Ethical principles in prescribing drugs to elderly patients

Abstract

Several ethical considerations should be taken into account when prescribing drugs to elderly patients, owing to the great importance of iatrogenic diseases at this age. An excess of medications exposes the elderly to a higher risk of side effects, not to mention the tendency to either self prescribing or to poor compliance to a recommended lreatment schedule. The authors single out some ethical principles in drug-prescription in order to reach the therapeutic effect minimizing the risks and with consideration of the needs of the elderly patient as a person: of paramount importance are a correct drug history, to specify the main therapeutic goal, to prescribe only the drugs tbe patient can cope with, to simplify tbe treatment regime, and to give a complete information to the patient and to his/her relatives to improve compliance. It is essential to carefully follow up the patient for side-effects, bearing in mind that he/she is at high risk of poor compliance and of iatrogenic consequences. Fundamental task of the "global treatment" of the elderly patient is to help him/her to keep or regain as much indipendence as possible, as long as possible. This not only implies the necessity of drug treatment, but also of rehabilitative treatment, including physical, occupational and socializing activities. Advanced and very advanced age should never prevent drug treatment, but more caution and controls are required together with a new and less "medical'' approach. The authors suggest some criteria to improve the patient's compliance to a treatment regime, speculate on tbe different levels of responsability of the physician in inducing the risk of iatrogenic disease in the elderly, and point out the possible solutions of the ethical problems involved. Multiple disease do not imply multiple prescription as a rule. Medications shall be limited to emerging diseases, giving priority to clinical problems, reducing dosage and avoiding drugs of not clearly proved utility and efficacy.