Turkish Journal of Geriatrics
2022 , Vol 25, Issue 1
CONTROVERSIAL ISSUES RELATED TO DRUG TREATMENT IN OLDER ADULTS
1 Hacettepe University, Faculty of Medicine Dept of PMR, Hacettepe University Research Center of Geriatric Sciences-GEBAM, Ankara, Turkey
DOI :
10.31086/tjgeri.2022.257
Drug therapy in older adults continues to pose problems and cause
controversy with its different aspects. Polypharmacy and inappropriate
medication, appears to be the major problem worldwide in terms of both
geriatric health and healthcare. Also increases the risk of geriatric syndrome and
affects the morbidity/mortality rates negatively. A definition for inappropriate
medication is "any drug in which the risks outweigh the benefits or where
these do not align with goals of care", since it encompasses both ineffective
or unnecessary treatment and those treatments with high risk. A range of
assessment tools have been developed to identify and measure inappropriate
prescribing. The most commonly recommended criteria for the use of drugs in
older adults are the Beers criteria by American Geriatrics Society. The "Screening
Tool of Older People Prescriptions (STOPP)" and the "Screening Tool to Alert
doctors to Right Treatment (START)" are other frequently recommended
screening approaches. It seems suitable also to establish consideration of
deprescribing within the continuum of treatment recommendations in clinical
guidelines. Deprescribing is defined as "the planned, supervised process of
medication discontinuation, addressing unnecessary polypharmacy which
continues to be a problem among older adults". Evidence-based deprescribing
guidelines could be a useful component in the effort to address the global
problem of polypharmacy. However, it is important to keep in mind that it is
essential to consider the ethical and legal dimensions in all these approaches.
Another issue is the herbal products and since the general knowledge about
food/beverage-drug interactions are found to be poor, there seems a need to
enhance the community awareness of these interactions especially for older
adults.
Keywords :
Geriatrics; Drug Therapy; Inappropriate Prescribing; Polypharmacy; Deprescriptions