- Section 1 Ageing population and policy
- Section 2 Key concepts in care of older adults
- Chapter 14 A life course approach for understanding later life sustainability
- Chapter 15 Ageing, multimorbidity, and daily functioning
- Chapter 16 Comprehensive geriatric assessment: evidence
- Chapter 17 Comprehensive geriatric assessment
- Chapter 18 Engaging older patients in their treatment and care
- Chapter 19 Models of healthcare for older people
- Chapter 20 History taking and physical examination
- Chapter 21 Communication
- Chapter 22 Interprofessional team building and case management
- Chapter 23 Age-friendly environments and their role in supporting Healthy Ageing
- Chapter 24 Principles of medication management
- Chapter 25 Optimizing pharmacotherapy for older patients
- Chapter 26 Limitations in the evidence for safe and effective medications for older people
- Chapter 27 General principles of recovery and rehabilitation
- Chapter 28 The approach of dying and death, and the mourning process of the survivors
- Chapter 29 Legal and ethical issues in care of older adults
- Section 3 Principles and organization of care
- Section 4 Age-related biological changes, altered physiology, and vulnerability to diseases and chronic conditions
- Section 5 Geriatric syndromes in clinical practice
- Section 6 Nutrition and metabolism
- Section 7 Mobility disorders: prevention, impact, and compensation
- Section 8 Infections in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 9 Cancer: epidemiology, pathophysiology, diagnosis, and management
- Section 10 Vascular diseases: epidemiology, pathophysiology, diagnosis, and management
- Section 11 Neurological disorders: epidemiology, pathophysiology, diagnosis, and management
- Section 12 Cognitive decline and dementia in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 13 Mental health of older adults
- Section 14 Management of common medical conditions: epidemiology, pathophysiology, diagnosis, and management
- Section 15 Palliative medicine and end-of-life care
- Section 16 Healthy ageing
(p. 183) Optimizing pharmacotherapy for older patients
- Chapter:
- (p. 183) Optimizing pharmacotherapy for older patients
- Author(s):
Denis O’Mahony
- DOI:
- 10.1093/med/9780198701590.003.0025
The prevalence of complex multimorbidity is increasing steadily in tandem with global population ageing. Complex multimorbidity is in turn intimately associated with polypharmacy, the relationship being one of cause-and-effect. Polypharmacy commonly leads to prescription of inappropriate drugs, resulting in a substantially higher risk of drug-related problems, principally adverse drug–drug and drug–disease interactions. These problems become manifest in the form of common geriatric symptoms such as falls, acute confusion, and incontinence and commonly result in increased healthcare utilization, including hospitalization, with obvious economic consequences. In addition, adverse drug reactions and adverse drug events lead to death in older people.
The challenge of optimization of pharmacotherapy in older people with complex multimorbidity is a major one. There is increasing evidence that avoidance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using validated PIM and PPO criteria lists leads to better and safer pharmacotherapy in this high-risk population.
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- Section 1 Ageing population and policy
- Section 2 Key concepts in care of older adults
- Chapter 14 A life course approach for understanding later life sustainability
- Chapter 15 Ageing, multimorbidity, and daily functioning
- Chapter 16 Comprehensive geriatric assessment: evidence
- Chapter 17 Comprehensive geriatric assessment
- Chapter 18 Engaging older patients in their treatment and care
- Chapter 19 Models of healthcare for older people
- Chapter 20 History taking and physical examination
- Chapter 21 Communication
- Chapter 22 Interprofessional team building and case management
- Chapter 23 Age-friendly environments and their role in supporting Healthy Ageing
- Chapter 24 Principles of medication management
- Chapter 25 Optimizing pharmacotherapy for older patients
- Chapter 26 Limitations in the evidence for safe and effective medications for older people
- Chapter 27 General principles of recovery and rehabilitation
- Chapter 28 The approach of dying and death, and the mourning process of the survivors
- Chapter 29 Legal and ethical issues in care of older adults
- Section 3 Principles and organization of care
- Section 4 Age-related biological changes, altered physiology, and vulnerability to diseases and chronic conditions
- Section 5 Geriatric syndromes in clinical practice
- Section 6 Nutrition and metabolism
- Section 7 Mobility disorders: prevention, impact, and compensation
- Section 8 Infections in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 9 Cancer: epidemiology, pathophysiology, diagnosis, and management
- Section 10 Vascular diseases: epidemiology, pathophysiology, diagnosis, and management
- Section 11 Neurological disorders: epidemiology, pathophysiology, diagnosis, and management
- Section 12 Cognitive decline and dementia in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 13 Mental health of older adults
- Section 14 Management of common medical conditions: epidemiology, pathophysiology, diagnosis, and management
- Section 15 Palliative medicine and end-of-life care
- Section 16 Healthy ageing