In Canada, seniors account for approximately 14% of the population yet receive 40% of prescriptions. This is undoubtedly related to the multiple co-morbidities of the elderly. With evidence-based guidelines for the management of conditions such as diabetes mellitus, hypertension, IHD, etc., an increasing number of medications are being prescribed for our seniors.

Reassessment involves reviewing these drugs for potential adverse effects/interactions and also considerations of compliance. Many seniors realistically can only take their meds if dosed once, twice or maybe three times per day (even if compliance aides such as dosette boxes and blister packs are used). The Beers criteria is the most widely cited reference to assess inappropriate drug prescribing in the elderly. Specific drugs to be avoided include long acting benzodiazepines, e.g. flurazepam, strong anticholinergics, e.g. amitriptyline and doxepin, barbiturates, and fluoxetine (with its very long half life). We also need to avoid prescribing cascades, that is one drug causing adverse effects requiring the introduction of a second drug.

Medication reassessment also involves treating the whole patient and ensuring that quality of life is improved (not adversely affected) by the multiple meds. I always ask my patients to bring all their meds (both prescribed and OTC) with them for every geriatric clinic appointment. I’d suggest that drug reassessment take place at least once per year by family doctors.

Reference

Arch Inter Med 2003;163:2716-24 Updating the Beers Criteria.

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