Prescribing psychotropics in older adults

Meet the patient

A frail 86-year-old in residential care is on nine regular medicines, including oxybutynin for urgency, diazepam "for nerves" for thirty years, quetiapine 25 mg "for sleep", and last month a GP added citalopram 20 mg for low mood. She has fallen three times this week and is now confused.[2][17][18]

Her sodium is 124 mmol/L, her QTc is 490 ms, and her anticholinergic burden score is off the page. Across the bay, an under-dosed 70-year-old with severe melancholic depression sits silently with a stockpile of paracetamol because his sertraline has never been titrated past 25 mg.[16][20]

The exam question that owns this topic: what exactly is wrong with both charts, and what will you do about it tonight? The first patient is over-sedated into harm; the second is under-treated into danger. Geriatric prescribing is the art of avoiding both.[1][5]

References20Show ledgerHide ledger

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