Drug Prescribing for Older Adults

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At Dr.Paul’s Clinic we take every precaution to prevent drug complications in all patients, especially older adults, who are more vulnerable to drug side-effects and interactions.

The possibility of an adverse drug event (ADE) should always be borne in mind when evaluating an older adult; any new symptom should be considered drug-related until proven otherwise. Pharmacokinetic changes lead to increased plasma drug concentrations and pharmacodynamic changes lead to increased drug sensitivity in older adults.

Clinicians must be alert to the use of herbal and dietary supplements by older patients, who may not volunteer this information and are prone to drug-drug interactions related to these supplements.

Various criteria sets exist identifying medications that should not be prescribed, or should be prescribed with great caution, in older adults. However, clinicians need to consider each patient’s individual situation, and they should use their best clinical judgment rather than strictly adhere to prescribing guidelines when making prescribing decisions.

Clinicians also under-prescribe medications, such as statins, that could provide benefit for older adults. Clinicians may be better at avoiding overprescribing of inappropriate drug therapies than at prescribing indicated drug therapies. Patient financial constraints and unavailability of prescribed doses may contribute to medication underutilization.

ADEs result in four times as many hospitalizations in older, compared with younger, adults. Prescribing cascades, drug-drug interactions, and inappropriate drug doses are causes of preventable ADEs.

ADEs are a particular problem for nursing home residents; atypical antipsychotic medications and warfarin  are the most common drugs involved in ADEs in this population.

A stepwise approach to prescribing for older adults should include: periodic review of current drug therapy; discontinuing unnecessary medications; considering nonpharmacologic alternative strategies; considering safer alternative medications; using the lowest possible effective dose; including all necessary beneficial medications.

If you feel you have a drug interaction issue with one of the medications prescribed at our office, please call Dr.Paul’s Clinic immediately. Thank you for your cooperation.

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