RT Book, Section
A1 Steinman, Michael A.
A1 Holmes, Holly M.
A2 Williams, Brie A.
A2 Chang, Anna
A2 Ahalt, Cyrus
A2 Chen, Helen
A2 Conant, Rebecca
A2 Landefeld, C. Seth
A2 Ritchie, Christine
A2 Yukawa, Michi
SR Print(0)
ID 1100065537
T1 Principles of Prescribing for Older Adults
T2 Current Diagnosis & Treatment: Geriatrics, 2e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179208-0
LK accessmedicine.mhmedical.com/content.aspx?aid=1100065537
RD 2024/04/19
AB On  the  surface,  prescribing  for  older  adults  is  similar  to  prescribing  for  younger  adults,  requiring  understanding  of  drug  indications,  dosing,  potential  adverse  reactions,  and  drug–drug  interactions.  However,  prescribing  for  older  adults  is  complicated  by  a  variety  of  factors.  Physiologic  changes  as  patients  get  older  result  in  alterations  in  drug  metabolism  and  susceptibility  to  adverse  events.  The  presence  of  multiple  chronic  conditions  and  multiple  medications  leads  to  potentially  complex  drug–drug  and  drug–disease  interactions,  as  well  as  the  need  to  balance  multiple  competing  recommendations.  Changes  in  cognitive  function,  manual  dexterity,  and  social  supports  complicate  adherence  to  medications,  and  heterogeneous  goals  of  care  require  special  attention.  Because  clinical  trials  that  inform  many  practice  guidelines  are  often  conducted  in  younger  patients,  there  can  be  ambiguity  about  the  extent  to  which  these  evidence-based  recommendations  apply  to  older  adults.  Thus,  mastering  prescribing  for  older  patients  requires  expertise  not  only  in  technical  elements  of  drug  use,  but  also  in  synthesizing  evidence  and  biomedical  and  psychosocial  factors  into  a  coordinated  plan  of  care  that  meets  each  individual’s  unique  needs.  More  details  about  polypharmacy  can  be  found  in  Chapter  53,  and  more  details  about  extrapolating  the  evidence  from  clinical  research  to  older  patients  can  be  found  in  Chapter  74.