Managing Drug Therapy of Older Patients in Primary and Secondary Care

Abstract

The progressive aging of the European population faces us with a new challenge for healthcare, secondary to the increasing prevalence of chronic diseases and subsequent drugs use. In Europe, population aged 65 and older consume 2–3 times more health resources than younger ones. Onder et al. described that in Italy, prescription drug costs represent approximately 17 % of total public health expenditures. In this country, in 2012, public expenditure for pharmaceuticals in primary care exceeded 11 billion Euros, and adults aged 65 or older accounted for more than 60 % of these costs [1]. Furthermore, it is well known that older people are at higher risk of adverse events than younger ones, mainly related to pharmacokinetic and pharmacodynamic changes associated with aging, high comorbidity rates, and subsequent polypharmacy . Surprisingly, there are not targeted Clinical Practice Guidelines for managing older people with multimorbidity, leading to a great amount of different prescription recommendations from several guidelines of specific diseases. Consequently, treatment of chronic conditions in older adults is frequently associated with polypharmacy, and an increased risk of interactions and adverse events. The risk–benefit ratio of each medication individually, and in association with other drugs, should be considered to optimize drug prescription in older people with multimorbidities, to achieve realistic therapeutic objectives. Limited evidence is available to perform this drug selection, but giving thought to patient preferences, prognostic of the diseases, and life expectancy will be necessary to achieve appropriate prescription . Moreover, regular reassessment of drug indication is often forgotten, and should be included as a routine to warrant that the medication is used uniquely while there are relevant benefits, hence avoiding “for life” prescriptions.