Patients over the age of 65 have an increased risk of drug interactions, adverse drug reactions and falls. Although it can sometimes be appropriate to prescribe new medications, a thorough medication review should be done concurrently. The review should ensure that the medications are having the desired effect, that the lowest effective doses are being used, that the patient has been involved in the decision to use them and that they align with the patient’s goals of care. There is a paucity of research on clinical outcomes associated with medication review tools however, the STOPP/START, Beers criteria and the McLeod criteria have been reviewed in a Cochrane analysis. Another useful resource is www.Medstopper.com.
Bourgeois FT, et al. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf. 2010 Sep;19(9):901-10. PMID: 20623513.
Cooper JA, et al. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015 Dec 9;5(12):e009235. PMID: 26656020.
Fried TR, et al. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc. 2014 Dec;62(12):2261-72. PMID: 25516023.
Fulton MM, et al. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005 Apr;17(4):123-32. Review. PMID: 15819637.
Mallet L, et al. The challenge of managing drug interactions in elderly people. Lancet. 2007 Jul 14;370(9582):185-91. PMID: 17630042.
Marcum ZA, et al. Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans. J Gerontol A Biol Sci Med Sci. 2012 Aug;67(8):867-74. PMID: 22389461.
Payne RA, et al. Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol. 2014 Jun;77(6):1073-82. PMID: 24428591.
Weng MC, et al. The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases. QJM. 2013 Nov;106(11):1009-15. PMID: 23836694.