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What doctors need to know: prescribing or not for the oldest old.

Kydd, Angela; Fleming, Anne


Anne Fleming


Given the global increase in the number of people over the age of 85, there is a growing body of work concerning this group, termed the oldest old. Much of this work is confined to the literature specialising in geriatrics and the more generic health care papers refer to ‘older people’ with little definition of what is meant by ‘older’. Iatrogenesis (ill health caused by doctors) is a major issue and general practitioners (GPs) need practical help in prescribing for the oldest old. This paper presents a narrative review of the literature on prescribing and the oldest old. The results showed that all papers sourced referred to prescribing for the ‘old’ as those aged over 65, with only scant mention of oldest old. Yet prescribing for the oldest old involves clinical judgement and knowledge of the patient. It includes weighing up what will do good, cause no harm and is acceptable to the individual. GPs have to make treatment choices mostly in isolation from colleagues, during time-limited consultations and with few relevant guidelines on managing multi-morbidities in the oldest old. A major issue in prescribing for people over the age of 85 is that guidelines for diseases are based on trials with younger adults, outline the best practice for one disease in isolation (i.e. not in the presence of other diseases) and take little account of the interactions between the drugs used in managing several diseases in frail older people. There is a growing body of work, however, calling for specialist services for the oldest old.


KYDD, A. and FLEMING, A. 2016. What doctors need to know: prescribing or not for the oldest old. Maturitas [online], 90, pages 9-16. Available from:

Journal Article Type Article
Acceptance Date May 3, 2016
Online Publication Date May 4, 2016
Publication Date Aug 31, 2016
Deposit Date Feb 28, 2020
Publicly Available Date Feb 28, 2020
Journal Maturitas
Print ISSN 0378-5122
Electronic ISSN 1873-4111
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 90
Pages 9-16
Keywords Oldest old; Iactrogenesis; Polypharmacy; Primary care; Prescribing; Frail elderly; GP assessment
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