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Introduction to Drug Therapy in the Elderly

by J. Mark Ruscin, PharmD, Sunny A. Linnebur, PharmD, FCCP, BCPS, CGP

Prevalence of prescription drug use among older adults increases substantially with age. Among people 65, 90% use at least 1 drug per week, > 40% use at least 5 different drugs per week, and 12% use 10 different drugs per week. Women take more drugs, particularly psychoactive and arthritis drugs. Drug use is greatest among the frail elderly, hospitalized patients, and nursing home residents; typically, a nursing home resident is given 7 to 8 different drugs on a regular basis.

Providing safe, effective drug therapy for the elderly is challenging for many reasons:

  • They use more drugs than any other age group, increasing risk of adverse effects and drug interactions, and making adherence more difficult.

  • They are more likely to have chronic disorders that may be worsened by the drug or affect drug response.

  • Their physiologic reserves are generally reduced and can be further reduced by acute and chronic disorders.

  • Aging can alter pharmacodynamics (see Pharmacodynamics in the Elderly) and pharmacokinetics (see Pharmacokinetics in the Elderly).

  • They may be less able to obtain or afford drugs.

There are 2 main approaches to optimizing drug therapy in the elderly:

  • Using appropriate drugs as indicated to maximize cost-effectiveness

  • Avoiding adverse drug effects

Because the risk of adverse drug effects is higher, overprescribing (polypharmacy) has been targeted as a major problem for the elderly. However, underprescribing appropriate drugs must also be avoided.

* This is a professional Version *