Guidelines for Medication for the Elderly Revised for the First Time in 10 Years: Toward Healthy Longevity Through Safe Medication Use [Japan Geriatrics Society]

Tama-chan and GG Yumeta's Witty Talk!! [Health

'Guidelines for Medication for the Elderly' Talk

Tama-chan:GG, I saw in the newspaper that the 'guidelines for medicine for grandpas and grandmas' have changed. What does that mean? It sounded kind of difficult and I didn't really understand it.

GG Yumeta:Oh, Tama-chan! You're as bright as ever to be interested in something that sounds so difficult. Shall I explain it to you in a way that's so easy it'll make you laugh?

Tama-chan:Making me laugh? You're already funny, GG! Yeah, tell me, tell me!

GG Yumeta:Alright, alright. Actually, unlike you young people, the bodies of grandpas and grandmas change little by little. For example, medicine might become too effective, or the body's ability to flush out medicine might weaken. Plus, as you get older, things start to break down here and there, so you end up taking many different kinds of medicine, right? This is called 'polypharmacy'.

Tama-chan:Poly-phar-ma-cy... that's a lot of kanji! Is that bad?

GG Yumeta:Yes, that's the tricky part. When you take a lot of medicine, the medicines can fight each other, or unexpected side effects can easily occur. To use an analogy, it's like putting chocolate or natto into the ramen you like. Huh? You wouldn't eat that? That's right, just imagining it makes it taste weird, doesn't it! Medicine is the same; instead of being good for the body, it can sometimes have a bad effect.

Tama-chan:Wow, ramen with natto is impossible! So, these guidelines are to make sure it doesn't become that weird ramen?

GG Yumeta:Exactly! As expected of you, Tama-chan, you're quick on the uptake! The Japan Geriatrics Society, which is made up of doctors who specialize in studying the bodies of grandpas and grandmas, has updated these 'Guidelines for Safe Pharmacotherapy for the Elderly' for the first time in 10 years. The goal is simply to ensure that grandpas and grandmas don't have trouble with their medicine or get into dangerous situations.

Tama-chan:Huh! 10 years is a long time! What kind of things are written in it?

GG Yumeta:Well, there are three main points. First, there is a list of 'medicines you should be a little careful with'. For grandpas and grandmas, there are medicines that should be used with caution, even if they are fine for young people. They have summarized that in an easy-to-understand way.

Tama-chan:I see, I see.

GG Yumeta:Second, there is a list of 'medicines you should take'. Sometimes, doctors are too cautious and don't prescribe medicine that should actually be taken. If that happens, the illness becomes harder to cure. So, this is about thinking carefully about that.

Tama-chan:It sounds like a game strategy guide!

GG Yumeta:Oh, Tama-chan, you put that well! It's exactly like that! And the third point is 'detailed precautions for each disease'. For example, for heart disease, diabetes, or dementia, which grandpas and grandmas often get, there are little tricks to using medicine. In this revision, it's written in detail not just for doctors, but also for pharmacists who handle medicine, and for medical care when grandpas and grandmas are living at home, in other words, 'home medical care'.

Tama-chan:Huh, so with this, my grandpa can take his medicine with more peace of mind!

GG Yumeta:That's right! And one more important thing, I want you to tell your grandpa and grandma too: 'Don't stop taking medicine on your own judgment'! Even if you think, 'Huh? Do I need this medicine?' or 'I feel a bit off,' it's always best to consult a doctor or pharmacist.

Tama-chan:Yeah! I got it! GG, your story was super interesting and easy to understand! Thank you!

GG Yumeta:You're very welcome! It makes me proud to hear you say that, Tama-chan. Now you're all set to take good care of your grandparents! If there's anything else you're curious about, feel free to ask me anytime! I'll be sure to tell you another joke that'll make you laugh.

Regarding the revision of the guidelines for pharmacotherapy in the elderly by the Japan Geriatrics Society, I will delve into related information and explain it using the following chapter structure.

[Detailed Explanation] Background and Importance of the Revision of Guidelines for Safe Pharmacotherapy in the Elderly

1. Introduction: Current Status of Pharmacotherapy for the Elderly

In an aging Japan, pharmacotherapy is essential for maintaining health, but changes in physiological functions due to aging, the presence of multiple diseases (multimorbidity), and the associated use of multiple medications (polypharmacy) increase the risk of adverse drug events. Compared to younger people, elderly individuals are more susceptible to the effects of drugs, and it has been reported that adverse drug events occur in 10-16% of hospitalized patients. Given this background, there has been a demand for guidelines for safe pharmacotherapy specifically tailored to the elderly.

2. Purpose and Background of the Guideline Revision

The Japan Geriatrics Society created its first guidelines in 2005 with the aim of improving the safety of drug therapy for the elderly. This revision (the 2025 edition), the first in 10 years, has evolved into more practical content by reflecting new evidence accumulated during that time and the needs of the medical field. The main purpose is to prevent adverse drug events and ensure that the elderly can receive safe and effective treatment.

Key Points and Content of the Guidelines

1. Basic Principles and Precautions for Pharmacotherapy in the Elderly

The guidelines emphasize points that require special attention in pharmacotherapy for the elderly. This includes strategies to avoid adverse drug events, appropriate medication management, and the importance of centralized medication management when visiting multiple medical institutions. Patients, their families, and caregivers are strongly advised not to stop taking medication on their own judgment and to always consult with a doctor or pharmacist.

2. Screening Tools for Prescribing Optimization

To prevent inappropriate prescriptions for the elderly and promote appropriate ones, the following two lists are provided.

• List of "Drugs Requiring Special Caution": This list specifically identifies drugs that carry a high risk of side effects in the elderly or require caution during use. Doctors are required to exercise greater caution when using these drugs.

• List of "Drugs to Consider Starting": To prevent undertreatment (failure to provide necessary treatment) for the elderly, this list suggests drugs and treatment methods that should be considered for initiation. This prevents patients from losing opportunities for treatment.

3. Domain-Specific Guidelines and New Items

These guidelines provide detailed pharmacotherapy guidance specialized for diseases and conditions commonly seen in the elderly. Examples include psychiatric disorders (insomnia, depression, dementia-related), neurological disorders (Parkinson's disease), respiratory diseases, cardiovascular diseases, hypertension, kidney disease, gastrointestinal diseases, diabetes, dyslipidemia, urological diseases, and musculoskeletal diseases. Furthermore, in addition to diabetes, dyslipidemia, kidney disease, and musculoskeletal diseases, the 2025 edition includes new items regarding home medical care, medical care in nursing facilities, and the role of pharmacists. This reflects the current situation where the living environments of the elderly are diversifying and the importance of medical collaboration is increasing.

Recommendations for Stakeholders and Future Outlook

1. Expectations for Healthcare Professionals

All healthcare professionals, including doctors, pharmacists, and nurses, are expected to use these guidelines as a reference to select and implement optimal pharmacotherapy after comprehensively evaluating each elderly person's condition (physical function, cognitive function, comorbidities, living environment, etc.). Professional intervention by pharmacists is considered effective in reducing adverse events associated with polypharmacy and lowering medical costs, and the importance of their role has been reaffirmed.

2. Collaboration with Patients, Families, and Caregivers

In pharmacotherapy for the elderly, it is essential to respect the patient's own wishes and living situation, and to maintain close communication with healthcare professionals. When patients, their families, and caregivers actively participate in treatment and share their questions and concerns, it leads to safer and more effective medication use. Since discontinuing medication on one's own judgment can increase health risks, it is important to always consult with a professional.

The revision of these guidelines is a major step toward ensuring that the elderly can receive pharmacotherapy with peace of mind and lead healthy lives.

References:

• Guidelines for Medication in the Elderly Revised by the Japan Geriatrics Society for the First Time in 10 Years - 47NEWS

• Guidelines for Safe Pharmacotherapy for the Elderly 2025 - Medical View Co., Ltd.

• Guidelines for Safe Pharmacotherapy for the Elderly - Japan Geriatrics Society (PDF)

• Pharmacotherapy Guidelines | Healthy Longevity Net

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