How Can Drug Consumption among the Elderly be Improved?

The report summarises the results of SBU’s systematic review of the literature concerning potential improvements to drug consumption among the elderly (from the patient’s perspective). The report does not address specific diseases or groups of drugs, nor does it compare the merits of different drug distribution systems.

SBU’s conclusions

Drug therapy is an important medical intervention that improves health and quality of life into old age. Nevertheless, such therapy among elderly patients calls for considerable improvement. As things stand today, drug-related problems cause many elderly to suffer unnecessarily and cost the community hundreds of millions of euros a year.

• While the elderly do not necessarily consume an excessive number of drugs, too many of them are prescribed unsuitable medications. Evidence shows that improved education and information, first and foremost for doctors, reduces prescription of unsuitable drugs for the elderly.
• More thorough medical evaluations and better diagnostic methods for frail, elderly patients with a number of concomitant diseases are needed if various drug-related problems are to be minimised. The symptoms experienced by such patients are treated too often on an acute, short-term basis without taking a holistic approach or planning for active follow-up. The result may be unnecessary suffering, as well as interference with, or delay of, functional and medical recovery – not to mention longer periods of hospitalisation.
• Individual dosage procedures and regular reviews of prescriptions can minimise the drug-related problems of frail, elderly patients with a number of concurrent diseases. Organ system function is frequently impaired to one extent or another in ageing patients. Given that the benefits and harms of drugs change with age, any drug therapy that has been prescribed must be continually re-examined. There is evidence that a number of drugs (such as non-steroidal anti-inflammatory drugs, drugs with anticholinergic effect and benzodiazepines) pose greater risks. Such drugs should be regarded as risky for the elderly.
• Routines for regularly monitoring the effects of drug therapy during consultations with elderly patients who have multiple health problems and are taking a number of different drugs would significantly improve the situation. That current clinical practice so often lacks such routines is ethically indefensible.
• No single measure, such as medication reviews, can solve the problems associated with drug consumption among elderly patients. A series of simultaneous changes are needed when it comes to information handling, drug distribution and education, as well as prescription and follow-up routines and tools. Moreover, organisational structures and allocation of responsibility within the healthcare system should be modernised and made more transparent. A number of different actors must cooperate for the good of individual patients. Organisational collaboration is also required among regions, county councils, local authorities, administrators, pharmaceutical experts, trade associations, patient advocates and other stakeholders. These actors should promptly be requested to develop a joint action plan that takes a holistic approach characterised by a series of simultaneous measures at various levels.