MEDICATION USE BY THE ELDERLY

Medication use is correlated with the age-associated onset of chronic diseases for which drug therapy offers symptomatic relief, and assists in preventing the onset of disabling and life-threatening complicatio ns. However, high rates of medication use by older people raise a numb er of issues, ranging from concerns with rising expenditures for indiv iduals and third-party insurers; increased risk of adverse drug reacti ons; toxic or interaction effects from concomitant use of multiple pha rmaceutical agents, both physician and self-prescribed; and poor compl iance with complex medication regimens by the more physically and ment ally impaired. Although existing data do not support the theory of age as an independent predictor of drug-specific adverse reactions, older people have typically been excluded from clinical trials in the dynam ic and changing field of pharmacotherapy. Furthermore, ingestion of a greater number of different agents clearly exposes individuals to high er risk of adverse reactions and interactions. Recent advances in info rmation technology have facilitated multicenter clinical trials and po st-marketing epidemiological surveillance studies of specific and conc omitant medication use by individuals of all ages. The employment of s uch technology by insurers to determine appropriate prescribing or to control costs in the present limited state of knowledge is, however, p remature. Furthermore, such techniques will not replace the need for c areful clinical review of symptoms and total drug therapy by prescribi ng physicians, with modification of regimens and provision of appropri ate information and instructions to older individuals and their caregi vers.