LAUSR

Abstract Populations around the world are ageing. This can be attributed, in part, to the availability of more effective therapeutic interventions for many diseases, better risk factor management and overall improvements in healthcare. However, this has resulted in increasingly frailer patients with multiple co-morbidities who are often taking many different medicines (polypharmacy). Prescribers must be able to take into account the pharmacokinetic and pharmacodynamic changes in elderly individuals and cope with the complexity of polypharmacy, which provides the potential for more drug–drug and drug–disease interactions. Rational prescribing in this age group should avoid inappropriate polypharmacy and include continued monitoring of the balance between the benefits and harms of drug treatment, which frequently changes with ageing and further medical events. Several tools have been developed to help to identify potentially inappropriate medications and guide deprescribing, such as the STOPP/START and Beers criteria. Identification of a ‘frailty syndrome’ has helped to deliver more individualized, patient-centred care for older adults. Involving patients and carers in medication formulation and regimen choice also helps towards better medication adherence and therefore improved health outcomes.