UK RCP Examines Drug Use In The Over-65s

Doctors need to be fully aware of the risk/benefit ratio whenprescribing for older people, and should do so only after the patient has been individually assessed for capacity to benefit from treatment, irrespective of age. Also, the need for medication should be reviewed at regular intervals, says the second edition of Medication for Older People, published by the UK Royal College of Physicians (Marketletter May 19).

The over-65s constitute 18% of the UK population but receive 45% of all prescription items, 78% of which are repeats, it says. They are potentially the greatest beneficiaries of appropriate, optimal drug therapy, but they also suffer much drug-related iatrogenic disease due to inappropriate treatment, eg incorrect medication, inappropriate polypharmacy and/or inadequate monitoring of therapy, particularly in continuing care. The study urges prescribers to think carefully, make every reasonable effort to establish an accurate diagnosis, consider if drug treatment is appropriate, not overprescribe, and review the need for repeat prescriptions regularly.

A thorough drug history should be taken before prescribing, including the patient's current medication, over-the-counter therapies, previous adverse drug reactions and social support to monitor compliance. If this seems incomplete, a collateral history should be taken from relatives, the general practitioner, primary care nurses etc.