Define the goal of drug therapy. Then start with small doses and titrate to the response desired. Wait at least three half-lives (adjusted for age) before increasing the dose. If the expected response does not occur at the normal adult dosage, check blood levels. If the expected response does not occur at the appropriate blood level, switch to a different drug.
4.
Maintain a high index of suspicion regarding drug reactions and interactions. Know what other drugs the patient is taking, including over-the-counter and botanical (herbal) drugs.
5.
Simplify the regimen as much as possible. When multiple drugs are prescribed, try to use drugs that can be taken at the same time of day. Whenever possible, reduce the number of drugs being taken.
American College of Cardiology Foundation Task Force: ACCF/AHA 2011 Expert consensus document on hypertension in the elderly. J Am Coll Cardiol 2011;57:2037.
American Geriatrics Society 2015 Beers Update Expert Panel: American Geriatrics use in older adults. J Am Geriatr Soc 2015;63:2227.
Ancolli-Israel S, Ayalon L: Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry 2006;14:95.
Aronow WS: Drug treatment of systolic and diastolic heart failure in elderly persons. J Gerontol A Biol Med Sci 2005;60:1597.
Blackburn EH, Epel ES, Liu J: Human telomere biology: A contributory and interactive factor in aging, disease risks, and protection. Science 2015; 350:1193.
Calcado RT, Young NS: Telomere diseases. N Engl J Med 2009;361:2353.
Chatap G, Giraud K, Vincent JP: Atrial fibrillation in the elderly: Facts and management. Drugs Aging 2002;19:819.
Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31.
Dergal JM et al: Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 2002;19:879.
Docherty JR: Age-related changes in adrenergic neuroeffector transmission. Auton
Neurosci 2002;96:8.
Drugs for cognitive loss and dementia. Treat Guidel Med Lett 2013;11:95.
Epstein NU et al: Medication for Alzheimer’s disease and associated fall hazard:
A retrospective cohort study from the Alzheimer’s disease neuroimaging initiative. Drugs Aging 2014;31:125.
Ferrari AU: Modifications of the cardiovascular system with aging. Am J Geriatr Cardiol 2002;11:30.
Gandy S: Lifelong management of amyloid-beta metabolism to prevent Alzheimer’s disease. N Engl J Med 2012;367:864.
Guarente L: Sirtuins, aging, and medicine. N Engl J Med 2011;364:2235.
Hubbard BP, Sinclair DA: Small molecule SIRT1 activators for the treatment of aging and age-related diseases. Trends Pharmacol Sci 2014;35:146.
Jager RD, Mieler WF, Miller JW: Age-related macular degeneration. N Engl J Med 2008;358:2606.