Clinical Review

Prescribing for older people

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39503.424653.80 (Published 13 March 2008) Cite this as: BMJ 2008;336:606
  1. James C Milton, specialist registrar in geriatric and general medicine 1,
  2. Ian Hill-Smith, general practitioner2,
  3. Stephen H D Jackson, professor of clinical gerontology1
  1. 1Clinical Age Research Unit, Department of Clinical Gerontology, King’s College Hospital Foundation Trust, London SE5 9PJ
  2. 2Stopsley Group Practice, Churchfield Medical Centre, Luton LU2 9SB
  1. Correspondence to: J C Miltonjim_milton{at}hotmail.com

    Summary points

    • Prescribing for older people is problematic

    • Older people are often prescribed unnecessary drugs, drugs that are contraindicated in their age group, or the wrong dose for their age

    • Misconceptions about age may prevent them being given drugs with a specific indication and evidence base

    • Inappropriate prescribing may be reduced by reviewing drugs regularly, electronic prescribing, regular auditing, and limiting the number of prescribers

    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.

    Sources and selection criteria

    We searched the National Library for Health, PubMed, and Embase databases using the keywords “elderly” and “prescribing”, including synonyms by the MeSH or major descriptor headings. Our search was limited to studies undertaken in humans that were published in English during the past five years. We displayed abstracts of interest using Abstract Plus before obtaining the full text of articles of interest. In addition, we searched the Cochrane Library and our own personal archives of references

    What physiological changes occur with ageing?

    Pharmacokinetic and pharmacodynamic changes

    With age the body undergoes several changes that can affect the distribution, metabolism, and excretion of drugs. These …

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