Antirheumatic drug therapy in the elderly

Abstract

In developed nations about 10 percent of the population are elderly, defined as 65 years or older [1]. Predictions forecast a doubling of this percentage by the year 2030 [2]. At present the elderly use approximately 75 percent of doctors’ time and require 20–40 prescriptions per person annually [3]. In the United Kingdom the elderly occupy more than 50 percent of all hospital beds, and some 40 percent of acute speciality beds [4]. Chronic illness, particularly rheumatic disease, is common, and it is therefore not surprising that so many non-steroidal anti-inflammatory analgesics and other antirheumatic drugs are prescribed for the elderly. There is growing evidence that adverse reactions to antirheumatic drugs, especially non-steroidal anti-inflammatory analgesics, may be more common in the elderly, especially women [5]. This can be explained, with respect to elderly patients in general, by three factors: elderly patients receive an increased number of medications, the physiological changes which occur with ageing may affect pharmacokinetic drug distribution, and the elderly patient may be more sensitive to the pharmacodynamic effects of drugs.