[Important aspects of geriatric pharmacotherapy].

Drug prescription for geriatric patients is one of the most prevalent yet also one of the most difficult interventions in geriatrics. Although this article focuses solely on specific important aspects of geriatric pharmacotherapy, medication in clinical practice is only one type of geriatric intervention that needs to be embedded in a well-coordinated bundle of multidimensional interventions addressing functional and psychosocial aspects alike. Not every older patient is per se a geriatric patient, nor is each geriatric patient per se of very old age. Therefore, this article initially proposes a clinical definition of the geriatric patient before summarizing the most significant physiological age changes affecting pharmacokinetics and pharmacodynamics as well as summarizing the most prevalent risks associated with the age-correlated increase in multiple drug use in order to describe the background from which general principles of geriatric pharmacotherapy have evolved. The quality of geriatric pharmacotherapy must not only be determined by avoidance of any kind of over medication, but also by the avoidance of under medication as well as the avoidance of inappropriate drugs for elderly patients. Treatment failures do not only result from mere polypharmacy, but can also be due to under utilization of drugs as well as due to the prescription of inappropriate medications. In fact, the problem of under medication in certain age-correlated diseases (e. g. depression, dementia, pain) has rarely been addressed systematically in clinical or epidemiological studies until now. In order to improve quality and safety of geriatric pharmacotherapy, a group of experts in the field developed a set of explicit age-adjusted criteria for potentially inappropriate drugs in 1991. These criteria have been regularly updated thereafter until 2003 and focus on age-related aspects of specific drugs and dosages as well as on co-morbid states and co-medications. As long as geriatric patients are rarely included in clinical trials on drug effectiveness and drug safety, these criteria should be applied and used in clinical practice at least to identify any demand for a detailed explicit justification of a therapeutic decision not in line with the explicit criteria in order to enhance safety of drug treatment in geriatric patients.