Prescribing in Older People

Summary of important points • Analyse clinical trial evidence closely for conclusionsrelevant to older people.• Balance evidence for efficacy against the likelihoodof adverse drug reactions given your patient’scomorbidity, age and other medications.• Avoid polypharmacy if possible, as it increases therisk of adverse drug reactions and medicationerrors.• Allow patients autonomy in the decision to pre-scribe.• Choose a dose (usually lower) based on clinical trialdata. In the absence of such data, be guided bypharmacokinetic data or generalisations about agerelated changes in hepatic and renal function.• Monitor patients closely for efficacy and adverseeffects after commencing any new medication.• Implement deprescribing regimens under supervi-sion in older patients with polypharmacy. Use stepdown doses where adverse effects may occur (eg.reflex sympathetic stimulation).• Consider an adverse drug reaction as a possiblecause for any clinical presentation in older patients,especially falls and confusion.Conflict of interest: none declared.