Optimizing Drug Therapy is an Essential Part of Elderly Care

The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient’s physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation.

Many medications need to be used with special caution because of age-related changes in pharmacokinetics (i.e., absorption, distribution, metabolism, and excretion) and pharmacodynamics (the physiologic effects of the drug). Particular care must be taken in determining drug doses when prescribing for older adults.

Nearly three-quarters of community-dwelling older adults with dementia fill prescriptions for psychotropic drugs, similar to the prescription rate in eldercare facilities, a new study has found.

Investigators analyzed Medicare records from more than 730,000 people with dementia who lived in the community as opposed to a care facility. In a one-year period, 74% of study participants filled at least one prescription for an antidepressant, opioid painkiller, epilepsy drug, anxiety medication or antipsychotic drug, reported lead author Donovan Maust, M.D., M.S.

There are reasons behind the prescriptions, but none of the drug classes studied have received Food and Drug Administration approval for use in dementia. The study is the first large-scale look into prescription-filling patterns for psychoactive medications outside of long-term care facilities, the researchers said.


Takeaway: Psychotropic and opioid prescriptions most commonly prescribed for community-living elderly patients