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Clinical Pearls | Geriatric Considerations |
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In geriatric patients, total body mass and body water are decreased. These changes in body composition lead to a relative increase in body fat and decrease in body water, which changes the distribution patterns for most drugs. Aging also reduces plasma levels of albumin, a blood protein that binds with and transports many drugs. As a result, more unbound drug may circulate, which typically increases the pharmacologic action of drugs that are extensively protein-bound. Other factors that affect the distribution of drugs in geriatric patients include declining cardiac output, poor nutrition, dehydration, inactivity, prolonged bed rest, extremes of body weight, and electrolyte and mineral imbalances. Perhaps the most significant factor is physical size: Because geriatric patients are typically smaller than younger adults, the same drug dose may result in higher blood drug levels in a geriatric patient. |
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