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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."
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.
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.
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