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Background/Objective: Numerous age-related changes in hepatic structure and function have been described, although liver function seems to be quite well maintained in old age. Few consistent and reproducible observations and a lack of correlation between structural and functional data characterize the present state of our knowledge. In contrast to renal clearance, no equally reliable method exists to estimate hepatic drug clearance. The contribution of age to altered drug clearance in the elderly is difficult to assess as drug interactions, numbers and types of drugs taken at a time, underlying disease and increased interindividual variability are superimposed to the aging process. Methods: A comprehensive computer-assisted search of the literature. Results: A decline in liver volume and blood flow and a reduction in in vitro and in vivo metabolic capacity have been shown in older subjects, and the physiologic basis of reduced hepatic drug clearance in this age group. Conclusions: After decades of research into the matter, the old and well-known aphorism ‘start lower – go slower’ is valid more than ever in the field of geriatric prescribing. Not only renally excreted drugs but also substances which are metabolized and excreted by the liver should be used at a starting dose which is 30–40% smaller than the average dose used in middle-aged adults.

Objectives-To compare the efficacy and gastroduodenal safety of a fixed-dose combination of diclofenac sodium 50 mg and misoprostol 200 ,ig twice daily with those of piroxicam 10 mg twice daily and naproxen 375 mg twice daily in patients with osteoarthritis.

Palliative therapy in elderly cancer patients deserves special attention because of differences between young and elderly cancer patients. In elderly patients, the treatment produces more adverse effects and the disease is cured less frequently, but the prognosis is usually better than in young patients with cancer. In the elderly population, cancer is seen more frequently than in the young population, yet elderly patients are less frequently included in trials. It is obvious that the results obtained from the treatment of young cancer patients do not necessarily apply to elderly cancer patients. The existing lack of formal data for the management of elderly cancer patients justifies 5 distinctive steps: collection of individual information; review of the available and appropriate knowledge; definition and specification of treatment goals; selection of treatment tools; and assessment of outcome. Following these steps will lead to coordination of oncology and palliative medicine.