Prescribing to the Oldest Old

Abstract

Compared to younger people, older people are more likely to suffer the adverse effects of medications. On the other hand, older people as a group are more likely to reap the benefit of medications because they have more symptomatic disease and are more at risk of outcomes that can be prevented by medications. In this context, the challenge when prescribing to older people is to do more good than harm. A comprehensive understanding of the patient and the medications they are taking is the key to optimal prescribing. This will help establish the goals of treatment. Prescribers of medication to older people need to know about the medications that are under-prescribed to older people and the medications considered potentially inappropriate. Polypharmacy is common in older people, so it is important to know about the potential adverse effect of medications including drug–drug interactions and drug–disease interactions. Prescriber also needs to have an understanding of the process of de-prescribing medications. This chapter will provide some guidance on the factors to consider and processes to follow to achieve optimal medication regimens for older patients.