Rules for Improving Pharmacotherapy in Older Adult Patients: Part 2 (Rules 6–10)

Abstract

The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers.

Appropriate Pharmacotherapy in the Elderly

“…Because elderly patients can be quite sensitive to a drug's effects, it always prudent to review and understand the patient's medical background and current medical profile before drugs are prescribed. Obviously, in emergency situations this may not always be possible [5].…”

“…For this information, the practitioner is encouraged to research a particular drug before prescribing it to an older patient and use the best information available. It is always advisable to start with a low dose of an unfamiliar drug and titrate to response or adverse effects [5].…”

“…Medications (and active metabolites) cleared via the kidney are greatly affected by the aging process as glomerular filtration rate (GFR) is greatly reduced as one ages. Unlike hepatically metabolized drugs, GFR can be calculated and this estimation can be utilized to calculate appropriate drug doses [5,8].…”

“…The way the body responds to certain drugs may be altered because of changes in receptor binding, alterations in enzymatic response and other subtle changes in body function. The effects should be noted as drug therapy is considered [5].…”

“…These rules are not new, unique or groundbreaking but instead are based on common-sense principles that should be used by all be prescribers for all patients. These rules are especially appropriate in the elderly because they are so susceptible to drug-related problems [5,6].…”