prescribing medication for the elderly
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1
Prescribing Medicine for the Elderly
PRESCRIBING FOR THE ELDERLY
By
Abdalla Ibrahim
Family Doctor, PHC, MOH, Bahrain
Accreditation Specialist, Healthcare Surveyor
Email: abdallaibrahim@hotmail.com
2
2014
Mapping of the presentation 3
General principles of geriatric medicine
Especial consideration on elder-drug prescription
Guidelines
introduction 4
In elder people, an abrupt decline in any system is due
to disease and not to normal aging, that is to say, “Old
people are sick because they are sick, not because they
are old”.
Definition 5
Human aging:
A progressive constriction of each
organ system’s homeostatic reserve.
This decline is often referred to as
homeo-stenosis. It begins in the third
decade and is linear and variable
among individuals (Resnick NM, 1998).
General principles of geriatric
medicine 6
1. Disease presentation is often atypical and symptoms
depend on which organ system is the “weakest link”
often the brain, LUT, CVS and musculo-skeletal
system.
2. Because of impairment of compensatory mechanisms,
diseases in elders presents at earlier stage
General principles (cont.)
7
3. Multiple abnormalities occur concurrently.
4. Many findings that are abnormal in younger
patients are common in elder and may not be
responsible for particular symptoms.
General principles (cont.)
8
5. Symptoms in elder are due to multiple causes.
Think of more than one diagnosis. When diagnosis
is correct, treatment of a single disease is unlikely
to result in cure.
6. Elder respond equally or even more effectively to
treatment than younger patients (Resnick NM, 1998).
Special Consideration 9
Patient compliance
Polypharmacy
Susceptibility
Patient compliance 10
Up to 50% of patients fail to achieve full
compliance and 33% never take their medicines.
Compliance for short term and self –administered
therapies are higher (about 75%) than long –
term therapies (<25% for completion of
antibiotic therapy for acute infection).
Patient compliance (cont.)
11
Compliance rates are inversely correlated with the
number of interventions prescribed, complexity and
cost. Thus regimen should be as simple as possible.
Patients recall instruction to medicines than to comply
with recommendation to follow diet, exercise and
self-care activities.
Polypharmacy 12
How elder people make their own polypharmacy?
Elder people receive multiple drugs for multiple
diseases
Self-medication from OTC based on previous
experience or prescription
Polypharmacy (cont.)
13
Symptoms associated with social stress (e.g.
headache and sleeplessness) can lead to further
prescription
Manifestation of aging may be misleading for drug
prescription
Susceptibility 14
Increased permeability of the BBB
Aging of the renal system:
Limited function of the renal system
Slow excretion of drugs
Increased susceptibility to nephrotoxic drug
Guidelines 15
Indication:
First question yourself whether the drug is indicated
at all
Limit your range:
Prescribe from limited range of drugs and be
thoroughly familiar with their effect in the elderly
Guidelines (cont.)
16
Reduce Dose
Dose should be lower than in younger patient and it
is common to start with 50% of adult dose
Review regularly:
You may need to reduce the dose, repeat the dose
or even stop the drug completely
Guidelines (cont.)
17
Explain clearly
Write full instruction on each prescription
Repeats and disposal
Try to prescribe matching quantities. Instruct
patients what to do when drugs run out
Third party
Enrol the help of third party when necessary
Guidelines (cont.)
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Regimen and form of prescription
Regimen should be as simple as possible (once
or twice a day)
Self-administered drug is preferable (avoid
injection)
Liquid forms are preferred to tablets or
capsule ones which need ample amount of
fluid
Recommendation 19
NSAID
For osteoarthritis, soft-tissue lesion, back pain try the
following
Weight reduction, warmth, exercise and walking stick
Paracetamol with low dose opioid analgesic
Paracetamol with small dose NSAID
Monitor for GI bleeding
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Diuretics
Should not be used on long-term basis. For gravitational
oedema encourage increase movement, raising the leg
and support stockings
Hypnotics
Avoid hypnotics with long half-lives which have serious
hangover effects of drowsiness, unsteady gait, slurred
speech and confusion. Short course hypnotics are
occasionally useful to help patient go through acute
illness or some other crisis.
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