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