About a fifth of the population in the United Kingdom is 60 years or older,1 yet people in this age group receive 59% of dispensed prescriptions and account for more than half of NHS drug costs.2 Older people often have several coexisting medical problems and take multiple drugs. Increasing age is associated with changes in pharmacokinetics and pharmacodynamics, so prescribing in this age group can be problematic.3

Many randomised controlled trials involving older patients focus on managing a single disease state, such as hypertension or osteoporosis, but people in this age group often have many interacting conditions and are taking many drugs, so guidance on their treatment often has to be based on consensus and involves extrapolating data derived from healthier patients. This review highlights some of the difficulties in prescribing in older patients and offers guidance for appropriate prescribing.