title: Thinking through the medication list - appropriate prescribing and deprescribing in robust and frail older patients.
abstract: BACKGROUND
  Medicines in older patients have the potential to provide great gains as well as significant harms.
  
  
  OBJECTIVE
  To provide an ethically sound, evidence based discussion of the benefits and harms of medications commonly used in primary care among older patients.
  
  
  CONCLUSIONS
  Appropriate prescribing and deprescribing (drug withdrawal) for older patients requires a thorough understanding of the individual, their therapeutic goals, the benefits and risks of all of their medicines, and medical ethics. There is very limited evidence on the safety and efficacy of medicines in older adults, particularly in the frail, who often have multiple comorbidities and functional impairments. In robust older patients, therapy usually aims to delay or cure disease and to minimise functional impairment. In frail older patients, symptom control, maintaining function and addressing end-of-life issues become the main priorities. Optimising medicines is a time-consuming, multidisciplinary process that requires extensive communication, frequent monitoring and review, and has a major clinical impact.
authors.affiliation: Northern Clinical School, Sydney Medical School, University of Sydney, New South Wales, Australia. sarah.hilmer@sydney.edu.au
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D026686:Beneficence; D015897:Comorbidity; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016330:Frail Elderly; D006304:Health Status; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D010347:Patient Care Planning; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000941:ethics; D011320:Primary Health Care / Q000941:ethics / Q000379:methods*; D018570:Risk Assessment; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D013453:Sulfonylurea Compounds