The challenges of prescribing drug therapy to older people

Older people often have multiple health conditions that require drug therapy. In Ontario in 1998, drug expenditure by people aged >65 years of age was estimated at 1.03 billion dollars, accounting for 74% of total drug costs to the Ontario Drug Benefit (ODB) Program. Prescribing drug therapy for older people presents a challenge to many physicians. Inappropriate prescribing such as the excessive and unnecessary use of drug therapy or the under prescribing of proven beneficial therapy, appears to be a common problem. Several factors place older people at risk for serious drug complications including advanced age, frailty, and increased drug use. Long-term care residents are a particularly vulnerable population, as they are primarily, older, frail women, who take an average of eight medications. Drug-related problems, including reaction to medication, are estimated to account for as many as 28% of hospital admissions.1 With an increase in the aged population, and the associated increasing drug costs, it is imperative that older people receive optimal pharmacotherapy. Reducing drug related morbidity and mortality is, therefore, important both to improve the quality of life of older people, and to reduce healthcare costs.