MEDICATION USE IN SENIORS - CHALLENGES AND SOLUTIONS

Use of prescribed and over-the-counter medication increases with age. Although drug therapy often results in beneficial effects and improve functional status, drug related illness is a significant health proble m, accounting for 5 to 23 per cent of hospitalization, 1.75 per cent o f ambulatory Visits and one in 1000 deaths. In most studies, drug-rela ted illness is more common in the elderly. Four factors influence the likelihood that a patient will experience adverse effects from a drug: the type of drug prescribed, the characteristics of patients receivin g the drug, the characteristics of physicians who are prescribing the medication, and health care system policy and practice. Cardiovascular drugs, psychotropic drugs and NSAIDs are the three groups of drugs th at are most commonly implicated in drug related illness, probably beca use they are the three groups of drugs that are most commonly prescrib ed in the elderly. The risk of an adverse effect with drug increases w ith the number of drugs prescribed. Several mechanisms may account for this phenomenon including (1) increased sensitivity of diseased tissu e to drug toxicity (2) potential drug interactions, and (3) difficulti es in patient compliance with an increasing number of drugs. Physician prescribing habits can increase the risk of adverse drug effects thro ugh two mechanisms: (1) the prescription of drugs that are unnecessary for the treatment of ailments that might be better managed through no n-pharmacologic management and (2) the inappropriate prescription of d rugs that are either contraindicated or prescribed in combination with other drugs that produce potential drug interaction. Errors in prescr ibing accounting for 19 to 36 per cent of hospital admissions due to d rug-related events and up to 72 per cent of drug related events occurr ing in the hospital setting. Health care system policies influence the list of drugs that are included in the formulary, the conditions unde r which they are accessible and payment policy, all of which strongly influence the likelihood that a drug will be utilized. Physician payme nt policy may also influence drug prescribing and the success of initi atives to discontinue drugs. Interventions to improve the optimal use of medication will need to target policy, patients and physicians. Bet ter information needs to be provided to physicians and patients about the risks and benefits of drug therapy, and the problems of patient co mpliance and inappropriate and unnecessary prescribing need to be addr essed.