BCGP key terms

An expert-maintained list of medications considered potentially inappropriate for adults 65 and older, organized by drug class and clinical concern, used to guide safer prescribing and deprescribing decisions.

A drug whose risks generally outweigh benefits in older adults because of age-related sensitivity, limited evidence, or safer alternatives, prompting review rather than automatic discontinuation.

A European screening tool pairing explicit indicators for stopping inappropriate medicines (STOPP) with indicators for starting indicated medicines (START), used to structure medication review in older patients.

The systematic, supervised process of reducing or stopping medications whose harms now exceed benefits, planned with the patient and accompanied by monitoring for withdrawal effects or disease recurrence.

A sequence in which a drug's adverse effect is misread as a new illness, leading to another drug being added, which can compound risk and obscure the original cause.

The cumulative effect of multiple medications with anticholinergic activity, which can cause confusion, urinary retention, constipation, dry mouth, and falls in older adults.

Use of multiple medications at once, often defined as five or more, and clinically important when the regimen lacks indication, duplicates therapy, or creates interacting risks.

A more extreme medication count, commonly ten or more concurrent drugs, associated with higher risk of adverse events, hospitalization, and functional decline in older adults.

A structured comparison of a patient's full medication list across care settings to identify omissions, duplications, and dose errors, ideally completed at admission, transfer, and discharge.

The movement of a patient between settings such as hospital, rehabilitation, and home, a period of elevated risk for medication errors, information loss, and unplanned readmission.

Patient education delivered before leaving a care setting that covers each medication's purpose, dose, timing, expected effects, and whom to contact with problems.

Any harm or injury resulting from a medication, including errors in prescribing, dispensing, or administration, as well as predictable adverse effects and drug interactions.

A harmful response to a drug at normally used doses, classified as predictable (type A) or unpredictable (type B), and tracked when reporting to safety programs.

How the body handles a drug over time through absorption, distribution, metabolism, and elimination, each of which can change with aging and disease.

How drugs affect the body, including receptor sensitivity and homeostatic reserve, which in older adults can produce stronger or altered responses at the same drug concentration.

The apparent space into which a drug distributes relative to plasma concentration; age-related changes in body water and fat alter this value and thus loading and maintenance doses.

The time required for a drug's plasma concentration to fall by half, a value that lengthens with reduced clearance and predicts how quickly effects resolve after a dose change.

An estimate of kidney filtration derived from serum creatinine, age, sex, and weight, used to adjust doses of renally eliminated drugs in older adults.

Age-related loss of skeletal muscle mass and strength that reduces mobility, increases fall risk, and can alter drug distribution and nutritional status.

A syndrome of reduced physiologic reserve and vulnerability to stressors, often identified by unintentional weight loss, exhaustion, weakness, slow gait, and low activity.

A multidimensional evaluation of medical, functional, cognitive, psychological, and social status that produces an integrated care plan for an older adult.

A drop in blood pressure on standing, commonly defined as at least 20 mmHg systolic or 10 mmHg diastolic within three minutes, increasing fall and syncope risk.

The likelihood of an unplanned descent to the floor, increased by impaired gait, sedating or hypotensive drugs, vision problems, and environmental hazards, and assessed for prevention planning.

Transient loss of consciousness caused by insufficient cerebral blood flow on assuming an upright posture, often linked to volume depletion or antihypertensive therapy.

An irregular supraventricular rhythm with disorganized atrial activity that raises stroke risk and often requires anticoagulation, rate control, or rhythm control.

A point-based tool estimating stroke risk in atrial fibrillation using age, sex, heart failure, hypertension, diabetes, and prior stroke or vascular disease, guiding anticoagulation decisions.

Therapeutic prevention of clot formation with agents such as warfarin or direct oral anticoagulants, requiring assessment of bleeding risk, renal function, and adherence in older adults.

A heart failure syndrome with normal or near-normal ejection fraction but impaired filling, common in older adults and managed with diuretics, comorbidity control, and selected newer agents.

An acute, fluctuating disturbance of attention and awareness often triggered by infection, medications, pain, or metabolic derangement, requiring prompt identification of reversible causes.

A progressive decline in cognition that impairs daily function, distinguished from delirium by its chronic course, and affecting medication adherence, capacity, and drug sensitivity.

A potentially life-threatening toxicity from serotonergic drugs marked by agitation, tremor, clonus, hyperreflexia, and fever, requiring drug withdrawal and supportive care.

A gradual, planned dose reduction of a benzodiazepine or related sedative to limit withdrawal and rebound symptoms, ideally paired with behavioral support.

Abnormally low blood glucose, often defined as below 70 mg/dL, causing confusion, sweating, and falls, with higher risk in older adults using insulin or sulfonylureas.

An individualized blood glucose goal chosen for an older adult based on life expectancy, comorbidity, and hypoglycemia risk, often relaxed in frail or functionally limited patients.

Reduced bone mass and disrupted bone structure that raise fracture risk, managed with calcium, vitamin D, weight-bearing activity, and pharmacologic therapy.

Converting a patient from one opioid to another using equianalgesic estimates and then reducing for incomplete cross-tolerance, to improve analgesia or limit toxicity.

Infrequent or difficult bowel movements that are common in older adults and often worsened by opioids, anticholinergics, low fluid intake, and immobility.

Involuntary loss of urine that impairs function and quality of life, with causes including detrusor overactivity, sphincter weakness, medications, and mobility limitation.

The capacity to obtain, understand, and act on health information, which shapes how medication instructions and counseling should be delivered and confirmed.

A patient's voluntary agreement to treatment after receiving and understanding information about benefits, risks, and alternatives, supported by assessment of decision-making capacity.