The influence of aging on the metabolism of phenazone (antipyrine), and the relationship between the formation of 3 phenazone metabolites and the metabolic clearance of theophylline in healthy and frail elderly women, were examined. Whereas the elimination half-life did not change, clearance of phenazone decreased by about 50% with age in healthy women receiving phenazone without theophylline. However, the summation of the urinary recovery of phenazone and the measured metabolites, expressed as percentage of the phenazone dose, was lower in the healthy elderly (37 +/- 9% vs 74 +/- 15%). In both healthy and frail females the clearance of formation of 4-hydroxy-phenazone and the metabolic clearance of theophylline correlated strongly (r = 0.93 and 0.90, respectively). In non-healthy elderly females, strong correlations were also observed between the other metabolic pathways of phenazone and the metabolic clearance of theophylline. Coadministration of theophylline in the elderly increased the percentage of the phenazone dose excreted as the measured metabolites. A considerably higher interindividual variability in the disposition of phenazone and theophylline was observed in the frail elderly women. This high degree of variability in drug metabolism may be one of the explanations for the problems often occurring after drug prescription in the elderly.

One hundred patients aged 75 years and over who were discharged from an accident and emergency department were selected at random for follow-up at home. Over half of the patients had suffered minor trauma, but 26 had increased dependency in one or more activities of daily living. Increased support was provided by the relatives for the majority of patients, by friends and neighbours in seven cases, and by a district nurse in 14, whilst only one patient received increased home help. Eight patients were known to be readmitted to hospital within 14 days of discharge. Staff in accident and emergency departments need to be aware that the functional consequences of an apparently minor injury in an elderly person may be severe, and that discharge must be carefully planned.