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Principles of medication management 

Principles of medication management
Principles of medication management
Oxford Textbook of Geriatric Medicine (3 edn)

David G. Le Couteur

, Andrew J. McLachlan

, and Sarah N. Hilmer


Older people use numerous medications, yet the evidence for effectiveness in old age is often limited while the evidence for medication-related harm is substantial. Issues common in older people such as multimorbidity, polypharmacy, frailty, dementia, and terminal illnesses influence the decision to prescribe or deprescribe. Age-related changes in drug disposition, coupled with concerns about adverse drug reactions often necessitate lower maintenance doses. Medical ethics and the principles of pharmacokinetics and pharmacodynamics provide overarching frameworks to tailor evidence-based medicine and single disease guidelines to the individual needs and goals of older and frail people. Close monitoring combined with the assumption that any symptom can be medication-related are key clinical skills required for the ongoing optimization of medication use in older people.

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