Safe Prescribing and Monitoring in the Older Person

This chapter will consider the main factors that increase the risk of adverse drug reactions and events in older people. This will include changes in physiology that affect the older person. It will also outline how older people should be prioritized for medication review and the monitoring that is needed to minimize harm, while optimizing patient outcomes from the use of medications. The chapter will also discuss the essential factors to be considered while prescribing and the monitoring that is needed to improve medication use and safety in this group. Various tools and methods that could be employed when prescribing and selecting medications that are considered appropriate for this population, including tools to review appropriate prescribing, monitoring of medication use, at the various levels of delivery of patient care and at a systems level, will be discussed. Medications which require special consideration among this group of patients will also be discussed, including review of existing medication and, in particular, the importance of patient prioritization due to high-risk medication use. Case studies will be used to illustrate how a person-centered approach can be taken in the reviews, including shared decision-making.