Most Common Medications Prescribed to Older Adults
Cardiovascular medications, antidiabetic agents, and statins are the most commonly prescribed medications in older adults, with specific agents including aspirin, atorvastatin, metformin, lisinopril, and amlodipine leading the list. 1
Cardiovascular Medications
Antiplatelet agents (aspirin, clopidogrel) are among the most frequently prescribed medications in older adults due to the high prevalence of cardiovascular disease, which affects 65-70% of persons aged 60-79 and 79-86% of those aged ≥80 years 1
Antihypertensives are extremely common, as hypertension affects approximately 70% of adults 75 years and older, making it the most prevalent modifiable cardiovascular risk factor in this population 1
Thiazide diuretics (particularly chlorthalidone) are recommended as first-line medications for older adults with hypertension due to their superior efficacy in preventing heart failure and cardiovascular events 2
Calcium channel blockers (amlodipine) are among the top 20 most commonly prescribed medications in older adults and are recommended as first-line agents for hypertension management 1, 2
ACE inhibitors (lisinopril) and angiotensin receptor blockers (valsartan) are frequently prescribed for older adults with hypertension, heart failure, and diabetic nephropathy 1, 3
Beta-blockers (metoprolol, atenolol) are commonly prescribed for older adults with cardiovascular conditions, though they are less effective than diuretics for prevention of stroke and cardiovascular events in elderly patients 1, 2
Diabetes Medications
Metformin is the preferred first-line agent for older adults with type 2 diabetes unless contraindicated, due to its effectiveness, safety profile, and low risk of hypoglycemia 1, 4
Special consideration is needed when prescribing metformin to older adults as its pharmacokinetics change with aging, primarily due to changes in renal function 5
Sulfonylureas have been associated with greater risk of hypoglycemia in older adults, and this risk increases with age. Glyburide specifically should generally be avoided in older adults with type 2 diabetes due to high hypoglycemia risk 1, 6
For older adults with diabetes, medications with low risk of hypoglycemia are preferred, especially for those with hypoglycemia risk factors 1
Lipid-Lowering Medications
Statins (atorvastatin, simvastatin) are among the most commonly prescribed medications in older adults 1
Statin therapy provides significant benefits in older patients with established arteriosclerosis, with greater absolute risk reductions compared to younger patients due to higher baseline risk 4
Plasma concentrations of atorvastatin are approximately 40% higher for Cmax and 30% higher for AUC in healthy elderly subjects (age ≥65 years) compared to young adults 7
Prescribing Considerations for Older Adults
Polypharmacy (use of multiple medications) is common in older adults and increases the risk of adverse drug reactions, drug-drug interactions, and drug-disease interactions 1
Overtreatment is common in older adults and should be avoided, particularly for diabetes medications where deintensification may be appropriate for those at high risk of hypoglycemia 1
Cost is an important consideration when prescribing for older adults, as they tend to be on many medications and often live on fixed incomes 1
Adverse drug reactions in elderly adults (aged 65 years or older) account for more than 700,000 emergency department visits and 120,000 hospitalizations in the U.S. each year 1
Four medications or medication classes are implicated in 67% of hospitalizations for adverse drug reactions in older adults: warfarin (33.3%), insulin (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%) 1
Special Considerations
For older adults with multiple chronic conditions, cardiovascular drugs (β-blockers, calcium channel blockers, RAS blockers, and statins) are associated with reduced mortality for their indicated conditions 8
Simplification of complex treatment regimens, especially insulin, is recommended to reduce the risk of hypoglycemia and decrease treatment burden in older adults 1
Medication regimens should be periodically reviewed and adjusted based on changes in renal function, cognitive status, and functional abilities 1