Commentary |

Medication Use in Older Patients:  Better Policy Could Encourage Better Practice

Jerry Avorn, MD
JAMA. 2010;304(14):1606-1607. doi:10.1001/jama.2010.1495.
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The use of medications in older patients is arguably the single most important health care intervention in the industrialized world. Individuals older than 65 years are the most active consumers of health care, and this group continues to increase more rapidly than most other segments of the population. Although this age group remains underrepresented in pivotal clinical trials,1 elders benefit as much as younger patients from most preventive therapies, and sometimes more so.2 Yet changes in drug metabolism, excretion, and receptor sensitivity, along with a higher prevalence of comorbidity and potentially interacting drugs, also mean that elderly patients are far more likely to experience adverse effects from their prescribed regimens, causing considerable morbidity and mortality.2 Economically, too, medication use by patients older than 65 years looms large.3 Passage of the Medicare Part D benefit, with scant attention paid to its funding, made the federal government the single largest purchaser of prescription drugs in the United States. And if the costs of illnesses prevented or caused by pharmacotherapy in elderly patients are also considered, it becomes clear that prescribing decisions drive far greater expenditures than are accounted for by drug costs alone.



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