Geriatric Psychopharmacology in Acute Settings

Background: Pharmacological management of geriatric patients in acute settings is complex due to the presence of medical comorbidities, risk of drug-drug interactions, and potential patient sensitivity to side effects. Objectives: This article will review the basic pharmacologic principles of management of older adults in acute settings. Method: The aforementioned principles will be described and illustrated with two clinical examples. These principles include prioritizing the safety of patients and staff; obtaining a history that is as complete as possible, in order to support the working diagnosis; using the lowest medication dose that controls the symptoms; closely monitoring for side effects and drug-drug interactions; minimizing polypharmacy and discontinuing medications that are no longer necessary; double-checking all orders, so as to avoid medication errors; and involving the patients family and caregivers in treatment planning. Additionally, agents with anticholinergic properties, antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, and opioids should be used cautiously in older individuals, particularly those with dementia. Practical tips, formulations, dosages, and selected adverse effects of antipsychotics and mood stabilizers used with geriatric patients in acute settings are included. Results: This clinical review will be useful for psychiatrists and other clinicians who treat older adults in acute medical settings.