Rational therapeutics in the elderly

The potential for altered responsiveness to drugs in elderly patients together with their high frequency of multiple disease states for which drug therapy might be indicated makes it important to define certain basic principles of prescribing for them in order to obtain maximum efficacy with minimum unwanted effects. Many diseases from which the elderly suffer do not require drug treatment and, if it is required, the decision should be made in light of the pharmacokinetic and pharmacodynamic characteristics of the alternatives, the increased potential of certain drugs to produce adverse effects in the elderly and a regular review of the need for continued medication. In order to improve compliance with prescribing instructions, the minimum number of drugs and doses should be prescribed, the size, shape and colour of tablets and capsules should also determine choice, and attention paid to packaging and labelling. The methods by which the patient living at home can manage his/her medication effectively should be carefully considered.