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Prescribing in the elderly
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Prescribing in the elderly - special considerations, why there are considerations and case examples
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Prescribing in special groups- elderlypatients - 4.10
⚡ Learning outcomes:
Define what is meant by elderly
Explain the pharmacokinetics and pharmacodynamics changes likely to occur in elderly
patients
Critically discuss the likely impact on your patients
Critically discuss the aims of therapy in patients with co-morbidities
⚡ What is ‘ELDERLY’ ?
WHO definition: “Most developed world countries have accepted the chronological age of
65 years as a definition of 'elderly' or older person”
NICE defines older people ..“people aged 65 or older”
Average life expectancy in UK approximately 81 years old
Approximately 20% of population is elderly
This is likely to increase
⚡ Why is this group important?
Prescribing in special groups- elderly patients - 4.10 1
, A significant proportion of the patients seen by pharmacists
90% use at least 1 drug per week
40% use at least 5 drugs
12% more than 10 drugs
A nursing home patient given on average 7 to 8 different drugs
⚡ Adult versus elderly dosage examples:
Digoxin (heart failure/ anti-arrhythmic) - maintenance dose (ADULT - Maintenance 125–
250 mcg daily, dose according to renal function and initial loading. ELDERLY - Prescription
potentially inappropriate —> STOPP criteria in heart failure with normal systolic ventricular
function (no clear evidence of benefit). At a long-term dose greater than 125 mcg daily if
eGFR less than 30 mL/minute/1.73 m2 - risk of digoxin toxicity if plasma levels not
measured.
Morphine (opioid) - acute pain (ADULT - Initially 10 mg every 4 hours, adjusted according
to response, subcutaneous injection not suitable for oedematous patients, dose can be given
more frequently during titration, use dose for elderly in frail patients. ELDERLY - Initially 5
mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for
oedematous patients, dose can be given more frequently during titration).
Apixaban (anti-coagulant) - stroke prophylaxis (ADULT - 5 mg twice daily, alternatively 5
mg twice daily, reduced dose used in patients with at least two of the following
characteristics: age 80 years and over, body-weight 60 kg or less, or serum creatinine 133
micromol/litre and over).
Ramipril – hypertension (ADULT - Initially 25–2.5 mg once daily, increased if necessary up
to 10 mg once daily, dose to be increased at intervals of 2–4 weeks. ELDERLY -
Prescription potentially inappropriate (STOPP criteria): with hyperkalaemia OR with
persistent postural hypotension i.e. recurrent drop in systolic blood pressure ≥ 20 mmHg
(risk of syncope and falls) or reduced dose).
Prescribing in special groups- elderly patients - 4.10 2
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