In juxtaposition to past experience, there has been a shift in the leading causes of death from acute illness to chronic disease. Chronic conditions are defined as conditions lasting ≥1 year which require either ongoing medical attention or that limit activities of daily living [9]. In 2012, chronic diseases accounted for 68 % of all deaths with cardiovascular disease, cancer, chronic lung disease, and diabetes being most prevalent [10]. In the USA, the top ten causes of death among people aged 65 years and older are heart disease, malignancy, chronic respiratory disease, cerebrovascular disease, Alzheimer disease, diabetes, influenza and pneumonia, nephritis, unintentional injury, and septicemia [11].

The transition from acute to chronic illness as the leading cause of mortality represents a significant challenge for the healthcare system. Among individuals in the geriatric age group, chronic conditions are common, costly, and morbid. Three in four Americans age 65 years or older suffer from multiple chronic conditions [12]. Care for individuals with multiple chronic conditions accounts for 71 % of total healthcare spending in the USA, and, among elderly Medicare beneficiaries, this increases to 93 % of Medicare spending [13, 14]. With each chronic condition developed, the risk of impaired daily function, hospitalization, and premature death increases [12]. Over the next several decades, as continued growth in the number of elders with one or more chronic illnesses results in increasing strain on the healthcare system, providing high-quality, evidenced-based care will be critical to improving patient outcomes and minimizing financial burden.

As individuals are living longer and suffering from multiple chronic illnesses, many are taking numerous medications. This is reflected by the fact that elders comprise slightly more than 13 % of the population but consume 40 % of prescription medications and 35 % of over-the-counter drugs [15]. On average, individuals between 65 and 69 years of age take 14 prescriptions per year, and this increases to 18 per year among elders 80–84 years of age [15]. Unfortunately, increasing numbers of medications are associated with greater risk of adverse drug reactions and side effects. Among community dwelling elders, one in three taking ≥5 medications will have an adverse drug reaction within 1 year [16]. It is estimated that at least 350,000 adverse drug events occur annually in long-term care residents and more than half of these are preventable [17]. In addition, despite the implementation of Medicare Part D prescription drug benefits in 2006, drug costs continue to be a significant financial strain for many elders. This often leads to difficult decisions about how financial resources will be spent (i.e., food and rent versus medications) and medication noncompliance. When making medication decisions in the elderly, clinicians should incorporate the ethical principles of non-maleficence (not inflicting intentional harm) and beneficence (having the best interest of the patient at heart). Careful consideration should be given to the patient’s goals of medical care when considering the addition or discontinuation of any medication. In addition, the possible risks and benefits of all medications should be carefully reviewed so that patients can make an informed decision prior to starting any new therapy. Clinicians should have frank discussions with patients regarding the financial implications of their medication regimens and be open to considering lower-cost, alternative therapies or assisting patients in pursuing sources of reduced cost pharmaceuticals.