Abstract

The family doctor plays a special role in the health system. S/he looks mainly after chronically ill, elderly and multimorbid patients and strives to control the course of disease of these patients with the aid of their own multiple mostly pharmaco-therapies as well as those of other specialists. Evidence-based recommendations that support G.P’s in the therapy of their patients are lacking. Therefore, the Hesse Guidelines Group has put together these guidelines to support family doctor’s in the drug therapy of the aged. General rules for the management of age-associated diseases by family doctors are: Before prescribing medication for the elderly patient the family doctor is required to carry out a thorough check of the patient’s pharmacotherapy including self-medication and drugs prescribed by other doctors. Key questions for family doctors are: Is the therapy causal or symptomatic? Can therapy goals be arranged according to priority in order to avoid unnecessary medication? Which interactions and side effects must be expected? Does the patient understand and accept the prescription? Interface hospital: As a rule, the family doctor is in charge of managing the therapy and takes sole responsibility for the prescriptions after a patient has been discharged from hospital – (including economic and legal aspects). The framework for choosing medication in an out-patient environment differs from that in a hospital. Following-up the progress of therapy: The patient history (questions on previous incompatibilities, additional OTC-drugs taken, drugs prescribed by other doctors), progress checks and close observation of the effects determine the therapeutic approach because at any given time not all possible negative influences on the efficacy of the medication can be known. Elderly patients should always begin drug therapy with a low dose in order to reach the required maintenance dose (and steady-state) and which, as a rule, will be low without over-shooting.

Author Details

Authors

• F.W. Bergert
• D. Conrad
• K. Ehrenthal
• J. Feßler
• J. Gross
• K. Gundermann
• B. Kluthe
• W. Lang Heinrich
• A. Liesenfeld
• P.G. Loew
• E. Luther
• R. Pchalek
• J. Seffrin
• A. Sterzing
• H.-J. Wolfring
• U. Zimmermann

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