[Drug therapy for older people : Choosing wisely]

Area of Science:

• Gerontology
• Pharmacology
• General Practice Medicine

Background:

• The elderly population is growing rapidly, often presenting with multimorbidity.
• Polypharmacy in older adults carries significant risks and benefits.
• General practitioners face challenges in optimizing complex medication regimens due to time constraints and the need for a holistic patient view.

Purpose of the Study:

• To evaluate the effectiveness of clinical aids in managing inappropriate medication in the elderly.
• To compare the utility of positive/negative assessment lists with purely negative lists.

Main Methods:

• Review of clinical aids for medication assessment in the elderly.
• Analysis of the performance of STOPP/START criteria and FORTA classification.
• Comparison with negative-only lists like Beers and PRISCUS.

Main Results:

• STOPP/START criteria and FORTA classification show clinical success in aiding medication decisions for the elderly.
• Purely negative lists (Beers, PRISCUS) have been less effective due to a lack of patient-specific considerations.
• These aids help address the prognostic and symptomatic importance of diagnoses in drug treatment.

Conclusions:

• Clinically tested aids, particularly those with positive/negative assessments, are crucial for improving medication management in elderly patients.
• Integration of these decision-making aids into healthcare, including IT systems, can enhance care quality for older adults.
• A holistic approach considering individual patient needs is essential for safe and effective pharmacotherapy in the elderly.