The key to preventing older adults from adverse effects of medicines lies in certain precautions that doctors may exercise prescribing drugs, say clinicians at Tufts University School of Medicine.
In an article, published in American Family Physician, they have written that physicians and other healthcare providers should avoid overuse, misuse, and underuse of medication in order to prevent older adults from adverse events.
"About one in three older persons taking at least five medications will experience an adverse drug event each year, and about two-thirds of these patients will require medical attention. Approximately 95 percent of these reactions are predictable, and about 28 percent are preventable," write the authors.
They suggest that doctors avoid drugs listed on the Beers Criteria, a widely-adopted list of drugs that labels medications as "potentially inappropriate" for older persons or for older persons with specific medical conditions.
Just in case a doctor does not have any alternative to choose, the best choice for a necessary drug is to start at the lowest effective dose, and discontinue its use when possible, they add.
The authors have also warned against increasing the number of medications and overdosing.
They recommend taking to exercise or cognitive therapy, as they may help reduce inappropriate prescriptions in certain cases.
Avoiding underuse of medication—underprescribing and non-adherence—is their next recommendation.
"Despite concerns about overprescribing, many conditions remain underdiagnosed or undertreated," write the authors.
They add, "Ascribing all symptoms to degenerative disease or old age will potentially miss treatable conditions," including heart disease, depression, osteoporosis and pain.
The authors described non-adherence as a complex phenomenon determined by a variety of issues, including physician-patient communication, cognitive decline, and the cost of medication.
According to them, though most interventions focus on education or on cognitive aids, the combination is more promising.
In certain cases, cost is a factor that will not be mentioned unless the physician inquires.
"Simply asking whether a patient plans to use his or her prescription may open a dialogue about the costs of a patient's prescriptions. Sometimes there are alternatives, including prescriptions for generic substitutes or identifying a combination drug that may be less expensive than two individual drugs," says Dr. Robert Dickman, one of the authors.