Systemic Therapy in Older People

Abstract

Advances in medical science have contributed to a worldwide increase in life expectancy. Skin problems in older people present therapeutic and logistic challenges compounded by problems such as insomnia, dementia, poor eyesight and hearing, comorbidities and polypharmacy. Prescribing systemic medications, especially in frail older people, requires careful consideration to minimise adverse effects and maximise therapeutic benefit. This chapter provides an overview of the general principles and considerations when prescribing systemic therapy in older people. ‘Frailty’ refers to the syndrome of impaired homeostasis and decline in physiological reserves that results in an increased vulnerability to decompensation in response to low-level stressor events. Older patients are particularly susceptible to pharmacokinetic changes, predominantly associated with increased drug tissue concentration due to age-related decline in renal function. The most common indications for systemic dermatological therapy in older people are severe psoriasis or eczema, intractable idiopathic pruritus and bullous pemphigoid.