First Do No Harm: Psychotropic Prescribing Principles and Guidelines for Older Adults

Area of Science:

• Geriatric Psychiatry
• Psychopharmacology
• Health Services Research

Background:

• Prescribing psychiatric medications aims to alleviate suffering, but can lead to polypharmacy and adverse effects.
• Older adults with comorbid medical conditions are particularly vulnerable to medication overload and prescribing cascades.
• Current practices may prioritize symptom remission over patient quality of life and preferences.

Purpose of the Study:

• To highlight the challenges of polypharmacy in older adults with psychiatric disorders.
• To advocate for a collaborative, patient-centered approach in managing complex medication regimens.
• To emphasize the need to re-evaluate treatment goals and simplify care for this population.

Main Methods:

• Review of current prescribing practices in psychiatry, focusing on older adults.
• Discussion of the risks associated with polypharmacy and prescribing cascades.
• Emphasis on collaborative decision-making involving patients, families, and providers.

Main Results:

• Polypharmacy and prescribing cascades are significant concerns in older psychiatric patients.
• A focus on symptom remission can lead to excessive medication use.
• Individualized care plans are essential for managing complex medication needs.

Conclusions:

• Treating older adults with psychiatric disorders and multimorbidities requires a shift from guideline-based approaches to collaborative goal setting.
• Re-evaluating patient priorities, examining tradeoffs, and reducing medication overload are key to simplifying care.
• Available resources can support clinicians in optimizing medication management for this vulnerable population.