Appropriate prescribing in the elderly: Current perspectives

Table 7 Key considerations when prescribing for older patients

Use non-pharmacological treatment whenever possible

Include the patient (and carer where appropriate) in prescribing decisions

Ensure each medication has an appropriate indication and a clear therapeutic goal (this involves careful clinical assessment and appreciation of time to obtain treatment effect and life expectancy)

Start at the smallest dose and titrate slowly according to response and efficacy

Use the simplest dosing regimen (e.g., once a day preferable to three times per day) and most appropriate formulation

Provide verbal and written instructions on indication, time and route of administration and potential adverse effects of each medication

Regularly review prescriptions in the context of co-exiting disease states, concurrent medications, functional and cognitive status and therapeutic expectation

Be aware that new presenting symptoms may be due to an existing medication, drug-drug interaction or drug-disease interaction (avoid prescribing cascade)

When stopping a medication check that it can be stopped abruptly or whether it needs to be tapered, e.g., long-term steroids, benzodiazepines