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Introduction to Drug Therapy in the Elderly

By J. Mark Ruscin, PharmD, Southern Illinois University Edwardsville School of Pharmacy ; Sunny A. Linnebur, PharmD, FCCP, BCPS, CGP, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO

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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 the Professional Version. *