[Appropriate drug prescribing in the elderly]

The frequency of chronic illness and the expenditure of medications increase with the older age. If drug-prescribing is very often beneficial for the patients, elderly subjects are particularly exposed to the side-effects of medications, and to their consequences. Although the age in itself do not generally forbid a medication, it can modify some of the objectives and the modality of the treatment.

Four main factors explain the growing frequency of the iatrogenic pathology in the old age: polymedication, pharmacological modifications that occur with the ageing process, lack of coordination between different prescribers, and physical and psycho-social deficiencies which are the keys for identifying the "frail elderlies".

In regard to the frequent polypathological conditions of the oldest patients, one does not have to consider a sum of sicknesses, but a global situation, and one needs to replace a condition in a general context, and to establish priorities in the goals of the treatment. Appropriate drug-prescribing also needs to take account of the latest medical recommendations concerning numbers of medications, and a more frequent involving of elderly subjects in clinical trials.