Prescribing guidelines for the elderly
Use of inappropriate drugs can be a significant contribution to morbidity in older age groups.
• take carefully drug history (may need to bring all drugs in for a complete review)
• carefully consider necessity of drug avoid unnecessary drugs (especially for minor, nonspecific or self limited conditions)
• is the drug the most appropriate for the indication(s) – the risk/benefit ratio of a drug may be less favourable in the older person
• consider alternatives (any non-pharmacological approaches?)
• consider not using drugs if symptoms are minor
• consider dosing reductions
• discontinue drugs when no longer indicated or needed
• minimise number if drugs used if possible reduced complexity
• do not use drug that are not going to be necessarily useful (eg lipid lowering drugs in the very elderly)
• appropriate dose, keeping in mind the significant inter-individual variability of clinical response to a given dose. Start with low doses and increase slowly
• monitor frequently (especially if low therapeutic index)
• type of formulation/packaging (can it be used by those with a disability?)
• check patients compliance (especially if regimen is complex)
• provide card with list of medications
• review regularly for supervision
Regular review is essential to optimise medication use. Clear and complete communication is needed regarding the goals of each drug.
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