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Contempo 1999
July 14, 1999

Prescribing for Seniors: Neither Too Much nor Too Little

Author Affiliations

Author Affiliations: Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Institute for Clinical Evaluative Sciences, and Clinical Epidemiology and Health Care Research Program, Departments of Medicine and Public Health Sciences, University of Toronto, Toronto, Ontario (Dr Rochon); Meyers Primary Care Institute, the Fallon Healthcare System and University of Massachusetts Medical School, Worcester (Dr Gurwitz).

JAMA. 1999;282(2):113-115. doi:10.1001/jama.282.2.113

Over the past few years the pendulum has swung from concern about the risks of excessive prescribing of inappropriate or unnecessary drug therapy to concerns about the consequences of underprescribing of potentially beneficial therapies to seniors (65 years and older). Concerns about excess drug use are for good reason. Use of greater numbers of drug therapies, rather than age alone, has been associated with an increased risk of developing adverse drug reactions.1 Furthermore, prescribing additional drugs to treat drug-induced symptoms can lead to prescribing cascades that develop when an adverse drug reaction is misinterpreted as a new medical problem.2 However, prescribing strategies that seek to limit the number of drugs prescribed to elderly patients in the name of improving quality of care may be seriously misdirected. A broader view of prescribing for seniors recognizes that problems occur from both the overprescribing and underprescribing of drug therapies. The past few years have seen a number of studies, a handful of which are cited in this article, illustrating the adverse consequences associated with underprescribing of beneficial drug therapies. These studies point to a more complex model for assessing the quality of prescribing for seniors than simply counting the number of different medications that an elderly patient is receiving.