Guidelines for Medical Treatment and Its Safety in the Elderly

Abstract

“Guidelines for medical treatment and its safety in the elderly 2015” described a revised list of potentially inappropriate medications, going through several processes of clinical questions, and a systematic review. This paper, referring to the guidelines, describes treatments for mental symptoms such as insomnia, depression, and behavioral and psychological symptoms of dementia（BPSD）in the elderly.

It is important to keep in mind that non-pharmacotherapy should be performed before pharmacotherapy for symptoms in the elderly. It is also important to search for the causes of the symptoms and to manage them.

For pharmacotherapy of insomnia in the elderly, benzodiazepine drugs should be prescribed with special caution. Non-benzodiazepine drugs should also be used with caution due to similar risks of fall and fracture. For elderly patients with depression, tricyclic antidepressants should be prescribed with special caution due to severe anticholinergic effects. It is necessary to bear in mind that SSRIs pose a risk of gastrointestinal bleeding. Sulpiride should be prescribed with special caution due to the adverse effect of Parkinsonism. It is reasonable to monitor the effects of cholinesterase inhibitors and memantine on BPSD in patients with Alzheimer’s disease. Typical anti-psychotics be avoided, and atypical antipsychotics should be used at an effective minimum dosage and duration.