Prescribing Decisions and Seniors: Suggested Reading and Resources

According to many internists, family physicians, and other specialists dealing with seniors, concerns about geriatric dosing arise fairly frequently in their practices.

How many times have you been confronted by a family member who wonders why an elderly parent is having more falls and seems less alert and energetic?  You know that aging affects absorption, distribution and metabolism of drugs, even those that have been taken for a long time. When your physical examination fails to reveal any significant changes, but your medication reconciliation identifies several drugs that could be the cause, where do you turn?

Your initial online research locates a range of online sources with varying costs and content. But are they reliable?

According to gerontologist Judith Black, MD, “Medication use among older adults comes with many rewards and some challenges. Aside from the pharmacokinetic (PK) and pharmacodynamics (PD) changes, medication adherence and procurement can be significant barriers to achieving desired outcomes in this population.  Primary care physicians caring for older adults need accessible, up-to-date, evidence-based, and patient-centered drug information.

“The following list of references provides both background as well as evidence-based drug information resources that can be used at the point of care.”

This list is not comprehensive, nor are the resources endorsed by PAMED, but they are offered to members as suggestions.

Geriatric Dosing Handbook – Contains monographs with geriatric-sensitive information including drug interactions and drug dosing. Comprehensive and includes off-label usage. Cost is $61.95 for the 2013 edition

Aging Biology and Geriatric Clinical Pharmacology – An article discussing the effects of aging on biological systems that require alteration of therapeutic dosing in geriatric populations.

Clinical Geriatric Psychopharmacology – This book discusses the complexity of prescribing for geriatric populations who not only have medical conditions with numerous medications but are also experiencing mental illness, such as dementia, depression and anxiety.  Dosing and other complex issues are discussed by nationally recognized specialists.

Facts and Comparisons – An online app or print resource of drug information for all populations that includes detailed drug dosing, side effects and specific conditions requiring alteration of dosing.

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: Results of a US Consensus Panel of Experts  – An article with a 2012 update of the Beers Criteria for adults over age 65 that uses evidence based research to identify drugs inappropriate in this population based either on age or chronic illness.

Geriatrics at Your Fingertips (GAYF) – Hard copy and mobile application availabile; complimentary for American Geriatric Society members. Succinct approaches to common geriatric medical conditions.

iGeriatrics – Free mobile application. Includes Beer’s Criteria, immunization, and disease state management drug information.