Medication in the elderly - considerations and therapy prescription guidelines

The aim of this study was to integrate and present pertinent findings from the literature dealing with the treatment of the elderly within a primary care setting. Medical care for the elderly is an integral part of a general practitioner's (GPs) everyday work and is challenging for many reasons. Older people often experience multiple chronic diseases concurrently (comorbidity, multimorbidity) and they often have deteriorated organ function and decreased physiological reserves due to the natural aging process. The choice of appropriate medication for each particular disease is a complex process and can cause "therapeutic confusion", especially among younger GPs in the field. Elderly people are prone to develop adverse side-effects to usual dosages of medications and the side-effects are even 7 times more frequent in elderly than in younger patients. Moreover, in therapy for elder patients, a responsible clinician always needs to think about potential drug to drug interactions and possible compromised pharmacokinetic dynamics in the aging body. Professional geriatric societies in many countries (USA, Germany, UK) have developed lists of potentially inappropriate medications for the elderly, and they update them systematically. Lists such as The Beers Criteria list and STOPP/START criteria should always be consulted when administering therapy to elderly patients. In this paper we emphasized the importance of medication lists as an important practical support in a GP's everyday work. Implementation of such therapeutic aids reduces the possibility of medical error and minimizes the chance of an inappropriate prescription for this vulnerable population stratum.

When prescribing drugs for the elderly, GPs should take into account the specificities of the elderly, their biological and chronological framework and should always apply the principles of rational, conservative and evidence-based pharmacotherapy.