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In older people, medicines are considered appropriate when they have a clear evidence-based indication, are well tolerated in the majority and are cost-effective.
Appropriate prescribing in older people also entails an individual patient's life expectancy, avoiding preventive therapies in those with a poor survival prognosis and promoting drugs with favourable risk:benefit ratios.
Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs.
IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET).
“There are a lot of drug-drug interactions, but we’ve narrowed this list down to clinically meaningful and impactful information,” incoming ASCP president Nicole Brandt, Pharm D, MBA, CGP, BCPP, FASCP, told session attendees.
AGS Beers Criteria panel co-chair Todd Sempla, MS, Pharm D, BCPS, FCCP, AGSF, exclusively told that pharmacists “will have to explain [the changes] to the prescribers and the teams that they work with.” He also noted that pharmacists may have a “steeper learning curve” if they haven’t previously adopted the Beers Criteria into their practices.
Medicines that are potentially inappropriate in older people, by contrast, either have no clear evidence-based indication, carry a substantially higher risk of adverse side-effects compared to younger people or are not cost-effective.
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In these patients, the risk of ADRs increases in proportion to the number of simultaneous prescription drugs [ 5 ].
Avoiding the use of high-risk drugs is an important, simple and effective strategy in reducing medication-related problems and adverse drug events in older adults.
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