Ageing Physiology Changes

An older adult can develop medication toxicity on a previously tolerated regimen without receiving an excessive dose. Reduced renal and hepatic reserve, altered body composition, lower albumin during illness or malnutrition, and greater pharmacodynamic sensitivity can all increase the effect of a drug. A normal serum creatinine does not reliably exclude reduced renal clearance. For the nurse practitioner, the practical question is not whether a patient is “old enough” for a dose reduction. It is whether the current drug, dose, route, organ function, indication, and monitoring plan still fit this patient. A new medication, dose change, intercurrent illness, fall, episode of confusion, bleeding, or syncope should prompt a medication review.