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The use of transdermal patches as a method of drug administration has become more commonplace in recent years. Tina Wills explores their usefulness for older people.
Medication use is a major issue for older people. Older individuals tend to use more prescribed medications for longer periods than younger people, purchase more over-the-counter drugs and experience more adverse drug reactions. There is a complex web of physiological, psychological and social reasons for this and the implications are enormous, in both human and financial terms. The use of transdermal patches as a method of drug administration has become more commonplace in recent years and patches offer the potential to overcome many of the problems that older people experience in taking medications as prescribed, such as in reducing the complexity of drug regimes and avoiding the need to open childproof containers. This article explores the advantages and disadvantages of transdermal patches for older people and offers some guidance on their use.
The ageing skin
As human skin ages it develops characteristic physiological signs, such as wrinkles, thinning and some alteration of pigment. These changes are influenced by genetics, environment (particularly ultra-violet fight) and disease processes.
Changes to the epidermis appear subtle: skin may be thinner and oxygen consumption can be decreased. In the dermis, elasticity and thickness are reduced and the organisation of collagen fibres becomes less effective.
Changes at a cellular level are more complex. Campsisi (1998) describes changes in two different types of cell - postmiotic (which never divide) and miotic (which can divide). Epithelial cells are miotic but they do not replicate indefinitely; there is a point at which they stop. This process is termed cellular senescence and may compromise the function and integrity of the skin. Senescent fibroblasts appear to accumulate with age in human skin.
These changes become particularly relevant when the skin is required to perform an absorption function, as intended by the application of topical medications and transdermal patches.
The principle functions of the skin include protection, excretion, secretion, absorption, thermoregulation, sensory perception and regulation of our immunological processes. Cerimele et al (1990) state that these functions are all affected by the structural changes which occur in the skin in the course of ageing. They illustrate that, following middle age...