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Prescribing in the elderly

The following considerations should be borne in mind when prescribing in the elderly:

  • Decide whether drug therapy is really necessary. Polypharmacy can lead to problems with compliance for elderly patients. Review drug therapy on admission and whenever possible to consider if the therapy is required.

  • Multiple drug therapy may lead to multiple drug interactions. Review therapy wherever possible.

  • Consider if a particular drug can be used to treat more than one disease state.

  • Is a drug being prescribed simply to treat the side effect of another drug.

  • Since the elderly often have multiple pathology, consider the possible adverse effects of a new drug on existing diseases.

  • Use the smallest doses and increase drug doses slowly whilst monitoring for side effects.

  • Elderly patients may be more sensitive to the effects of some drugs and reduced doses may be required. An example of this is warfarin and lower doses are often required when loading patients with this agent.

  • Elderly patients may be more prone to the adverse effects of drugs. Particular care is needed for example not to prescribe drugs which may worsen confusion.
  • NSAIDs should be avoided where possible in the elderly.
  • Renal function may be impaired in the elderly so ensure care is taken when prescribing drugs which are renally excreted or may worsen renal function.
  • Liver function may be impaired in the elderly so ensure care is taken when prescribing drugs which are excreted by the liver.
  • Consider that elderly patients often take medicines which they have purchased themselves e.g. laxatives.

  • Take care when prescribing drugs which may lower blood pressure as compensatory mechanisms may be compromised and orthostatic hypotension may result.

  • Albumin levels may be lower in the elderly. This can affect levels of free drug for drugs which are highly protein bound, especially at the start of treatment.