Pharmacological Management of the Older Patient

Abstract

Nearly one-third of all the prescription medications used in this country today is consumed by Americans aged 65 and older (1–3). In the community setting, this patient population receives, on average, two to six prescription medications at one time; this does not include the multiple over-the-counter and herbal medications (3). The number of drug exposures increases with age and tends to be higher in patients treated in long-term care facilities or nursing homes, compared to community-dwelling elders. The prescription rate in nursing facilities is, on average, five to eight medications per patient, not including medicines dispensed on an “as needed” basis (4). Not surprisingly, pharmacologic management was ranked as the number one target for quality improvement by experts in geriatric care from a list of 78 conditions common among vulnerable older adults (5). In persons 65 yr and older, the combination of complex medication regimens, altered pharmacodynamics, and multiple prescription and nonprescription medications places this patient population at high risk for adverse drug events, drug—drug interactions, and noncompliance.