Overview of Pharmacologic Therapy in Older Adults

The prevalence of prescription drug use increases substantially with age. Survey data from 2010–2011 indicated that almost 90% of ambulatory older adults regularly take at least 1 prescription medication, almost 80% regularly take at least 2 prescription medications, and 36% take at least 5 prescription medications (polypharmacy) (1). Subsequent survey data from 2020 indicated that the mean number of prescription medications taken by older adults had increased to approximately 4 prescription medications (2). Polypharmacy in older adults also increased to 43% from 2017 to 2020 and hyperpolypharmacy (taking at least 10 prescription medications) increased to 6.1%. When over-the-counter and dietary supplements are included, these prevalence rates increase substantially. Medication use is greatest among frail older adults, hospitalized patients, and nursing home residents.

Providing safe, effective pharmacologic therapy for older adults is challenging for many reasons:

• They use more medications than any other age group, increasing risk of adverse effects and drug interactions, and making adherence more difficult.

• They are more likely to have chronic disorders that may be worsened by the medication or affect drug response.

• Their physiologic reserves are generally reduced and can be further reduced by acute and chronic disorders.

• Aging can alter pharmacodynamics and pharmacokinetics of medications.

• They may be less able to obtain or afford medications.

There are 2 main approaches to optimizing pharmacologic therapy in older adults:

• Using appropriate medications as indicated and to maximize cost-effectiveness

• Avoiding adverse drug effects by ensuring medications are dosed correctly, discontinuing unnecessary medications, and avoiding drug-drug and drug-disease interactions

Because the risk of adverse drug effects is higher, overprescribing (polypharmacy) has been targeted as a major problem for older adults. However, underprescribing appropriate and therapeutically beneficial medications must also be addressed. (See also Medication-Related Problems in Older Adults and Drug Categories of Concern in Older Adults.)