Geriatric Prescribing Principles and Interprofessional Healthcare Team Leadership

People are living longer with multiple comorbid chronic disease states leading to polypharmacy and a high risk of adverse events. The presence of comorbid conditions often leads to the exclusion of older persons in clinical drug trials. Insufficient expertise regarding physiologic, pharmacokinetic, and pharmacodynamic changes of aging contributes to increased risk of inappropriate prescribing. Assessment of the whole patient to provide person-centered care, and particularly each medication, is essential to high-quality clinical decision-making. All symptoms should be carefully assessed with a keen eye toward potential side effects of existing medication as the cause to avoid the prescription cascade and polypharmacy. Consideration for deprescribing includes downward titration to the lowest amount of medication to balance treatment with the highest quality of life. Effective interprofessional care teams are superior to the parallel efforts of siloed professionals and decrease functional decline and hospital length of stay among elder persons. Fluid leadership among team members that provides for the needs of person-centered care is superior to static leadership based on position or profession. Communication among the patient, family, and care team is vital to achieving the patient’s treatment goals.