Prescribing in Older People

Abstract

The pharmacokinetics and pharmacodynamics of most drugs are altered to an important extent in older people. Older people often have a number of concurrent illnesses and may require treatment with several drugs. Older people may be more prone to develop serious adverse effects such as agranulocytosis and neutropenia with clozapine, stroke with antipsychotic drugs and bleeding with selective serotonin reuptake inhibitors. This chapter summarizes guidance for discontinuation of dementia medication in clinical practice. People with dementia are more susceptible to cognitive side effects of drugs. Medications prescribed for physical disorders may interact with cognitive‐enhancing medication. The evidence for efficacy of antidepressants in behavioural and psychological symptoms of dementia is mixed and limited showing that antidepressants are most helpful for treating agitation and less so for depression, apathy, anxiety or psychosis in dementia. The chapter deals with covert medication provision within UK law only. In mental health settings it is common for patients to refuse medication.