Table 1.

Actions to consider when reviewing the medications of extreme elderly patients

ACTIONSAGENTS
Initiate or maintain these agents

  • ASA for secondary prevention only

  • Bisphosphonates in case of elevated FRAX or CAROC scores

Modify these agents

  • Oral hypoglycemic agents in presence of asymptomatic hyperglycemia < 14 mmol/L and tolerating HbA1c level of ≤ 8.5%

  • Antihypertensive agents if BP level is < 150/90 mm Hg in the presence of risk factors such as kidney injury, electrolyte imbalance, falls, and orthostatic hypotension

Suspend these agents

  • Long-term PPI use without clear indication

  • Statins both for primary and secondary prevention

  • ASA—acetylsalicylic acid, BP—blood pressure, CAROC—Canadian Association of Radiologists and Osteoporosis Canada, FRAX—Fracture Risk Assessment Tool of the World Health Organization, HbA1c—hemoglobin A1c, PPI—proton pump inhibitor.

  • Data from Ricard and Nabid,9 and the Diabetes Canada Clinical Practice Guidelines Expert Committee.10