The process of aging produces important physiologic changes in the central nervous system, including neuroanatomic, neurotransmitter, and neurophysiologic changes. These processes result in age-related symptoms and manifestations for many older persons. These physiologic changes develop at dramatically variable rates in different older persons, however, the decline being modified by factors such as diet, environment, lifestyle, genetic predisposition, disability, disease, and side effects of drugs. These changes can result in the common age-related symptoms of benign senescence, slowed reaction time, postural hypotension, vertigo or giddiness, presbyopia, presbycusis, stiffened gait, and sleep difficulties. In the absence of disease, these physiologic changes usually result in relatively modest symptoms and little restriction in activities of daily living. These changes decrease physiologic reserve, however, and increase the susceptibility to challenges posed by disease-related, pharmacologic, and environmental stressors.
[...] The elderly are particularly vulnerable to adverse drug reactions because of multiple-drug regimens, multiple chronic diseases, relative renal and hepatic insufficiency, decreased physiologic reserve, and altered drug metabolism with aging. Inappropriate drug use has been reported in about 40% of hospitalized older patients, with more than one quarter of these patients having absolute contraindications to the drug and the others being given a drug that was unnecessary. Because 50% of adverse drug events occur in patients receiving inappropriate drugs, the potential for reducing these adverse events is substantial. [...]
[...] Although not routinely evaluated in the standard medical assessment, determination of the patient's degree of functional incapacity based on their medical and neuropsychiatric conditions is crucial to understanding the burden of disease and its impact on the individual's daily life. The important relationship of functional status with health in older persons is reflected in the finding that functional measures are stronger predictors of mortality after hospitalization than are admitting diagnoses. Functional measures strongly predict other important hospital outcomes in the elderly, such as length of stay, functional status at discharge, future care needs, caregiver burden, risk for institutionalization, and long-term prognosis. [...]
[...] MENTAL STATUS EXAMINATION In addition to a detailed neurologic examination, evaluation of neuropsychiatric disturbances in older persons requires a careful mental status examination, including an assessment of mood, affect, and cognition. Brief screening tests are available to evaluate these domains and to assist in the detection of potential problems requiring further evaluation and treatment. For depression screening, scores of 6 or more on the 15-item short-form Geriatric Depression Scale indicate substantial depressive symptoms requiring further evaluation. Alternative depression screening instruments include the General Health Questionnaire; for cognitively impaired patients, observer-rated depression scales, such as the Hamilton Depression Scale, are recommended. [...]
[...] Patients frequently underestimate the toxic potential of over-the- counter medications and herbal remedies, and they may be using a variety of such agents that could potentiate the side effects or directly counteract the desired effects of prescription medications. Discussion Screening methods for cognitive and functional decline in older persons will continue to be refined and simplified. An important future direction will be to incorporate these screening measures into the routine care of all older persons in physicians' offices, clinics, hospitals, nursing homes, and other settings. [...]
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