Medicines and elderly

Lower doses should be considered in the elderly for all medicines.

 

General Advice

• When prescribing, ‘start low and go slow’; adjust dose in relation to renal and metabolic function.
• Reduce polypharmacy.
• Review all medicines frequently, use minimum dose required for effect, and discontinue unnecessary medicines.
• Consider patient non-adherence and utilise appropriate dosage forms (e.g. for swallowing difficulties) and compliance aids e.g. blister packs.
• Give clear instruction on use to ensure the patient/care-giver understands the treatment plan.

 

Pharmacokinetic Problems

• Impaired renal and hepatic drug clearance.
• Both renal function and drug metabolism decline by approximately 1% per year after the age of 40 years.

 

Pharmacodynamic Problems

• Altered sensitivity (mostly increased) to most drugs resulting in:
  • adverse drug reactions (ADRs), e.g. CNS medicines
  • Impaired ability to compensate for increased effects, e.g. antihypertensives
  • Increased susceptibility to toxicities, e.g. NSAID nephrotoxicity