Prescribing Principles Problems in Implementing Best Prescribing Practices: Multiple medications, multiple providers, insufficient time for coordination of care in busy practices and short visit times. Disproportionate use of OTC remedies by older adults, often not reported to doctor. Medication compliance problems due to: financial burden of drug costs on fixed incomes cognitive impairment physical frailty same medications/different names: duplicates General Principles of Medication Management for Older Adults: Review all medications; ask patient to bring all medications in. Avoid prescribing for nonspecific symptoms or without clear diagnosis. Update and discontinue medications where able. Remember...medication lists accumulate if untended! Consider drug adverse effects if you observe decline in physical or cognitive functions or self-care abilities. A single pharmacy can help monitor for drug interactions, but many people fill chronic medications through the mail and acute prescriptions locally, making this difficult. Medication boxes setup in advance may be helpful. Prescribing Principles when a new medication is needed: Start Low, Go Slow. Treat adequately to achieve goals of therapy. Provide patient education, using written instructions to reinforce proper drug use at home. Avoid complex dosing schedules if possible. Proceed to Adherence Challenges Back to Module Content