Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Increasing numbers of prescribed medications correlate with frailty, falls and hospital admissions, and substantial numbers of older people’s admissions to hospital are caused by or related to their medications.
Medication Review Process
1. Obtain full medication history
a. Primary care prescription
b. Pharmacy dispensation history
c. Prescribed medications from other providers (eg private healthcare, from abroad)
d. Other medications taken (eg leftover tablets, medicines prescribed for others)
e. Herbal supplements, vitamins etc
f. Illicit drugs
2. Review medication use – in general and for each medication
a. In general:
i. “Are you good at remembering your pills?”
ii. “Can you swallow them OK?”
iii. “What are you most concerned about with your tablets?”
b.For each medication:
i. “Do you take this?”
ii. “How often?”
iii. “What for?”
iv. “Do you think it works?”
v. “Does it have any side effects?”
3. Review full drug list for pharmacological interactions or common side effects.
The STOPP list or equivalent is useful here, as well as the BNF or e-prescribing decision support to check for interactions. This will guide further questioning.
4. Obtain sufficient medical history and current disease status to assess appropriateness of prescribing and patient understanding, eg:
a. If on anti-anginals: “How often do you get angina?”
b. If there is a previous history of stroke: “You’re not taking a blood-thinner. Do you know why that is?”
c. If on painkillers: “This tablet is a painkiller. What type of pain do you use it for? Does it work?”
d. If possible issues identified eg on STOPP: “Do you suffer from constipation?”
The Medication Review is one of 5 sub-domains of the
The Medical Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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5. Review each medication for appropriateness given the medical history.
The MAI can be useful here, at least as a framework for evaluating the key issues related to each medication.
6. List and prioritise medication-related issues and discuss changes with the patient.
a. Any high-risk prescribing should be changed urgently
b. Patient priorities are very important to both guide the process and build trust
c. Changes should generally be introduced progressively over time unless there is a significant, urgent problem
d' New medications should also usually be introduced one-by-one (to avoid confusion if prescribing or de-prescribing causes new symptoms)
e. Reduce old medications gradually if necessary to avoid rebound effects (physiological or psychological dependence) and introduce new medications gradually too – start low and go slow.
f. Arrange to assess progress and, if necessary, make further changes in the future
This Read More page is an extension of Medication Review
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