The Ambiguous Reality of Prescribing in Geriatric Practice

Every medical care provider wants to do the right thing. The challenge in care of older persons is that the “right” thing is often unclear. Older patients have extraordinary physiological, functional, and prognostic diversity, and this means that one-size-fits-all protocols and algorithms have far less utility than they do for younger populations. Older patients rarely, if ever, have just 1 medical problem; so research findings may be difficult to generalize to the patient in front of you. Furthermore, for many patient groups—long-term care residents being a prime example—research is so limited that the “evidence base” consists largely of “expert opinion.” On top of these challenges is that, in comparison to younger populations, older patients are more likely to suffer adverse consequences from both action and inaction.