[Difficulties in pharmacotherapy of the elderly]

Pharmacotherapy in the elderly is a challenge as the real risk-benefit ratio of many drugs and treatment strategies often remains unknown in these patients. Furthermore there are some special adverse drug reactions such as falls and delirium not only occurring more often but also causing an increased proportion of adverse outcomes. Finally there is the phenomenon of multimorbidity and polypharmacy responsible for treatment errors and inadequate drug treatment. A comprehensive risk-benefit analysis is needed to avoid both under- and over-treatment. This analysis should cover patients preferences, vulnerability, resources and functionality. Some simple treatment rules may improve drug treatment in the elderly, but an improved characterization of drugs and treatment strategies with regard to the elderly is essential.