Medication Use in Older Adults

Cardiovascular Medications

The European Society of Cardiology recommends antiplatelet agents, such as aspirin, for 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
The American Heart Association states that 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 2
Thiazide diuretics, such as chlorthalidone, are recommended as first-line medications for older adults with hypertension due to their superior efficacy in preventing heart failure and cardiovascular events 3
Calcium channel blockers, such as amlodipine, are among the top 20 most commonly prescribed medications in older adults and are recommended as first-line agents for hypertension management 1, 3
ACE inhibitors, such as lisinopril, and angiotensin receptor blockers, such as valsartan, are frequently prescribed for older adults with hypertension, heart failure, and diabetic nephropathy 1

The American Diabetes Association recommends metformin as 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 4, 5
The American Geriatrics Society states that sulfonylureas have been associated with greater risk of hypoglycemia in older adults, and this risk increases with age, making glyburide a medication to generally avoid in older adults with type 2 diabetes 4
Medications with low risk of hypoglycemia are preferred for older adults with diabetes, especially for those with hypoglycemia risk factors 7

Statins, such as atorvastatin, are among the most commonly prescribed medications in older adults and provide significant benefits in older patients with established arteriosclerosis 1, 6

The European Heart Journal notes that polypharmacy is common in older adults and increases the risk of adverse drug reactions, drug-drug interactions, and drug-disease interactions 1, 7
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 7, 8
Cost is an important consideration when prescribing for older adults, as they tend to be on many medications and often live on fixed incomes 7, 9
Adverse drug reactions in elderly adults account for more than 700,000 emergency department visits and 120,000 hospitalizations in the U.S. each year, with four medications or medication classes implicated in 67% of hospitalizations: warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents 10

Simplification of complex treatment regimens, especially insulin, is recommended to reduce the risk of hypoglycemia and decrease treatment burden in older adults 7
Medication regimens should be periodically reviewed and adjusted based on changes in renal function, cognitive status, and functional abilities 8, 9