Multiple medication use has been coined 'polypharmacy'. Polypharmacy is highly prevalent in older patients secondary to the increased number of co-morbid disease states with ageing. Existing practice guidelines recommend multiple drug use for certain chronic diseases (i.e., HIV, tuberculosis, hypertension, etc.). A polypharmacologic approach for certain diseases has been shown to improve therapeutic response, decrease morbidity and mortality. On the contrary, polypharmacy may induce iatrogenic complications that are often unseen prior to the initiation of medicinal regimens. This paper will review the potential clinical consequences of polypharmacy in the elderly and common medication administration errors that may occur. Consequences of polypharmacy include adverse drug effects, drug-drug interactions, disease-drug interactions, food-drug interactions, nutraceutical-drug interactions and medication cascade effect. Medication administration errors, such as phonetic confusion, flip-flopping dosing errors and pill visual-cue errors, are also reviewed. Prescribing for the elderly, whose medications are vast in number, is often uncharted physiologic territory. The clinician must expect the unexpected and think of the unthinkable in the geriatric patient, when dealing with polypharmacy and the potential consequences.

Testosterone has been available to practitioners for several decades. However, testosterone prescriptions have increased in recent years partly because of the introduction of newer delivery systems that are topical and have good bioavailability. In the US alone, approximately 2 million prescriptions for testosterone were written in 2002. This represents a 30% increase from 2001 and a 170% increase from 1999. There has also been a 500% increase in prescription sales in the past 10 years. The rise in prescriptions may be in part due to the increasing recognition of hypogonadism in ageing males or andropause. Treatment relating to hypogonadism has relieved symptoms and improved the quality of life of many individuals. Epidemiological studies point toward an association with increased morbidity and mortality, with low testosterone states in ageing males. For example, there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty and even dementia with low testosterone states. Recently, there have been some concerns raised regarding the long-term safety of testosterone replacement therapy (TRT) from the Institute of Medicine. Current evidence suggests no causal relationship between prostate cancer and physiological dosing of testosterone, especially with careful selection and monitoring of patients. Cardiovascular risks have, overall, been neutral, although suggestions have been made that there are positive vasodilatory properties with testosterone. Mild eythrocytosis can be a common side effect of TRT, but thromboembolic events have rarely been reported in the literature. This paper addresses the evidence to date regarding the safety aspects of TRT. The medical-legal implications of TRT for men at this point in time is also discussed.

In the elderly, Hispanic ethnicity, unlike black ethnicity, is significantly associated with lower use of antihypertensive drug therapy compared with non-Hispanic white ethnicity, adjusting for relevant sociodemographic and health factors.

Androgen decline with aging typically occurs after 50 years, although the fall in testosterone levels can begin as early as 30 years of age. The patient may or may not be symptomatic. Symptoms can range from fatigue to sexual dysfunction. Long-term effects of lowered testosterone can be seen in organ systems including the brain, muscle, adipose tissue, hair, bone, and the cardiovascular system. There is no consensus for androgen replacement as prevention, but there is consensus in the treatment and reversal of symptoms associated with hypogonadism. However, treatment must be carefully monitored. While there are significant benefits in the improvement of symptoms, there are also possible side effects that will be discussed in detail in this article. A careful risk–benefit analysis has to be carried out and treatment must be individualized.