Medication adherence in the aging population : the role of pharmacokinetics and pharmacodynamics

Abstract

It is well known that some older patients respond positively to some medicines, while others may experience adverse effects. The hitter may result in a lack of medicine adherence. Predicting which patients will react in which way has been the focus of a great deal of research in recent years, with the onset or personalised medicine. A key aspect which will determine personalised medicine are pharmacokinetic processes which determine the time course or the drugs and pharmacodynamics i.e., what the drug docs to the patient. Pharmacokinetics and pharmacodynamics arc important in older persons because they arc predictive sciences. They will help to determine the dose and dosage regimen needed, predict drug-drug and drug-food interactions and can lead to individualised prescribing or personalised medicine and thus enhance patient adherence. This chapter will give an overview of how an understanding of pharmacokinetics and dynamic parameters can enhance adherence. It will also show how while several or these parameters can genetically determined e.g., metabolising enzymes, other factors can also influence these processes especially in older persons e.g., co morbid conditions, smoking, diet, drug-drug interactions, race and frailty. In addition, changes in pharmacokinetics and pharmacodynamics parameters of medicines generally result in decreased clearance and increased sensitivity to medications in older persons. The objective of the chapter is to understand how patient adherence can be improved and personalized through a better understanding of the potential pharmacokinetic and pharmacodynamics factors that can impact the efficacy und adverse effects of drugs in the aging population.