BMJ  2008;336:606-609 (15 March), doi:10.1136/bmj.39503.424653.80

Clinical Review

Prescribing for older people

¹ Clinical Age Research Unit, Department of Clinical Gerontology, King’s College Hospital Foundation Trust, London SE5 9PJ, ² Stopsley Group Practice, Churchfield Medical Centre, Luton LU2 9SB

The first 150 words of the full text of this article appear below.

Summary points Prescribing for older people is problematic Older people are often prescribed unnecessary drugs, drugs that are contraindicated in their age group, or the wrong dose for their age Misconceptions about age may prevent them being given drugs with a specific indication and evidence base Inappropriate prescribing may be reduced by reviewing drugs regularly, electronic prescribing, regular auditing, and limiting the number of prescribers

About a fifth of the population in the United Kingdom is 60 years or older,¹ yet people in this age group receive 59% of dispensed prescriptions and account for more than half of NHS drug costs.² Older people often have several coexisting medical problems and take multiple drugs. Increasing age is associated with changes in pharmacokinetics and pharmacodynamics, so prescribing in this age group can be problematic.³

Many randomised controlled trials involving older patients focus on managing a single disease state, such as hypertension or osteoporosis, but . . . [Full text of this article]

Sources and selection criteria

What physiological changes occur with ageing?

Pharmacokinetic and pharmacodynamic changes
Multiple pathology and polypharmacy

What is inappropriate prescribing?

Which drugs should we avoid in older patients?

What drugs should we routinely consider in older patients?

How can inappropriate prescribing in older people be reduced?

Good prescribing practice
Box 1 Guidelines for good prescribing in elderly patients
Medication review
Using as few prescribers as possible
Education
Electronic prescribing
Audit
Box 2 Types of prescribing quality indicators³⁵
Quantitative indicators
Qualitative indicators
Evidence based indicators

What improvements can we expect in future?

Conclusions

Tips for non-specialists
Additional educational resources
Information for patients
Information for health professionals

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