#TBT: 10 Prescribing Principles for Older Patients & #WHCOA


As part of our “Throwback Thursday” blog series, we’re taking a look at a topic that’s currently in the news and tagging it with previous research, videos or commentaries in a relevant way. As the saying goes, “what’s old is new again” – and we hope you enjoy our wonky twist on #TBT.

Earlier this week, the 2015 White House Conference on Aging addressed issues that are shaping the landscape for older Americans, including healthy aging. During his remarks, President Obama expressed a desire to ensure that every older adult has what he or she needs to age with dignity.

Pharmaceuticals have changed the way people age by permitting individuals to not only live longer, but also by increasing their quality of life in managing health conditions that manifest as people age. The Centers for Medicare and Medicaid report that more than two-thirds of Medicare-aged beneficiaries have two or more chronic conditions, and 15 percent have six or more. Additionally, 81 percent of older persons use at least one medication, with 29 percent using five or more medications.

The complexity of caring for older patients who are facing more health challenges, and therefore are taking more prescriptions requires individualized drug therapy. Researchers have studied techniques that prescribers can utilize to reduce the risk of adverse drug events, and personalize patients’ medication regimens.  

In September 2001, a supplement to the peer-reviewed magazine Pharmacy & Therapeutics, “Individualized Prescribing for the Elderly,” (and our #TBT pick of the week) explained that the selection of pharmaceutical therapy for older patients is determined by three primary factors unique to this group: comorbidities, the physiological effects of aging and drug side effects.

The study authors provided 10 prescribing principles for older patients:

  1. Determine whether drug therapy is truly necessary or if there’s a better, non-drug alternative.
  2. Assess the patient’s current drug regimen (including prescription, over-the-counter and complementary medicines) before prescribing a new drug.
  3. Choose a drug that considers individual patient characteristics and encourages compliance.
  4. Begin with a low dose and increase as necessary until the desired therapeutic effect is achieved.
  5. Prescribe the fewest numbers of drugs possible, and eliminate any that are not useful.
  6. When prescribing a new drug, tell the patient what kinds of side effects to expect and to report serious problems immediately.
  7. Consider the possibility that any new symptom could represent drug side effects or drug withdrawal symptoms.
  8. Encourage frailer patients to have a close friend, relative or caregiver accompany them to appointments, and apprise this person of change in drug-therapy regimens.
  9. Provide a portable prescription record that can be taken to other physicians and pharmacists.
  10. Stay informed about pharmaceutical innovations (novel drugs, new diagnostics for predicting drug response, etc.) relevant to diseases of older patients.

Check out highlights from the 2015 White House Conference on Aging on Twitter, and learn about other topics that were addressed during the event in this factsheet. Additional online resources about aging can be found at the Alliance for Aging Research, the Gerontological Society of America and the Altarum Institute’s Center for Elder Care and Advanced Illness.