Thinking through the medication list - appropriate prescribing and deprescribing in robust and frail older patients

Medicines in older patients have the potential to provide great gains as well as significant harms.

To provide an ethically sound, evidence based discussion of the benefits and harms of medications commonly used in primary care among older patients.

Appropriate prescribing and deprescribing (drug withdrawal) for older patients requires a thorough understanding of the individual, their therapeutic goals, the benefits and risks of all of their medicines, and medical ethics. There is very limited evidence on the safety and efficacy of medicines in older adults, particularly in the frail, who often have multiple comorbidities and functional impairments. In robust older patients, therapy usually aims to delay or cure disease and to minimise functional impairment. In frail older patients, symptom control, maintaining function and addressing end-of-life issues become the main priorities. Optimising medicines is a time-consuming, multidisciplinary process that requires extensive communication, frequent monitoring and review, and has a major clinical impact.