Improving geriatric drug therapy.

Healthcare professional and society in general harbor ambivalent beliefs about drug therapy. Most of us anticipate that drugs will eventually control, or even cure many age-related diseases. On the other hand, there is a growing unease about the hazards of medications, which range from minor discomforts that diminish quality of life to life-threatening toxicity. Some clinicians and patients have responded to these threats with a nihilistic attitude toward drugs, but most recognize that rational drug therapy requires weighing the relative risks and benefits of each drug for the individual patient. It is inappropriate to prescribe medications for each symptom presented by the elderly and similarly irrational to deny the benefits of therapy to an individual merely because of advanced age. Inadequate research in serious limitations in the data base needed for making clinical decisions about the relative risks and benefits of drug therapy for the elderly. Despite the observation that the elderly are often the beneficiaries (or victims) of new pharmacologic agents, drug studies seldom have included subjects over 65 years old. Even less common subjects over 75 years of age, although gerontologists and pharmacologist now recognize that response to illness and medications in mostly likely to be altered in the "old-old" population. The purposes of this article are to survey the current state of knowledge in geriatric pharmacology and to anticipate, based upon current issues and trends over the past 10 years, the scientific and technological advances likely to promote improved drug therapy for the elderly in the next decade.