Be watchful for medications started at a younger age that have never been adjusted for patient aging or changes in renal and hepatic function.

Medications required in the short-term setting (e.g., hospital) are often not needed in the long-term setting, or they can be used at a much lower dose. The dose for a loop diuretic, for instance, may need to be increased fourfold or more in the hospital setting, yet the baseline dose is often sufficient once the acute crisis has passed.

Avoid adding medications to treat an adverse effect of another medication. The preferred options are to decrease the dose, discontinue the medication, or, if necessary, change to a different medication.

Ask about self-medication with over-the-counter and herbal medications, which can interact with prescribed medications.

Do not automatically increase the dose of a medication because of a subtherapeutic level or suboptimal response without first verifying adherence to therapy.

Identifying an adverse drug event in older adults may be difficult because of atypical presentations or because the symptoms are being attributed to the disease; for example, altered mental status may be attributed to dementia, delirium, or forgetfulness when prescribed medications are the true cause.

When prescribing medications, use those with a wide therapeutic window.

Review medication lists regularly and reconcile them to the patient's problem list to discontinue duplicate therapies, adjust doses and dosing frequency, and discontinue unnecessary medications (i.e., issue is no longer a problem).

Set an end date and use objective criteria to determine the success or failure of an empiric trial and act accordingly. Do not continue these medications, particularly those used for pain, behavior, and cognition, indefinitely.

“Start low and go slow” in dosing new medications.

Set up regular visits (e.g., every two to four weeks), including appropriate laboratory testing, to monitor medication use in patients with multiple comorbidities.

Avoid starting two new medications in the same patient at the same time.

Regularly use a standardized method to review patient medications (e.g., the Beers, STOPP, and START criteria), including when the patient has a change in function (sentinel event) or problems with his or her medication.