Reviewing a complicated geriatric drug regimen

This qualitative review offers guidance in avoiding the pitfalls of geriatric prescribing. A thorough yet time-sparing method for reviewing complex geriatric drug regimens is presented. This method has been used extensively during geriatric clinical pharmacology ward rounds by physicians in training. The tool, consisting of 10 questions pertaining to the appropriateness and safety of the drug plan, can contribute to a better understanding of geriatric clinical pharmacology and the special needs of older patients, as well as to the better use of health care resources. The 10 questions are: 1/ Are the indications for each drug still valid? 2/ What are the therapeutic objectives? Have they been reached? 3/ Is there a need for an additional treatment (new, synergistic, preventive)? 4/ Are there any low therapeutic index drugs? 5/ Are there any complicating factors? (Drug allergies? Kidney failure? Hepatic failure?) 6/ Should the drug dosages be adapted? 7/ Are there any clinically relevant drug-drug interactions? 8/ Do any of the prescribed drugs affect the patient's mobility, continence, cognition or eating? 9/ Is compliance with the prescribed drug plan feasible? 10/ Is the drug regimen in conformity with drug laws, rules and regulations? Special consideration is also given to elaborating therapeutic objectives likely to make a difference in an elderly patient's life because they are specific, measurable, acceptable, realistic and time-framed (SMART).