Optimal quality of medical care for geriatric patients requires access to the safest and most efficacious drugs for treatment of psychiatric disorders and syndromes. Closed or restricted formularies discriminate against geriatric patients when they limit access to the most appropriate, individualized treatment. Individuals in the later stages of life have biologic and psychologic characteristics distinct from those of younger persons. Aging and disease are associated with changes in pharmacokinetics and pharmacodynamics that can alter both the therapeutic and adverse effects of drugs in geriatric patients.
Geriatric patients are more vulnerable to the adverse effects of drugs.
Therefore, restricting the choice of psychotherapeutic drugs may expose older adults to a disproportionate risk of adverse effects. There is also evidence that medically ill elderly patients have greater differences in their responsiveness to treatment with different psychotherapeutic drugs. Limiting the choice of psychotropic drugs based on claims of comparable efficacy in the general adult population therefore discriminates against older adults. Determinations of cost efficiency for the purpose of drug formulary decisions must emphasize considerations of safety and tolerability, as well as therapeutic efficacy and treatment effectiveness, and other factors that affect treatment compliance and outcomes in geriatric patients. Although different psychotherapeutic drugs may be similar in therapeutic efficacy, they often differ significantly in their side effect profiles.