[Drug therapy in the elderly :what are the problems? What are the dos and don'ts?]

With increasing age a clear increase in drug use exists in parallel with the age-related burden of disease. Elderly subjects have more frequent and more severe adverse drug reactions. Often polypharmacy causes a cascade which leads to the prescription of additional drugs to treat adverse drug reactions. To ensure safe medications, consideration of physiological changes and their relevance for pharmacodynamics and pharmacokinetics is necessary, as are critical prescription decisions with clearly defined individual therapeutic targets. Geriatric assessments should be performed more often. They comprise assessments of activities of daily living, the degree of autonomy and self-sufficiency, cognitive and nutritional status. Chronological age is only a minor criterion for prescription decisions. Practical help (dispensing devices, help when visual, tactile or cognitive impairments are present) will be able to improve adherence and thus safety and efficacy of drugs. Recognizing and preventing adverse drug reactions is probably the single most reversible affliction of geriatric medicine. Lists with potentially inappropriate medications (PIM) in the elderly are rather unsuitable due to their categorical character. Better consideration of patient-related factors and defining "potentially inappropriate patients (PIP)" seems preferable for preventing the prescription of risk-entailing medications.