Practical advice for prescribing in old age

The increase in inter-individual pharmacological variability with age makes prescribing in the older patient challenging. Notwithstanding the fact that it is frailty, rather than age, that predicts how well a person will cope with a given physiological challenge, the effects of drugs and the way they are handled by the body change in a number of ways with increasing age. 

With decreasing life expectancy, it may be that drugs used for secondary prevention become less appropriate, particularly where the adverse effects of these medications lead to reduction in short-term quality of life. Unfortunately, the process of weighing the benefits and risks in this group is made more difficult by a paucity of directly relevant evidence. 

A number of drugs and combinations of drugs are particularly likely to cause harm to the frail older patient, and these should be prescribed only where there is clear benefit. Formal criteria for identification of potentially inappropriate medications have been developed, but can be cumbersome to apply and suffer from a lack of flexibility. Regular medication review is an important part of management of this patient group. A suggested method for this is discussed.