Guidelines for medical treatment and its safety in the elderly
2017 Volume 34 Issue 3 Pages 155-158
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2017 Volume 34 Issue 3 Pages 155-158
In 2015, the Japan Geriatrics Society published “Guidelines for medical treatment and its safety in the elderly 2015”. These guidelines described a revised list of potentially inappropriate medication, going through several processes of clinical questions, a systematic review, and formulated guidelines for applying the Grading of Recommendations Assessment, Development, and Evaluation system advocated by Minds 2014. These guidelines differ from conventional treatment guidelines in that safety is the main issue. This paper, referring to the guidelines, describes pharmacotherapy for insomnia, depression, and behavioral and psychological symptoms of dementia (BPSD) in the elderly.
Basically, it is important to perform non–pharmacotherapy before the pharmacotherapy for insomnia, depression, and BPSD in the elderly. It is also important to search for the causes of these symptoms and to treat them.
For pharmacotherapy for insomnia in the elderly, benzodiazepine drugs are in the list of drugs to be prescribed with special caution. However, non–benzodiazepine drugs also should be used with caution due to similar risks of fall and fracture. For elderly patients with depression, tricyclic antidepressants are in the list of drugs to be prescribed with special caution due to severe anticholinergic effects. SSRIs should be prescribed with special caution for patients who have a risk of gastrointestinal bleeding. Sulpride is in the list of drugs to be prescribed with special caution due to the adverse effects of Parkinsonism. It is reasonable to use cholinesterase inhibitors for depression, anxiety, and apathy, and use memantine for excitement and aggressive behavior in patients with Alzheimer's disease. Cholinesterase inhibitor is also useful for hallucination, delusion, and anxiety in patients with dementia with Lewy bodies. Typical anti–psychotics are in the list of drugs to be prescribed with special caution. Since atypical anti–psychotics have a risk of increase of stroke and mortality, they should be used at an effective minimum dosage and duration.
