Prescribing for elderly people is difficult because the risks of polypharmacy, adverse drug effects and drug interactions are all greater. In addition, the results of drug trials are often difficult to apply to elderly people.

Several key principles should be considered when prescribing for elderly people. Quality of life is the most relevant outcome. GPs should manage the whole of their patient’s treatment regimen, treating the disease process rather than the symptoms, being cautious before adding a new medication and closely monitoring for adverse effects.

Chronic pain is common in elderly people, however it is often unrecognised, treated sub-optimally or not treated at all. Regular analgesia such as paracetamol and opioids can be very effective in managing pain.

Depression in elderly people can be a significant cause of disability and is under-recognised and often complex to treat. A SSRI such as citalopram can be used initially for most depressed older people, in addition to psychological and other therapies.

Older people have a higher cardiovascular risk and therefore appear to have the most potential to benefit from risk reduction, however they are often also at risk of adverse drug events and drug interactions. The decision to treat must be made on a case by case basis, taking into account the likely benefits and risks, quality of life and what the patient wants.

• The “science” of anti-ageing – life expectancy, anti-ageing medicine and immortality.
• Alternative treatments for osteoarthritis – there is a lack of evidence of clinical effectiveness for most supplements, however glucosamine and ASU may hold promise.
• The placebo effect – how to explain why some things work when they shouldn’t.

When prescribing for older Māori people, it is important to take their views and beliefs into consideration and provide information about their medicines in a way that they can relate to. Bevan Clayton-Smith shares his experiences.