Don’t prescribe a medication without conducting a drug regimen review (medication reconciliation)
The prevalence of polypharmacy in old age (commonly defined as the use of 5 or more drugs) is on the rise in high income countries. In Italy, the proportion of people 65 years of age and older prescribed five or more medications rose from 43% to 53% between 2000 and 2010. Risk of iatrogenic harm increases with the number of medications and approximately 10% of hospital admissions in the elderly are due to adverse drug reactions. Polypharmacy has been linked to a broad range of negative health outcomes, including lack of therapeutic adherence, increased risk of cognitive and functional impairment, worsening of falls. The Medication Reconciliation Process in elderly people, especially when a new drug is going to be started, is an essential tool for underprescribing and overprescribing evaluation, including potential drug interactions. A drug regimen review should deserve special attention in people with a limited remaining life expectancy.
1. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–2246.
2. O’Mahony D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–218.
3. Jonas W. Wastesson, Lucas Morin, Edwin C.K. Tan & Kristina Johnell (2018): An update on the clinical consequences of polypharmacy in older adults: a narrative review, Expert Opinion on Drug Safety, DOI: 10.1080/14740338.2018.1546841
4. American Geriatrics Society. Ten Things Physicians and Patients Should Question. www.americangeriatrics.org.
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.