Specific features of rational pharmacotherapy in elderly patients

Objective It is well-known that finding an optimum medication at the correct dose for elderly patients is challenging for the practitioner. This study aimed to examine the main trends in prescribing medications for elderly patients and their compliance with the principles of rational pharmacotherapy, and to establish the main factors affecting adherence to treatment in these patients. Methods 956 records of outpatients over 60 years of age were examined. The groups of medications prescribed, the dosage simultaneously prescribed to one patient, the structure of nosologies among elderly patients, and the frequency of side effects were studied. The second stage of the study with 147 patients involved examining the adherence to medications by elderly patients using the Brief Medication Questionnaire. Results A total of 147 patients (79 (53.7%) women and 68 (46.3%) men) aged over 60 years who were taking >= 4 medications for primary and concomitant diseases were surveyed. The phenomenon of polypragmasy is clearly seen when prescribing pharmacotherapy to elderly patients. Thus, 39% of patients were prescribed 2-4 drugs simultaneously, 55.4% were prescribed >= 5 drugs, and only 5.6% were prescribed one type of medication. Consequently, 90.5% of patients did not comply with the prescribed regimen of drugs. The main reasons for low adherence to treatment were: the complexity of the drug regimen (72.1% of cases); the high cost of drugs (63.9%); lack of appropriate knowledge about disease (67.3%); and no understanding of the necessity for drug intake and the pharmacotherapeutic effect in a particular situation (61.9%). Conclusion Optimisation of pharmacotherapy for elderly and senile patients requires consideration of functional changes in the body, the peculiarities of the pharmacodynamics and pharmacokinetics of drugs prescribed, the presence of polymorbidity, the prevalence of polypragmasy, and the low adherence to treatment.

Automated summary

The study examined trends in prescribing medications for elderly patients and their compliance with rational pharmacotherapy principles. Factors affecting adherence to treatment were also identified. The results showed a high prevalence of polypharmacy among elderly patients, with most patients not adhering to the prescribed drug regimen due to complexity, high costs, lack of disease knowledge, and understanding of drug necessity and efficacy.