber den Einflu~ von Altersver{nderungen des Organismus auf die Aufnahme, Verteilung, den Stoffwechsel und die Ausscheidung von Medikamenten werden die wesentlichen Erkrankungen im Alter und ihre Pharmakotherapie dargestellt. Die Einteilung in Pharmakagruppen erleichtert das Verst{ndnis f}r die unterschiedliche Reaktion im Alter. Eine Anpassung der Dosis ist dabei ebenso wichtig wie die Reduzierung der Zahl der Medikamente. Am Ende jedes Kapitels steht ein Pr{parate-Index, in dem die Freinamen (Generics) den Handelsnamen gegen}ber stehen. Allgemeinmediziner, Internisten und alle [rzte, die alte Menschen behandeln, werdes dieses Buch f}r ihre t{gliche Arbeit dankbar begr}~en.