The Rx Consultant

CE for this article is no longer valid.
Non Subscriber: Add to Cart

Drug Therapy in Elders: Clinical Tips

Clicking the "View this Article" button will open the issue as a resizable PDF. To take the test for the issue, return to this Introduction page and click the "Take the Test" button. The Introduction page will remain open after you open this issue.
You may need to re-size or close the issue in order to see the Introduction page.


Nearly 30% of older adults (aged 57-85) use 5 or more prescription medications concurrently – a key reason they are particularly susceptible to adverse drug events. Older adults are 4 to 7 times more likely than younger persons to experience adverse drug events that cause hospitalization. About 27% of the adverse drug events that occur in individuals 65 years of age or older are considered preventable.

The use of medications in elders is complex, with many factors contributing to medication problems. Polypharmacy (or “polymedicine”) is a broad term that can include the use of unnecessary and/or potentially inappropriate medications (PIMs). Age-related pharmacokinetic and pharmacodynamic changes – in addition to coexisting conditions (including physical disability and cognitive impairment) – contribute to a higher risk of adverse drug events. There are also more subtle underlying factors. Older individuals are frequently excluded from pre-marketing clinical trials and, as a result, approved indications and doses for medications may not be applicable to this population. The usefulness of clinical practice guidelines may be limited as well, because they are often based on evidence from studies that excluded either all older adults or older adults with multiple coexisting conditions.

This issue presents a brief update of age-related pharmacokinetic and pharmacodynamic considerations, drugs that should be avoided in older patients, and drugs that are likely to interfere with cognition and memory. Finally, you’ll find practical tips on drug therapy for several health conditions that are common in elders. Throughout, our goal is to provide you with practical tools you can use to optimize drug therapy for our elderly population.


Publication Date: 05/18/2013
Expiration Date: 05/18/2016
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


R. Ron Finley, BS Pharm, RPh, CGP, Tracy Farnen, PharmD, and Pamela Mausner, MD

Disclosure Statement

Ron Finley is a member of the Speakers Bureau for Novartis Pharmaceuticals. Dr. Farnen and Dr. Mausner report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Discuss the Beers criteria for potentially inappropriate medications (PIMs) in elders. List 2 PIMs in each of 3 different classes that should be avoided in elders.
    2. List at least 4 drug classes that have strong anticholinergic properties. List at least 4 other drug classes that can impair cognition in elders. Give 1-2 examples of drugs in each class.
    3. Discuss at least 1 important drug therapy management strategy in elders for each of the following: dementia, depression, insomnia, and seizure disorders.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

ACPE logo
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

California Board of Registered Nursing logo
Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-13-007-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

Technical Specifications

Hardware requirements

Any hardware that supports Microsoft Windows, Apple Mac OS, iOS, or Android, and meets the software requirements.

Software requirements

Browser that supports TLS 1.1 + and PDF files.

This includes Microsoft Internet Explorer 11, Google Chrome 38, Google Android OS 5.0 Browser, Apple Safari (version 7 for desktop, 5 for mobile), Mozilla Firefox 27, newer versions of these browsers, as well as some earlier versions that may require additional configuration.

Adobe Acrobat Reader is recommended, and is required for some browsers.

Note: TLS 1.1 and 1.2 support is required for browser security. Click here for TLS browser support details.

Internet Connectivity

Required. Broadband recommended. (T1, DSL, Cable, G4 or higher.)

Contact Us

Exam Processing Inquiries

The Rx Consultant

Educational Content Inquiries

The Rx Consultant

CE for this article is no longer valid.
Non Subscriber: Add to Cart