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Learning Objectives • Understand the epidemiology of drug therapy. • Understand the importance of pharmacokinetics and pharmacodynamics to prescribing decisions. • Describe practical approaches to prescribing medications to older persons including reviewing current drug therapies, discontinuing medications when no longer indicated, considering nonpharmacologic treatment options, and reducing the dose.

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• Describe measures of drug prescribing quality. • Understand the concept of the prescribing cascade. • Understand the importance of underuse of potentially beneficial drug therapy. • Understand the special considerations regarding drug therapy in the long-term care setting. • Recognize the potential gaps in information about drug therapy in older adults.

• Describe policy issues related to drug therapy by older adults. Key Clinical Points • Prescribing for older people offers special challenges because they take more prescribed medications than younger people. Older individuals are often at risk for drug interactions and adverse events.

• When prescribing medications to older adults, consider pharmacokinetic and pharmacodynamic changes that are observed with aging. • Criteria have been developed by experts internationally to assess the quality of medication use in older adults that can be applied in clinical practice. • Many different factors go into making the best prescribing decisions for an individual patient, and it is essential that the risks are balanced against the benefits of each medication. An important tension exists between avoiding inappropriate medications and underuse of potentially beneficial drugs.