Medicines in the Elderly: Geriatric Prescribing, Polypharmacy & Safe P

India's Ageing Population: A Pharmaceutical Challenge

India's population of adults over 60 has crossed 140 million and is projected to reach 300 million by 2050. This demographic shift carries profound implications for the healthcare system. Elderly patients disproportionately consume pharmaceutical resources — an average patient over 65 takes 4–6 medicines daily, and many take considerably more.

Age brings not just more disease, but fundamentally altered physiology that changes how medicines behave in the body. Understanding these changes is essential for safe, effective prescribing and appropriate medicine supply in geriatric care.

How Ageing Changes Drug Pharmacokinetics

Absorption

Gastric acid secretion decreases with age, affecting absorption of pH-dependent medicines. Gastric motility slows, potentially delaying drug absorption. Overall, absorption changes are generally modest and clinically less significant than other pharmacokinetic alterations.

Distribution

Body composition changes profoundly with age — lean muscle mass decreases, body fat increases, and total body water decreases. Water-soluble medicines (digoxin, lithium, alcohol) achieve higher concentrations in older patients due to reduced volume of distribution. Fat-soluble medicines (benzodiazepines, tricyclics) accumulate in fatty tissue, prolonging their duration of action.

Metabolism

Hepatic blood flow decreases by 40–50% with ageing, and hepatic enzyme activity declines. This reduces the first-pass metabolism of medicines like beta-blockers, calcium channel blockers, and opioids, increasing their bioavailability and requiring dose reductions.

Elimination

Renal function declines at approximately 1% per year after age 40. By age 80, GFR may be 50% or less of young adult values — even without overt kidney disease. Many medicines are primarily renally excreted (digoxin, metformin, low-molecular-weight heparins, many antibiotics), requiring dose adjustment as renal function declines.

The Beers Criteria: Medicines to Avoid in Older Adults

The American Geriatrics Society Beers Criteria is the most widely used reference for potentially inappropriate medicines in older adults. Key categories to avoid or use with great caution include:

• Benzodiazepines and Z-drugs: High risk of falls, cognitive impairment, and paradoxical excitation. Strongly avoid for insomnia
• First-generation antihistamines (Chlorpheniramine, Diphenhydramine): Anticholinergic effects cause confusion, urinary retention, and constipation
• Non-selective NSAIDs: Increased GI bleeding risk, renal toxicity, and fluid retention in elderly patients
• Tricyclic antidepressants: Anticholinergic burden, orthostatic hypotension, cardiac conduction effects
• Muscle relaxants (Baclofen at high doses): CNS depression, fall risk
• Glibenclamide (Glyburide): Long duration of action causes prolonged hypoglycaemia in elderly diabetics; safer alternatives include Glimepiride or DPP-4 inhibitors

Polypharmacy: The Geriatric Prescribing Challenge

Polypharmacy — the concurrent use of five or more medicines — is near-universal in elderly patients with multiple chronic conditions. With increasing drug count comes exponentially increasing risk of drug-drug interactions, adverse drug reactions, falls, hospitalisation, and cognitive decline.

Annual medication reviews using structured tools like the STOPP/START criteria can identify potentially inappropriate medicines to stop and necessary medicines that are missing. This medication optimisation process is one of the most impactful interventions in geriatric care.

Falls and Medicines: A Critical Safety Issue

Falls are the leading cause of injury-related hospitalisation in Indian elderly patients. Many commonly prescribed medicines independently increase fall risk: antihypertensives (orthostatic hypotension), benzodiazepines (sedation), antidepressants (balance impairment), antiepileptics (drowsiness), and alpha-blockers (blood pressure drop on standing). Reviewing and rationalising fall-risk medicines in every elderly patient is a geriatric care priority.

Kasdap Healthcare: Supporting Quality Care for India's Elderly

Kasdap Healthcare's distribution network supplies the full range of medicines required for elderly care — from chronic disease management products to geriatric nutritional supplements — ensuring consistent quality and availability for the growing population of older Indians who depend on daily medicines for their health and independence.