Too often clinical trials exclude those over the age of 65, even if they consume 55 percent of the medicines.
And so we find ourselves dealing with serious toxic effects. The abuse of tranquilizers is accused. Clinical research should involve all subjects, including children, women and the elderly, while instead it tends to be essentially a trial on young adults. In fact, older adults are often excluded from clinical trials: for example, in a recent study of nearly 10,000 patients recruited to study osteoarthritis drugs, only 2 percent were over 65, and virtually no patients were over 75. This situation does not only affect bone diseases, but also many other fields of medicine. In fact, studying drugs in the elderly is essential. Suffice it to think, for example, that 55 percent of the entire spectrum of pharmaceutical prescriptions is addressed precisely to these subjects who. paradoxically, they are instead the least considered on the real benefit of the treatment e. even less, on the possible toxic effects. Why? Because the elderly patient cannot be compared to the young adult patient. For various reasons. We see. First of all, the absorption of the drug in the elderly is more exposed to wide variability: the decrease in renal function, which is generally proportional to age, determines a strong reduction in the excretion of the drug or water-soluble metabolites, with the result of having an increase in the amount of the drug in the blood and therefore also a possible increase in the toxic effects. Not only that: in the elderly, the distribution and metabolism of drugs change and the targets on which they act can also change. A decrease in the receptors could lead to a change in the activity of the drugs. even at equal concentrations in blood. It therefore seems logical to assume that we have little information on optimal drug doses for use in the elderly, simply because they have never been studied. Depending on the case, there is thus the risk of having a reduced efficacy, or of obtaining increased toxicity compared to the studies carried out on young adult patients. A second difference between adults and the elderly depends on the fact that the elderly are often carriers of multiple pathologies. They may have had a heart attack, have circulation problems, be diabetic at the same time and therefore already be treated with multiple drugs and, it is known, the use of more drugs does not necessarily correspond to greater benefits. It often becomes unpredictable Very often the elderly are also carriers of several pathologies: the effects of several drugs can cause unpredictable situations for the body. the effect of the drug for good (efficacy) and for evil (toxicity). It also happens, to complicate the situation, that the elderly patient takes drugs not subjected to medical prescription. For example food supplements, antioxidants, as well as products purchased in herbal medicine; it may be necessary to use laxatives or expectorants or slimming. All this creates unpredictable situations in the body. A third difference concerns the use of psychotropic drugs in the elderly. Abuse of tranquilizers and antidepressants is typical, especially in residential institutions. If given without a precise purpose, they worsen the quality of life of the elderly, making them less reactive with worsening of memory, muscle strength, with a higher risk of falls. In conclusion, it is time for controlled clinical studies to increase, with the use of p
