[Appropriate drug prescribing in the elderly].
OBJECTIVE
The frequency of chronic illness and the expenditure of medications increase with the older age. If drug-prescribing is very often beneficial for the patients, elderly subjects are particularly exposed to the side-effects of medications, and to their consequences. Although the age in itself do not generally forbid a medication, it can modify some of the objectives and the modality of the treatment.


BACKGROUND
Four main factors explain the growing frequency of the iatrogenic pathology in the old age: polymedication, pharmacological modifications that occur with the ageing process, lack of coordination between different prescribers, and physical and psycho-social deficiencies which are the keys for identifying the "frail elderlies".


CONCLUSIONS
In regard to the frequent polypathological conditions of the oldest patients, one does not have to consider a sum of sicknesses, but a global situation, and one needs to replace a condition in a general context, and to establish priorities in the goals of the treatment. Appropriate drug-prescribing also needs to take account of the latest medical recommendations concerning numbers of medications, and a more frequent involving of elderly subjects in clinical trials.
Service de réadaptation gérontologique hôpital Notre-Dame-du-Bon-Secours, rue des Plantes, 75014 Paris, France. ferchichi@ndbs.org
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Ferchichi
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Antoine
D000368:Aged; D000375:Aging; D002986:Clinical Trials as Topic; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine; D016330:Frail Elderly; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D009017:Morbidity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*