Consider adverse drug events for any new symptom 

 Before adding a new therapy to the patient's drug regimen, clinicians should carefully consider whether the development of a new medical condition could be the presentation of an atypical adverse drug effect to an existing drug therapy. Many prescribing cascade scenarios have been identified

Consider nonpharmacologic approaches 

Some conditions in older adults may be amenable to lifestyle modification in lieu of pharmacotherapy. The Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated that weight loss and reduced sodium intake could allow discontinuation of antihypertensive medication in about 40 percent of the intervention group

Substitute with safer alternatives 

 When drug therapy is indicated for the older patient, it may be possible to substitute a safer alternative for the current regimen. As an example, in treatment of non-inflammatory arthritis, paracetamol may provide adequate pain relief and be a safer alternative to NSAIDs . Numerous studies have documented adverse events associated with NSAID use in older persons, including gastrointestinal bleeds , renal impairment , and heart failure

Reduce the dose 

 Many adverse drug events are dose-related. When prescribing drug therapies it is important to use the minimal dose required to obtain clinical benefit. Relative to those dispensed a low-dose, those dispensed a high-dose were more than twice as likely to develop parkinsonism .

Simplify the dosing schedule 

 When multiple medications are required, greater regimen complexity will increase the likelihood of poor compliance or confusion with dosing. Older adults, and particularly those with low health literacy, are not able to efficiently consolidate prescription regimens to optimize a dosing schedule. A standardized schedule for specifying medication dosing (morning, noon, evening, bedtime), recognises that 90 percent of prescriptions are taken four or fewer times daily .

Simplifying the medication dosing schedule, when possible, is also important in the long-term care setting where nursing staff and time requirements for medication administration are substantial. A study illustrated that within a seven-hour shift, on a 20-bed unit, with two scheduled periods of medication administration, the process of administering medications to the residents accounted for a third of the nursing time . This makes the nurse less available for other important patient care tasks.

Prescribe beneficial therapy 
The fewer-the-better approach to drug therapy in older adults is often not the best response to optimizing drug regimens. Avoiding medications with known benefits to minimize the number of drugs prescribed is inappropriate. Patients must be informed about the reason to initiate a new medication, and what the expected benefits are.