Good prescribing practice in the elderly

Abstract

Elderly patients are the most important target group of pharmacotherapy. Older individuals often suffer from multiple co-morbidities, which often results in polypharmacy. A therapy based on guidelines can be problematic and is only rarely examined in clinical trials of elderly patients. In addition, alterations in pharmacokinetics and pharmacodynamics due to increased age have to be considered. As a result of these changes, the elderly are particularly vulnerable to certain drugs. These drugs are classified as potentially inappropriate medication (PIM) for the elderly because they bear an increased risk of adverse drug events resulting in major safety concerns. Several classifications have been published to identify and avoid PIM. In this article, START/STOPP (Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' potentially inappropriate Prescriptions), PRISCUS (Latin: time-honoured) as well as the Austrian PIM-list and FORTA (fit for the aged) criteria are discussed and explained in detail. The use of these tools is considered to be potentially useful in improving the quality of drug therapy for elderly people. Further, a regular medication review is recommended. The determination of the renal function, which is often limited in the elderly, resulting in a required dose adjustment of the medication as well as the choice of a low initial dose when starting a new drug in the elderly may also contribute to increased medication safety.