Approaches to Appropriate Drug Prescribing for the Older Adult

Reconciling best practices in prescribing for older adults who have multiple diagnoses and the potential for polypharmacy and its adverse outcomes can be challenging for the office-based physician. To successfully prescribe medications for older patients, the physician must be attentive to changes in physiology that may accompany aging and thereby affect the pharmacokinetics and pharmacodynamics of many drugs and the potential drug-drug, drug-disease, and drug-herb interactions. Primary care physicians should also recognize the limited evidence base to support some prescribing recommendations, especially in old or frail old patients, while remaining attentive to those therapies that are effective in this population. Ultimately, the physician must forge partnerships with older patients in an effort to outline goals of care and determine which medications are important in achieving the goals.