Skip to main content

Special Considerations for the Elderly

  • Chapter
  • First Online:
Clinical Psychopharmacology for Neurologists
  • 1017 Accesses

Abstract

Prescribing psychotropic medication for 85-year-olds is more challenging than in younger adults. Due to age-related changes in hepatic metabolism and renal excretion, older adults may require 1/2 to 1/3 the dose of medications that younger adults may need to see therapeutic benefits. Older adults are also more likely to be on several prescriptions and over-the-counter medications – hence, the risk of drug-drug interactions is greater. Lastly, older adults are more sensitive to common side effects of medications, even at low doses. The American Society of Consultant Pharmacists has adopted the saying that “any symptom in an elderly patient should be considered a drug side-effect until proven otherwise.” They are particularly sensitive to sedating and cognitive-impairing side effects of commonly prescribed agents. It is important for clinicians to be familiar with the Beers Criteria or Beers List of so-called good drugs and bad drugs in the elderly.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover 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

Institutional subscriptions

References

  1. Desai AK. Use of psychopharmacologic agents in the elderly. Clin Geriatr Med. 2003;19:697–719.

    Article  PubMed  Google Scholar 

  2. Desai AK, Grossberg GT. Herbals and botanicals in geriatric psychiatry. Am J Geriatr Psychiatr. 2003;11:498–506.

    Article  Google Scholar 

  3. Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2005;118:251–8.

    Article  PubMed  Google Scholar 

  4. Steinman MA, Beizer JL, DuBeau CE, et al. How to use the AGS 2015 beers criteria – a guide for patients, clinicians, health systems, and payors. J Am Geriatr Soc. 2015;63(12):e1–7.

    Article  PubMed  Google Scholar 

  5. Schneider LS, Dagermen KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized, placebo-controlled trials. J Am Med Assoc. 2005;294:1934–43.

    Article  CAS  Google Scholar 

  6. Mollot, RJ Butler D. Federal requirements and regulatory provisions relevant to dementia care and the use of antipsychotic drugs. Long-Term Care Community Coalition. 2012;1–21.

    Google Scholar 

  7. Task Force on Aging Research: Medications and Errors. https://www.ascp.com/sites/default/files/file_Task_Force_2009_Final--3.pdf (2009). Accessed Jan 2017.

  8. Miller JJ. Serum levels of psychiatric drugs. Psychiatr Times. 2014;19:49.

    Google Scholar 

  9. Davis FA. DrugGuide.com. Accessed Jan 2017.

  10. Bigos KL, Pollock BG, Coley KC, et al. Sex, race, and smoking impact olanzapine exposure. J Clin Pharmacol. 2008;48:157–65.

    Article  CAS  PubMed  Google Scholar 

  11. Desai AK, Grossberg GT. Psychiatric consultation in long-term care. Baltimore: Johns Hopkins University Press; 2010. p. 302.

    Google Scholar 

  12. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17(1):37–49.

    Article  CAS  Google Scholar 

  13. Chakkamparambil B, Chibnall JT, Graypel EA, et al. Development of a brief validated geriatric depression screening tool: the SLU “AM SAD”. Am J Geriatr Psychiatr. 2015;23(8):780–3.

    Article  Google Scholar 

  14. Tariq SH, Tumosa N, Chibnall JT, et al. The St. Louis University Mental Status (SLUMS) examination for detecting mild cognitive impairment and dementia is more sensitive than the Mini-Mental Status Examination (MMSE): a pilot study. Am J Geriatr Psychiatr. 2006;14:900–10.

    Article  Google Scholar 

  15. Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.

    Article  PubMed  Google Scholar 

  16. Jennings L, Grossberg GT. Antipsychotics continue to have a place in the management of difficult behavior problems in patients with dementia. J Am Med Dir Assoc. 2013;14:447–9.

    Article  PubMed  Google Scholar 

  17. Devanand DP, Mintzer J, Schultz SK, et al. Relapse risk after discontinuation of risperidone in Alzheimer’s disease. N Engl J Med. 2012;367(16):1497–507.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Musich S, Yan C, Yeh CS. Pharmaceutical cost-saving strategies and their association with medication adherence in a medicare supplement. J Gen Intern Med. 2015;30(8):1208–14.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George T. Grossberg MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Grossberg, G.T. (2018). Special Considerations for the Elderly. In: Grossberg, G., Kinsella, L. (eds) Clinical Psychopharmacology for Neurologists. Springer, Cham. https://doi.org/10.1007/978-3-319-74604-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74604-3_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74602-9

  • Online ISBN: 978-3-319-74604-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics