Prescribing in Old Age Psychiatry
The general prescribing principles from both Old Age Psychiatrists and Geriatricians is to start at a low dose for a drug, and then titrate up slowly. A small dose for a general adult patient may be large than for an elderly patient, owing to co-existing factors such as low body mass index (BMI), kidney disease, liver disease, and polypharmacy. Medication choice should also be dictated by likely compliance, especially in light of cognitive impairment leading to unintentional overdose or suicidality. These patients often have a high pill burden and so like in a general hospital, can benefit from medicine reconciliation and optimisation. One way to do this can be by prescribing a modified release single dose of psychiatric medication, as opposed to repeated shorter-acting preparations.