Hospital Practice
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
Drug Prescribing for the Elderly Peter P. Lamy & Robert E. Vestal To cite this article: Peter P. Lamy & Robert E. Vestal (1976) Drug Prescribing for the Elderly, Hospital Practice, 11:1, 111-118, DOI: 10.1080/21548331.1976.11706485 To link to this article: http://dx.doi.org/10.1080/21548331.1976.11706485
Published online: 17 May 2016.
Submit your article to this journal
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [Monash University Library]
Date: 02 July 2016, At: 22:44
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Drug Prescribing for the Elderly
Downloaded by [Monash University Library] at 22:44 02 July 2016
PETER P. LAM Y and R 0 BERT E. VEST A L University of Maryland and Vanderbilt University
Many valuable drugs may pose special hazards for the elderly, and illness induced by drugs may mimic stereotypes associated with old age. An optimal approach to the geriatric patient and his medication is described.
Many valuable drug~ are especially hazardous in the old. Digitalis intoxication, potassium depletion from diuretics, paradoxical reaction to barbiturates, extrapyramidal symptoms from phenothiazines, phenylbutazone toxicity, gastrointestinal bleeding from aspirin, hemorrhagic reaction from heparin - all of these effects are more likely to occur in the geriatric patient than in other adults. Steering a safe, effective course between benefit and risk requires understanding of when to give and when not to give drugs. Ironically, drug-induced illness may go unperceived because it often mimics stereotypes associated with old age: forgetfulness, weakness, confusion, tremor, anorexia, and anxiety. Caution is the practical byword in geriatric prescribing. Dosages recommended for the "average" patient may not be assumed to he satisfactory for the elderly patient. The older person is an uncertain responder and sometimes the "average dose" may be excessive. There are hazard~ from age-associated decrements in physiologic function as well as from the effects of illness or trauma. The challenge to the physician is multiple: 1) to determine whether the patient's complaint is justification for medication; 2) if so, to determine what is the preferable agent; 3) toestimate how much of a total drug load may be safely imposed at any one time and therefore to decide whether among various conditions amenable to drugs some may wait until later for therapy; 4) to consider benefits and risks, understanding that they may balance differently for the elderly than for the young; and 5) to keep the total number of drugs in the patient's regimen at a minimum, with the usc of
any additional drugs deferred if possible. At the same time, while maneuverability often is less in prescribing for the elderly, sometimes the constraints are less too. For example, the currently controversial use of oral hypoglycemic agents may be more readily justified in a 7o-year-old than in a 40-year-old person, especially if insulin therapy would be difficult for such a patient. All of these considerations would seem to fall within the realm of the art rather than the science of medicine. Yet, a good deal has been learned that can be helpful to the office practitioner. Our purpose in this article is to offer some practical counsel based on pharmacologic concepts and experience. In considering such questions as the pharmacologic significance of some physiologic decrements that accompany aging and the uses and pitfalls of certain drugs, we take the view that the multiple-problem patient is not to be avoided because he or she cannot be cured. The ability to minimize infirmities - to help the patient function the very best he or she can and to be independent for as long as he or she can - can become one of the physician's most gratifying experiences.
Dr. La my is Professor of Pharmacy and Director, Institutional Phannacy Programs, University of Maryland Hospital/School of Pharmacy, Baltimore. Dr. Vestal is Research Fellow, Division of Clinical Pharmacology, Department of Phamwcology, Vanderbilt University, Nashville, Tenn. (fom~erly, Clinical Associate at the Gerontology Research Center, National Institute em Aging, National Institutes of Health).
Hospital Practice January 1
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
Drug Prescribing for the Elderly Peter P. Lamy & Robert E. Vestal To cite this article: Peter P. Lamy & Robert E. Vestal (1976) Drug Prescribing for the Elderly, Hospital Practice, 11:1, 111-118, DOI: 10.1080/21548331.1976.11706485 To link to this article: http://dx.doi.org/10.1080/21548331.1976.11706485
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [Monash University Library]
Date: 02 July 2016, At: 22:44
----------------------------------------------~------
Drug Prescribing for the Elderly
Downloaded by [Monash University Library] at 22:44 02 July 2016
PETER P. LAM Y and R 0 BERT E. VEST A L University of Maryland and Vanderbilt University
Many valuable drugs may pose special hazards for the elderly, and illness induced by drugs may mimic stereotypes associated with old age. An optimal approach to the geriatric patient and his medication is described.
Many valuable drug~ are especially hazardous in the old. Digitalis intoxication, potassium depletion from diuretics, paradoxical reaction to barbiturates, extrapyramidal symptoms from phenothiazines, phenylbutazone toxicity, gastrointestinal bleeding from aspirin, hemorrhagic reaction from heparin - all of these effects are more likely to occur in the geriatric patient than in other adults. Steering a safe, effective course between benefit and risk requires understanding of when to give and when not to give drugs. Ironically, drug-induced illness may go unperceived because it often mimics stereotypes associated with old age: forgetfulness, weakness, confusion, tremor, anorexia, and anxiety. Caution is the practical byword in geriatric prescribing. Dosages recommended for the "average" patient may not be assumed to he satisfactory for the elderly patient. The older person is an uncertain responder and sometimes the "average dose" may be excessive. There are hazard~ from age-associated decrements in physiologic function as well as from the effects of illness or trauma. The challenge to the physician is multiple: 1) to determine whether the patient's complaint is justification for medication; 2) if so, to determine what is the preferable agent; 3) toestimate how much of a total drug load may be safely imposed at any one time and therefore to decide whether among various conditions amenable to drugs some may wait until later for therapy; 4) to consider benefits and risks, understanding that they may balance differently for the elderly than for the young; and 5) to keep the total number of drugs in the patient's regimen at a minimum, with the usc of
any additional drugs deferred if possible. At the same time, while maneuverability often is less in prescribing for the elderly, sometimes the constraints are less too. For example, the currently controversial use of oral hypoglycemic agents may be more readily justified in a 7o-year-old than in a 40-year-old person, especially if insulin therapy would be difficult for such a patient. All of these considerations would seem to fall within the realm of the art rather than the science of medicine. Yet, a good deal has been learned that can be helpful to the office practitioner. Our purpose in this article is to offer some practical counsel based on pharmacologic concepts and experience. In considering such questions as the pharmacologic significance of some physiologic decrements that accompany aging and the uses and pitfalls of certain drugs, we take the view that the multiple-problem patient is not to be avoided because he or she cannot be cured. The ability to minimize infirmities - to help the patient function the very best he or she can and to be independent for as long as he or she can - can become one of the physician's most gratifying experiences.
Dr. La my is Professor of Pharmacy and Director, Institutional Phannacy Programs, University of Maryland Hospital/School of Pharmacy, Baltimore. Dr. Vestal is Research Fellow, Division of Clinical Pharmacology, Department of Phamwcology, Vanderbilt University, Nashville, Tenn. (fom~erly, Clinical Associate at the Gerontology Research Center, National Institute em Aging, National Institutes of Health).
Hospital Practice January 1
