Skip to main content
SpringerLink
Log in
Book cover

Medication Management in Older Adults pp 29–42Cite as

The Ethics of Prescribing Medications to Older People

  • Chapter
  • First Online:

  • 1280 Accesses

Abstract

The four principles of medical ethics – beneficence, nonmaleficence, autonomy, and justice – provide a pragmatic foundation and steadying influence to guide prescribing in older people where the evidence base for efficacy is uncertain and concerns regarding adverse drug reactions are protean. In most cases, the ethical principles are undermined not by intent, but more likely by lack of knowledge, not only in terms of the knowledge of the individual prescriber, but also the broader evidence and scientific knowledge that underlie geriatric pharmacology. Application of these ethical principles is paramount for those clinicians who publish and promote guidelines and recommendations about prescribing in older people because their capacity to do both good and harm influences the lives and health of many older people.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Anderson G, Kerluke K (1996) Distribution of prescription drug exposures in the elderly: description and implications. J Clin Epidemiol 49:929–935

    Article  PubMed  CAS  Google Scholar 

  2. Jorgensen T, Johansson S, Kennerfalk A, Wallander MA, Svardsudd K (2001) Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother 35:1004–1009

    Article  PubMed  CAS  Google Scholar 

  3. Kennerfalk A, Ruigomez A, Wallander MA, Wilhelmsen L, Johansson S (2002) Geriatric drug therapy and healthcare utilization in the United Kingdom. Ann Pharmacother 36:797–803

    Article  PubMed  Google Scholar 

  4. Shi S, Morike K, Klotz U (2008) The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol 64:183–199

    Article  PubMed  Google Scholar 

  5. Ebrahim S (2002) The medicalisation of old age. Br Med J 324:861–863

    Article  Google Scholar 

  6. Abernethy DR (1999) Aging effects on drug disposition and effect. Geriatr Nephrol Urol 9:15–19

    Article  PubMed  CAS  Google Scholar 

  7. Le Couteur DG, Naganathan V, Cogger VC, Cumming RG, McLean AJ (2006) Pharmacotherapy in the elderly: clinical issues and perspectives. In: Kohli K, Gupta M, Tejwani S (eds) Contemporary perspectives on clinical pharmacotherapeutics. Elsevier, New Delhi, pp 709–722

    Google Scholar 

  8. Hilmer SN, McLachlan A, Le Couteur DG (2007) Clinical pharmacology in geriatric patients. Fundam Clin Pharmacol 21:217–230

    Article  PubMed  CAS  Google Scholar 

  9. Cumming RG (1998) Epidemiology of medication-related falls and fractures in the elderly. Drugs Aging 12:43–53

    Article  PubMed  CAS  Google Scholar 

  10. Walker J, Wynne H (1994) The frequency and severity of adverse drug reactions in elderly people. Age Ageing 23:255–259

    Article  PubMed  CAS  Google Scholar 

  11. Denham MJ (1990) Adverse drug reactions. Br Med Bull 46:53–62

    PubMed  CAS  Google Scholar 

  12. Mannesse CK, Derkx FH, de Rigger MA, Man in’t Veld AJ, van der Cammen TJ (1997) Adverse drug reactions in elderly patients as contributing factor for hospital admissions: cross sectional study. Br Med J 315:1057–1058

    Article  CAS  Google Scholar 

  13. McLean AJ, Le Couteur DG (2004) Aging biology and geriatric clinical pharmacology. Pharmacol Rev 56:163–184

    Article  PubMed  CAS  Google Scholar 

  14. Spinewine A, Schmader KE, Barber N et al (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370:173–184

    Article  PubMed  Google Scholar 

  15. Routledge PA, O’Mahony MS, Woodhouse KW (2004) Adverse drug reactions in elderly patients. Br J Clin Pharmacol 57:121–126

    Article  PubMed  CAS  Google Scholar 

  16. Bordet R, Gautier S, Le Louet H, Dupuis B, Caron J (2001) Analysis of the direct cost of adverse drug reactions in hospitalised patients. Eur J Clin Pharmacol 56:935–941

    Article  PubMed  CAS  Google Scholar 

  17. Carbonin P, Pahor M, Bernabei R, Sgadari A (1991) Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? J Am Geriatr Soc 39:1093–1099

    PubMed  CAS  Google Scholar 

  18. Hurwitz N (1969) Predisposing factors in adverse reactions to drugs. Br Med J 1:536–539

    Article  PubMed  CAS  Google Scholar 

  19. Kellaway GS, McCrae E (1973) Intensive monitoring for adverse drug effects in patients discharged from acute medical wards. N Z Med J 78:525–528

    PubMed  CAS  Google Scholar 

  20. Pouyanne P, Haramburu F, Imbs JL, Begaud B (2000) Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. French Pharmacovigilance Centres. Br Med J 320:1036

    Article  CAS  Google Scholar 

  21. Roughead EE, Gilbert AL, Primrose JG, Sansom LN (1997) Drug-related hospital admissions: a review of Australian studies published 1988-1996. Med J Aust 168:405–408

    Google Scholar 

  22. Ebbesen J, Buajordet I, Erikssen J et al (2001) Drug-related deaths in a department of internal medicine. Arch Intern Med 161:2317–2323

    Article  PubMed  CAS  Google Scholar 

  23. Hilmer SN, Mager DE, Simonsick EM et al (2007) A drug burden index to define the functional burden of medications in older people. Arch Intern Med 167:781–787

    Article  PubMed  Google Scholar 

  24. Cao YJ, Mager DE, Simonsick EM et al (2008) Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther 83:422–429

    Article  PubMed  CAS  Google Scholar 

  25. Bugeja G, Kumar A, Banerjee AK (1997) Exclusion of elderly people from clinical research: a descriptive study of published reports. Br Med J 315:1059

    Article  CAS  Google Scholar 

  26. (1993) Do doctors short-change people. Lancet 342:1–2

    Google Scholar 

    Google Scholar 

  27. Mueller PS, Hook CC, Fleming KC (2004) Ethical issues in geriatrics: a guide for clinicians. Mayo Clin Proc 79:554–562

    Article  PubMed  Google Scholar 

  28. World Medical Association (2005) WMA medical ethics manual. WMA, Ferney-Voltaire

    Google Scholar 

  29. Kluge EW (2002) Ethical issues in geriatric medicine: a unique problematic. Health Care Anal 10:379–390

    Article  PubMed  Google Scholar 

  30. Fenech FF (2003) Ethical issues in ageing. Clin Med 3:232–234

    PubMed  Google Scholar 

  31. Kaufman SR, Shim JK, Russ AJ (2004) Revisiting the biomedicalization of aging: clinical trends and ethical challenge. Gerontologist 44:731–738

    Article  PubMed  Google Scholar 

  32. Gillon R (2003) Ethics needs principles – four can encompass the rest – and respect for autonomy should be first among equals. J Med Ethics 29:307–312

    Article  PubMed  CAS  Google Scholar 

  33. Beauchamp TL, Childress J (1979) Principles of biomedical ethics, 1st edn. Oxford University Press, New York

    Google Scholar 

  34. Gillon R (1994) Medical ethics: four principles plus attention to scope. Br Med J 309:184–187

    Article  CAS  Google Scholar 

  35. Harris J (2003) In praise of unprincipled ethics. J Med Ethics 23:303–306

    Article  Google Scholar 

  36. Campbell AV (2003) The virtues (and vices) of the four principles. J Med Ethics 29:292–296

    Article  PubMed  CAS  Google Scholar 

  37. Le Couteur DG, Hilmer SN, Glasgow N, Naganathan V, Cumming RG (2004) Prescribing in older people. Aust Fam Physician 33:777–781

    PubMed  Google Scholar 

  38. Martin FC, O’Mahony MS, Schiff R (2007) Complexity of treatment decisions with older patients: who, when and what to treat? Clin Med 7:505–508

    PubMed  Google Scholar 

  39. Gurnee MC, Hansen JM, Sylvestri MF (1992) Portrayal of the elderly in drug product advertisements: relationship to dosing recommendations and pharmacokinetic data in the geriatric population. J Pharm Mark Manage 7:17–31

    Google Scholar 

  40. Adhiyaman V, Kamalakannan D, Oke A, Shah IU, White AD (2000) Underutilization of antithrombotic therapy in atrial fibrillation. J R Soc Med 93:138–140

    PubMed  CAS  Google Scholar 

  41. Mangoni AA, Jackson SH (2006) The implications of a growing evidence base for drug use in elderly patients Part 2. ACE inhibitors and angiotensin receptor blockers in heart failure and high cardiovascular risk patients. Br J Clin Pharmacol 61:502–512

    Article  PubMed  CAS  Google Scholar 

  42. Le Couteur DG, Kendig H (2008) Pharmaco-epistemology for the prescribing geriatrician. Aust J Ageing 27:3–7

    Article  Google Scholar 

  43. Le Couteur DG, Bailey L, Naganathan V (2006) Beta-blockers and heart failure in older people. Eur Heart J 27:887–888

    Article  PubMed  Google Scholar 

  44. Fonarow GC, Abraham WT, Albert NM et al (2007) Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: an analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J 153:82.e1–82.e11

    Article  Google Scholar 

  45. Mangin D, Sweeney K, Heath I (2007) Preventive health care in elderly people needs rethinking. BMJ 335:285–287

    Article  PubMed  Google Scholar 

  46. Welch HG, Albertsen PC, Nease RF, Bubolz TA, Wasson JH (1996) Estimating treatment benefits for the elderly: the effect of competing risks. Ann Intern Med 124:577–584

    PubMed  CAS  Google Scholar 

  47. Leipzig RM, Cumming RG, Tinetti ME (1999) Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 47:40–50

    PubMed  CAS  Google Scholar 

  48. Leipzig RM, Cumming RG, Tinetti ME (1999) Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 47:30–39

    PubMed  CAS  Google Scholar 

  49. Green JL, Hawley JN, Rask KJ (2007) Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am J Geriatr Pharmacother 5:31–39

    Article  PubMed  Google Scholar 

  50. Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279:1200–1205

    Article  PubMed  CAS  Google Scholar 

  51. Juurlink DN, Mamdani MM, Lee DS et al (2004) Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 351:543–551

    Article  PubMed  CAS  Google Scholar 

  52. Mamdani M, Juurlink DN, Kopp A, Naglie G, Austin PC, Laupacis A (2004) Gastrointestinal bleeding after the introduction of COX 2 inhibitors: ecological study. BMJ 328:1415–1416

    Article  PubMed  Google Scholar 

  53. Aguilar MI, Hart R (2005) Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev CD001927

    Google Scholar 

  54. Buckingham TA, Hatala R (2002) Anticoagulants for atrial fibrillation: why is the treatment rate so low? Clin Cardiol 25:447–454

    Article  PubMed  Google Scholar 

  55. Gurwitz JH, Field TS, Radford MJ et al (2007) The safety of warfarin therapy in the nursing home setting. Am J Med 120:539–544

    Article  PubMed  CAS  Google Scholar 

  56. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115:2689–2696

    Article  PubMed  CAS  Google Scholar 

  57. Mant J, Hobbs FD, Fletcher K et al (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 370:493–503

    Article  PubMed  CAS  Google Scholar 

  58. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724

    Article  PubMed  Google Scholar 

  59. Gurwitz JH, Field TS, Avorn J et al (2000) Incidence and preventability of adverse drug events in nursing homes. Am J Med 109:87–94

    Article  PubMed  CAS  Google Scholar 

  60. Gurwitz JH, Field TS, Harrold LR et al (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107–1116

    Article  PubMed  Google Scholar 

  61. Laroche ML, Charmes JP, Nouaille Y, Picard N, Merle L (2007) Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 63:177–186

    Article  PubMed  Google Scholar 

  62. Stuart B, Kamal-Bahl S, Briesacher B et al (2003) Trends in the prescription of inappropriate drugs for the elderly between 1995 and 1999. Am J Geriatr Pharmacother 1:61–74

    Article  PubMed  Google Scholar 

  63. Zuckerman IH, Langenberg P, Baumgarten M et al (2006) Inappropriate drug use and risk of transition to nursing homes among community-dwelling older adults. Med Care 44:722–730

    Article  PubMed  Google Scholar 

  64. Mallet L, Spinewine A, Huang A (2007) The challenge of managing drug interactions in elderly people. Lancet 370:185–191

    Article  PubMed  CAS  Google Scholar 

  65. Field TS, Mazor KM, Briesacher B, Debellis KR, Gurwitz JH (2007) Adverse drug events resulting from patient errors in older adults. J Am Geriatr Soc 55:271–276

    Article  PubMed  Google Scholar 

  66. Bjorkman IK, Fastbom J, Schmidt IK, Bernsten CB (2002) Drug drug interactions in the elderly. Ann Pharmacother 36:1675–1681

    Article  PubMed  CAS  Google Scholar 

  67. Zhan C, Correa-de-Araujo R, Bierman AS et al (2005) Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations. J Am Geriatr Soc 53:262–267

    Article  PubMed  Google Scholar 

  68. Simons LA, Tett S, Simons J et al (1992) Multiple medication use in the elderly. Use of prescription and non-prescription drugs in an Australian community setting. Med J Aust 157:242–246

    PubMed  CAS  Google Scholar 

  69. Bjerrum L, Sogaard J, Hallas J, Kragstrup J (1999) Polypharmacy in general practice: differences between practitioners. Br J Gen Pract 49:195–198

    PubMed  CAS  Google Scholar 

  70. Rochon PA, Gurwitz JH (1997) Optimising drug treatment for elderly people: the prescribing cascade. Br Med J 315:1096–1099

    Article  CAS  Google Scholar 

  71. Gill SS, Mamdani M, Naglie G et al (2005) A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 165:808–813

    Article  PubMed  Google Scholar 

  72. Treloar A, Beats B, Philpot M (2000) A pill in the sandwich: covert medication in food and drink. J R Soc Med 93:408–411

    PubMed  CAS  Google Scholar 

  73. Treloar A, Philpot M, Beats B (2001) Concealing medication in patients’ food. Lancet 357:62–64

    Article  PubMed  CAS  Google Scholar 

  74. MacDonald AJ, Roberts A, Carpenter L (2004) De facto imprisonment and covert medication use in general nursing homes for older people in South East England. Aging Clin Exp Res 16:326–330

    PubMed  Google Scholar 

  75. Bullock R (2005) Treatment of behavioural and psychiatric symptoms in dementia: implications of recent safety warnings. Curr Med Res Opin 21:1–10

    Article  PubMed  CAS  Google Scholar 

  76. Ballard C, Waite J (2006) The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev CD003476

    Google Scholar 

  77. Secker B (1999) Labeling patient (in)competence: a feminist analysis of medico-legal discourse. J Soc Philos 30:295–314

    Article  PubMed  CAS  Google Scholar 

  78. Schneidermann LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD (1992) Effects of offering advance directives on medical treatments and costs. Ann Intern Med 117:599–606

    Google Scholar 

  79. Davis MW, Le Couteur DG, Trim G, Buchanan J, Rubenach S, McLean AJ (1999) Older people in hospital. Aust J Ageing 18(Suppl):26–31

    Article  Google Scholar 

  80. Clegg A, Bryant J, Nicholson T et al (2001) Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer’s disease: a rapid and systematic review. Health Technol Assess 5:1–137

    Google Scholar 

  81. Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP, van den Bussche H (2005) Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomised clinical trials. BMJ 331:321–327

    Article  PubMed  CAS  Google Scholar 

  82. Giordano S (2005) Respects for the equality and treatment of the elderly: declarations of human rights and age-based rationing. Camb Q Healthc Ethics 14:83–92

    Article  PubMed  Google Scholar 

  83. Howe EG, Lettieri CJ (1999) Health care rationing in the aged: ethical and clinical perspectives. Drugs Aging 15:37–47

    Article  PubMed  CAS  Google Scholar 

  84. Harris J (2005) The age-indifference principle and equality. Camb Q Healthc Ethics 14:93–99

    Article  PubMed  Google Scholar 

  85. Angell M (2005) The truth about drug companies. Scribe, Melbourne

    Google Scholar 

  86. Mulrow C, Lau J, Cornell J, Brand M (2000) Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev CD000028

    Google Scholar 

  87. Dhesi JK, Allain TJ, Mangoni AA, Jackson SH (2006) The implications of a growing evidence base for drug use in elderly patients. Part 4. Vitamin D and bisphosphonates for fractures and osteoporosis. Br J Clin Pharmacol 61:521–528

    Article  PubMed  CAS  Google Scholar 

  88. Nguyen ND, Eisman JA, Nguyen TV (2006) Anti-hip fracture efficacy of biophosphonates: a Bayesian analysis of clinical trials. J Bone Miner Res 21:340–349

    Article  PubMed  CAS  Google Scholar 

  89. Flather MD, Yusuf S, Kober L et al (2000) Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 355:1575–1581

    Article  PubMed  CAS  Google Scholar 

  90. Costa J, Borges M, David C, Vaz Carneiro A (2006) Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials. BMJ 332:1115–1124

    Article  PubMed  CAS  Google Scholar 

  91. Antithrombotic Triallists Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71–86

    Article  Google Scholar 

  92. Deedwania PC, Gottlieb S, Ghali JK, Waagstein F, Wikstrand JC (2004) Efficacy, safety and tolerability of beta-adrenergic blockade with metoprolol CR/XL in elderly patients with heart failure. Eur Heart J 25:1300–1309

    Article  PubMed  CAS  Google Scholar 

  93. Flather MD, Shibata MC, Coats AJ et al (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225

    Article  PubMed  CAS  Google Scholar 

  94. Dobre D, DeJongste MJ, Lucas C et al (2007) Effectiveness of beta-blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect-modification by age? Br J Clin Pharmacol 63:356–364

    Article  PubMed  CAS  Google Scholar 

  95. US product information for Inspra. Accessed at http://www.pfizer.com/files/products/uspi_inspra.pdf

Download references

Author information

Authors and Affiliations

  1. University of Sydney, Sydney, NSW, Australia

    David G. Le Couteur

  2. Centre for Education and Research on Ageing, Concord RG Hospital, Concord, NSW, Australia

    David G. Le Couteur

Authors
  1. David G. Le Couteur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hal Kendig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vasi Naganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew J. McLachlan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David G. Le Couteur .

Editor information

Editors and Affiliations

  1. , Division of Nursing and Midwifery, Latrobe University, Bundoora, 3552, Australia

    Susan Koch

  2. School of Medicine, Victory Springs Senior Health Associates, Johns Hopkins University, Business Center Drive 210, Reisterstown, 21205, USA

    F. Michael Gloth

  3. , Institute of Social Participation, Latrobe University, Bundoora, 3552, Australia

    Rhonda Nay

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Le Couteur, D.G., Kendig, H., Naganathan, V., McLachlan, A.J. (2010). The Ethics of Prescribing Medications to Older People. In: Koch, S., Gloth, F., Nay, R. (eds) Medication Management in Older Adults. Springer, New York, NY. https://doi.org/10.1007/978-1-60327-457-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-457-9_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-60327-456-2

  • Online ISBN: 978-1-60327-457-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation