How to Avoid Dangerous Medication Prescribing Practices

Sudeep Gill, MD, FRCPC
Fellow, Division of Geriatric Medicine,
University of Toronto, Toronto, ON.

Barbara Liu, MD, FRCPC
Kunin-Lunenfeld Applied Research Unit,
Baycrest Centre for Geriatric Care,
Sunnybrook & Women's College Health Sciences Centre,
Assistant Professor of Medicine,
University of Toronto, Toronto, ON.


An adverse drug reaction (ADR) is defined as any noxious or unintended reaction to a drug that is administered in standard doses for the purpose of prophylaxis, diagnosis or treatment.1 ADRs are common in the elderly--it is estimated that 10-17% of hospital admissions for older patients are directly related to ADRs. Furthermore, one in every 1,000 older inpatients dies as a result of complications of medication use. Many of these ADRs result from potentially inappropriate--and therefore avoidable--drug prescribing practices. In this article, we explore the following topics: pharmacokinetic changes that accompany aging; symptoms and signs that may lead to recognition of ADRs; risk factors that predispose to ADRs; and finally, an approach to appropriate drug prescribing in the elderly.

Drug Pharmacokinetics
Pharmacokinetics involves drug absorption, distribution, metabolism and excretion. With normal aging, there is no clinically significant decline in absorption.