Pharmacotherapy Considerations in Elderly Adults

James M. Wooten, PharmD


South Med J. 2012;105(8):437-445. 

In This Article

Tools for Appropriate Medication Decisions

Practitioners can use a number of tools to make appropriate medication decisions for their elderly patients. The Beers criteria is a list of medications that, based on the drugs' pharmacology (eg, mechanism of action, pharmacokinetics, adverse effect profile), may cause adverse effects in older people. The list was initiated in 1991 and an update was completed by the American Geriatrics Society in 2012. The criteria are intended to provide physicians and healthcare providers who treat elderly patients with a comprehensive list of medications that may be harmful to older adult patients. The updated criteria are composed of three detailed lists. The first list is classified as drugs that have been demonstrated to be problematic in elderly adults. The second classification lists drugs that may be inappropriate for older people who have certain diseases or risk factors. The third classification lists drugs that should be used with caution in elderly patients. Most of the medications on the lists are well known, and medical evidence supports their potential to be harmful in this patient class. The Beers criteria do not ban the use of drugs on the list for all elderly patients; instead, they emphasize the drugs that may pose the most harm so that they are used judiciously and with caution.[32,33]

Similar to but much more comprehensive than the Beers criteria is the Screening Tool of Older Persons' Prescriptions. Rather than a simple checklist of medications, it attempts to assess the use of a drug with a specific patient who has specific comorbidities.[32–35]

Whichever tool is used, the primary purpose is to prescribe medications to all elderly patients with care and consideration, which ensures that each older adult patient is provided with the best care possible. Achieving this goal will result in happy and healthy patients, less polypharmacy, fewer adverse drug effects, and lower healthcare costs.