Over the past few years the pendulum has swung from concern about the
risks of excessive prescribing of inappropriate or unnecessary drug therapy
to concerns about the consequences of underprescribing of potentially beneficial
therapies to seniors (65 years and older). Concerns about excess drug use
are for good reason. Use of greater numbers of drug therapies, rather than
age alone, has been associated with an increased risk of developing adverse
drug reactions.1 Furthermore, prescribing additional
drugs to treat drug-induced symptoms can lead to prescribing cascades that
develop when an adverse drug reaction is misinterpreted as a new medical problem.2 However, prescribing strategies that seek to limit
the number of drugs prescribed to elderly patients in the name of improving
quality of care may be seriously misdirected. A broader view of prescribing
for seniors recognizes that problems occur from both the overprescribing and
underprescribing of drug therapies. The past few years have seen a number
of studies, a handful of which are cited in this article, illustrating the
adverse consequences associated with underprescribing of beneficial drug therapies.
These studies point to a more complex model for assessing the quality of prescribing
for seniors than simply counting the number of different medications that
an elderly patient is receiving.
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