Drugs & Aging最新文献

{"title":"External Validation of a Community Pharmacy-Based Screening Tool for Frailty That Uses Routinely Collected Data.","authors":"Marie Carrein, Johan Van der Heyden, Els Mehuys, Mirko Petrovic, Koen Boussery","doi":"10.1007/s40266-026-01307-8","DOIUrl":"10.1007/s40266-026-01307-8","url":null,"abstract":"<p><strong>Background: </strong>Frailty increases the risk of medication-related harm in older adults, emphasising the importance of early detection of drug-related problems during medication reviews. A new frailty screening tool, using electronic pharmacy data on age, sex, preferential reimbursement of medical expenses, number of chronic medications and medication use, offers a practical solution for community pharmacists to identify this risk group.</p><p><strong>Objective: </strong>In this study, we aimed to externally validate this tool.</p><p><strong>Methods: </strong>For this external validation, data of community-dwelling participants with available frailty status from the HISLink project were used. This database contains data from the national Health Interview Survey 2018, a cross-sectional population survey conducted by Sciensano, linked to health insurance data (i.e. claims data from the Belgian Compulsory Health Insurance, which includes records on reimbursed healthcare utilisation and medication, and level of reimbursement of medical expenses). The Health Interview Survey 2018 database also contains frailty status assessed using SHARE-FI, which was used to evaluate the frailty screening tool's model performance and predictive accuracy. Logistic recalibration was applied to account for differences in baseline risk and predictor effects, between the development and validation cohorts. A subgroup sensitivity analysis was conducted.</p><p><strong>Results: </strong>Of the 2191 (mean age 74.4 ± 7.2 years, 53.5% female) participants, 20.7% were frail according to SHARE-FI. The screening tool detected 31.6% as frail. Discrimination was good with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval 0.74-0.79), sensitivity of 63.9% and specificity of 76.8% (positive predictive value 41.8% and negative predictive value 89.1%). Calibration was initially modest (Brier score of 0.17) but improved substantially after logistic recalibration (Brier score of 0.13). In the subgroup of individuals with polypharmacy, an area under the receiver operating characteristic curve of 0.72 (95% confidence interval 0.68-0.76) was reported with sensitivity of 76.6% and specificity of 55.6% (positive predictive value 49.3%; negative predictive value 80.8%).</p><p><strong>Conclusions: </strong>The frailty screening tool provides a valid and reliable method for identifying older adults at risk for being frail in the community pharmacy. Its previously observed good performance is confirmed through external validation using data from the HISLink project.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"647-655"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting the Geriatric Medicine 5Ms Framework to Geriatric Dermatology.","authors":"Karolina D Perez, Diane Hong, Xiaochen Zhong, Anne Lynn S Chang, Justin Endo, Daniel C Butler","doi":"10.1007/s40266-026-01309-6","DOIUrl":"10.1007/s40266-026-01309-6","url":null,"abstract":"<p><p>Older adults represent a growing proportion of dermatology patients, yet their care is complicated by multimorbidity, cognitive vulnerability, polypharmacy, functional decline, and competing health priorities. The Geriatric 5Ms framework (Mind, Mobility, Medications, Multi-Complexity, and Matters Most) offers a structured, patient-centered approach to address these challenges. This review applies the 5Ms to the management of common dermatoses in older adults, highlighting cognitive-regimen mismatch and preservation of autonomy (Mind), fall-risk and physical limitations affecting treatment feasibility (Mobility), polypharmacy and prescribing cascades (Medications), multimorbidity and caregiver context (Multi-Complexity), and alignment of care with patient goals (Matters Most). Integrating the 5Ms into dermatologic practice can enhance safety, preserve function, and align treatment with individual priorities.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"543-557"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of Prescribing Appropriateness Criteria (PAC) for Sri Lankan Older Adults.","authors":"Maneesha P Godakanda Arachchige, Rebekah J Moles, Sarath Lekamwasam, Margaret Jordan, Benjamin J Basger, Shukry Zawahir, Timothy F Chen","doi":"10.1007/s40266-026-01305-w","DOIUrl":"10.1007/s40266-026-01305-w","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate prescribing in Sri Lankan older adults, contributes to adverse drug events, hospital admissions and increased healthcare expenditure. Although international tools exist to assess prescribing appropriateness in older adults, their direct application in Sri Lanka is limited by differences in clinical practices, resource constraints and variability in medicine availability.</p><p><strong>Objective: </strong>We aimed to develop and validate country-specific prescription appropriateness criteria for Sri Lankan older adults, focusing on prevalent diseases.</p><p><strong>Methods: </strong>A literature review was conducted to develop a preliminary list of criteria, which was scrutinised by three internal reviewers. The criteria were then validated using the RAND/UCLA Appropriateness Method (RAM). A multidisciplinary Sri Lankan panel (medical specialists, hospital pharmacists and pharmacy academics) completed three rounds of ratings involving 15, 11 and 7 panellists, respectively.</p><p><strong>Results: </strong>The preliminary list contained 38 criteria; all were rated appropriate in round one, with clarity amendments suggested for seven criteria. Two additional criteria were proposed and accepted, producing a final set of 40 criteria. The criteria most frequently addressed medicines used for cardiovascular disease and diabetes mellitus, with additional focus on pain, musculoskeletal and bone health, asthma and neuropsychiatric disorders. Criteria not commonly included in international tools covered gabapentinoid prescribing for pain with renal dose adjustment, corticosteroid-associated glycaemic monitoring with antihyperglycaemic dose adjustment and blood monitoring requirements for methotrexate therapy.</p><p><strong>Conclusions: </strong>These criteria provide a context-specific framework to support safer prescribing for older adults in Sri Lanka. Their integration into clinical practice and pharmacist-led medication reviews could reduce medication-related problems and improve outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"621-646"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Ciprofol Versus Propofol for Anesthesia in Older Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Wenbo Gao, Qinru Yang, Yungong Wang, Hanqi Wang, Ming Yao","doi":"10.1007/s40266-026-01306-9","DOIUrl":"10.1007/s40266-026-01306-9","url":null,"abstract":"<p><strong>Background and objective: </strong>Propofol is widely used in clinical anesthesia, but its cardiorespiratory depressive effects may limit its safety in older patients. With the growing number of older adults requiring anesthesia, ciprofol has attracted interest because of its higher potency and relatively mild hemodynamic impact. This meta-analysis evaluated the efficacy and safety of ciprofol compared with propofol in older patients undergoing general anesthesia or painless endoscopy.</p><p><strong>Methods: </strong>We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science up to 7 November, 2025, to identify eligible studies. All statistical analyses were performed using RevMan 5.4 and R version 4.5.1.</p><p><strong>Results: </strong>A total of 12 randomized controlled trials involving 2027 older participants were included. For safety outcomes, ciprofol significantly reduced the incidence of hypotension (risk ratio = 0.76, 95% confidence interval 0.68-0.84; p < 0.00001) and injection pain (risk ratio = 0.16, 95% confidence interval 0.09-0.26; p < 0.00001) compared with propofol. No significant differences were observed between the two agents in the incidence of bradycardia, hypoxemia, and postoperative nausea and vomiting. Regarding efficacy outcomes, ciprofol was associated with a longer time to loss of consciousness compared with propofol (mean difference = 4.67 seconds, 95% confidence interval 0.65-8.70; p = 0.02), while no significant differences were observed in anesthesia success rate, procedure completion rate, and awakening time.</p><p><strong>Conclusions: </strong>Based on the currently available evidence from randomized trials conducted in China, ciprofol showed comparable efficacy to propofol and was associated with lower incidences of hypotension and injection pain in older patients. These findings may still be informative for anesthetic management in broader settings, although further validation is needed.</p><p><strong>Clinical trial registration: </strong>PROSPERO registration number: CRD420251179366.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"587-603"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-Directed Heart Failure Pharmacotherapy in Adults Aged ≥75 Years: Evidence Gaps, Tolerability, and Implications for Clinical Practice.","authors":"Rémi Esser, Olivier Maurou, Marine Larbaneix, Alejandro Mondragon, Marlène Esteban, Christine Farges, Vincenzo Palermo, Nicolas Pages, Sophie Nisse Durgeat, Marc Harboun","doi":"10.1007/s40266-026-01302-z","DOIUrl":"10.1007/s40266-026-01302-z","url":null,"abstract":"<p><p>Heart failure predominantly affects older adults, yet the evidence supporting guideline-directed medical therapy is largely derived from randomized controlled trials predominantly enrolling younger and less frail populations. Adults aged ≥75 years remain underrepresented, raising important questions regarding the generalizability of trial evidence to contemporary geriatric practice. This review focuses on the applicability, tolerability, and clinical relevance of guideline-directed medical therapy in adults aged ≥75 years, with particular attention to objective outcomes and feasibility markers such as adverse events, treatment discontinuation, hospitalization, mortality, frailty-related vulnerability, and patient-centred functional implications. We conducted a structured narrative critical review of pivotal randomized controlled trials underpinning modern heart failure pharmacotherapy, without formal systematic selection or meta-analysis. Published data were extracted on age distribution, exclusion criteria relevant to older adults, efficacy outcomes (mortality and hospitalization when reported), safety outcomes (hypotension, renal dysfunction, hyperkalaemia, and treatment discontinuation), and geriatric domains or frailty-related measures when available. Trial findings were interpreted through established geriatric frameworks, including frailty and multimorbidity constructs. Across major heart failure trials, mean participant age ranged from 61 to 67 years, with very limited inclusion of patients aged ≥75 years and very limited representation of patients aged ≥80 years. While relative treatment efficacy appears preserved with ageing, older participants experienced higher rates of hypotension, renal dysfunction, and treatment discontinuation, whereas frailty, functional status, cognition, and other geriatric domains were rarely measured. Key geriatric domains-frailty, functional status, cognition, nutrition, and polypharmacy-were systematically absent from trial designs. This narrative review highlights a persistent gap between clinical trial populations and older patients with heart failure in routine care. In adults aged ≥75 years, application of guideline-directed medical therapy should remain evidence-aligned but clinically adapted, with slower titration, closer monitoring, and acceptance of tolerated submaximal doses when frailty, multimorbidity, or limited physiological reserve reduce treatment feasibility.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"605-620"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Treatment for Hyperuricemia: The Drug Pipeline.","authors":"Austin Barry, Lindsay N Helget, Ted R Mikuls","doi":"10.1007/s40266-026-01313-w","DOIUrl":"10.1007/s40266-026-01313-w","url":null,"abstract":"<p><p>Gout is the most prevalent inflammatory arthritis worldwide and disproportionately affects older adults, who frequently have comorbid conditions such as chronic kidney disease and cardiovascular disease that lead to polypharmacy and complicate both urate-lowering therapy (ULT) and management of acute flares. Although treat-to-target ULT (lowering and maintaining serum uric acid levels below 6 mg/dL) remains the cornerstone of gout care, a subset of patients fail to achieve serum urate goals owing to intolerance, contraindications, or inadequate response with available agents. This narrative review summarizes current and emerging pharmacologic therapies for gout with a focus on ULT in clinical development and their relevance to aging populations. In addition to ongoing studies of novel xanthine oxidase inhibitors (XOI), the development of highly selective urate transporter 1 (URAT1) inhibitors underscores a renewed interest in uricosuric therapy. Agents such as dotinurad have demonstrated effective urate lowering with favorable renal and hepatic safety profiles in older individuals, including patients with chronic kidney disease, suggesting potential advantages in this higher-risk population. Likewise, novel uricase-based strategies, including immune-tolerizing platforms such as nanoencapsulated sirolimus plus pegadricase (NASP), aim to overcome immunogenicity and treatment burden associated with pegloticase. Novel agents targeting the NLRP3 inflammasome and IL-1β appear to have promise for anti-inflammatory prophylaxis and flare treatment that are integral to effective ULT. Currently, with several next-generation agents in late-phase trials, efforts will be needed to enhance the generalizability of these studies to older patients with comorbidity that are common to real-world gout care.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"559-570"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Real-World Data for Clinical Decision Making in Geriatric Oncology.","authors":"Adolfo González-Serrano, Charline Jean, Capucine Baldini, Enrique Soto-Perez-de-Celis","doi":"10.1007/s40266-026-01314-9","DOIUrl":"10.1007/s40266-026-01314-9","url":null,"abstract":"<p><p>Older adults represent most patients with cancer worldwide, yet they remain substantially underrepresented in randomized clinical trials (RCTs), limiting the evidence available to guide treatment decisions in this growing population. Real-world data (RWD), defined as data routinely collected from clinical practice such as electronic health records, administrative claims, clinical registries, wearable devices, and patient-reported outcomes, offer an opportunity to complement traditional trial evidence. In this narrative review, we aimed to synthesize the potential benefits, limitations, and considerations in leveraging RWD for clinical decision making in geriatric oncology. When analyzed rigorously, RWD can generate real-world evidence (RWE) that reflects the heterogeneity of patients seen in routine care and provides insights into treatment patterns, safety, effectiveness, healthcare utilization, and patient-centered outcomes. In geriatric oncology, these data sources are particularly valuable for capturing multidimensional health profiles that extend beyond chronological age, including comorbidities, functional status, and social determinants of health. RWD can also help characterize healthcare trajectories, identify predictors of treatment tolerance and toxicity, and evaluate outcomes such as quality of life and resource utilization. However, important challenges remain, including issues related to data quality and standardization, confounding and bias inherent to observational analyses, ethical considerations surrounding data sharing, and difficulties integrating RWE into clinical decision making. Advances in artificial intelligence, global data networks, regulatory acceptance of RWE, decentralized clinical trials, and expanded data infrastructure may further enhance the role of RWD in oncology. When used rigorously, RWE can help fill evidence gaps and support more personalized care for older adults with cancer.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"571-585"},"PeriodicalIF":4.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Non-interventional Changes of the FORTA Score are Associated with Changes of Cognitive and Physical Function Tests in Community-Dwelling Older People.","authors":"Farhad Pazan, Julia Knorr, Christel Weiss, Kathrin Heser, Alexander Pabst, Melanie Luppa, Birgitt Wiese, Horst Bickel, Siegfried Weyerer, Michael Pentzek, Hans-Helmut König, Christian Brettschneider, Dagmar Lühmann, Marion Eisele, Wolfgang Maier, Martin Scherer, Steffi G Riedel-Heller, Michael Wagner, Martin Wehling","doi":"10.1007/s40266-026-01301-0","DOIUrl":"10.1007/s40266-026-01301-0","url":null,"abstract":"<p><strong>Background: </strong>Listing tools were found to ameliorate drug treatment in older people; the FORTA (Fit-fOR-The-Aged) list is a clinically validated positive-negative list of medication appropriateness. Here, we retrospectively analyze longitudinal correlations between the FORTA score and key measures of physical and cognitive function in older people.</p><p><strong>Methods: </strong>504 participants of a multi-center cohort study (AgeCoDe/AgeQualiDe) for whom the FORTA score (sum of over- and under-treatment errors) had been assessed were studied at three follow-up (FU) time points (FU 6-8; mean age range 87.9-89.7 years); comparisons between data at these FUs separated by 10 months were available for 292-328 patients.</p><p><strong>Results: </strong>The univariate analysis of the association between FORTA_Delta_76 (change of FORTA score between FU 6 and 7) and ADL (Activities of Daily Living)_Delta_76 (- 0.155, p < 0.01) and between FORTA_Delta_76 and MMSE (Mini-Mental State Examination)_Delta_76 (- 0.203, p < 0.01) revealed significant correlations. Multivariable analysis (using a forward selection model, p < 0.05) revealed a significant association between FORTA_Delta_76 and MMSE_Delta_76 (p < 0.05). Univariate analyses for other comparisons were only significant for FORTA_Delta_86 and MMSE_Delta_86.</p><p><strong>Conclusion: </strong>This study indicates that longitudinal non-interventional changes of the FORTA score as an integral index of medication appropriateness are associated with changes in ADL and MMSE: the lower this score the better the functional outcome. These findings are in line with earlier interventional data and underscore the potential of FORTA to improve clinical endpoints in older people.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"507-516"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Mirabegron in Frail Older Adults with Overactive Bladder.","authors":"Christina Shaw, Adrian Wagg","doi":"10.1007/s40266-026-01300-1","DOIUrl":"10.1007/s40266-026-01300-1","url":null,"abstract":"<p><p>Overactive bladder (OAB) is a commonly occurring condition in older adults that has significant consequences on health and quality of life. In later life, many older adults also live with frailty, a condition characterized by vulnerability to insult and associated with a lesser probability of a full recovery. Frail older adults comprise a distinct group of older adults, often living with complex comorbid disease. There is a bidirectional relationship between frailty and OAB, though causation has not been established. β₃-Adrenoreceptor agonists like mirabegron offer a pharmacological alternative over antimuscarinics, which may be associated with intolerable side effects in older patients. While mirabegron has demonstrated efficacy and tolerability in community-dwelling older adults, prospective studies on its use in frail older adults remain limited. Here, we review available evidence on use of mirabegron in older adults and frail older adults, including safety, tolerability and efficacy. Evidence suggests that mirabegron has favourable safety and side effect profiles, decreases OAB symptoms, and improves quality of life. Mirabegron remains an acceptable alternative to antimuscarinic treatment in older adults and frail older adults.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"485-493"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalisation as an Opportunity to Optimise Quality Use of Medicines in Older Adults: A Systematic Review.","authors":"Crystal R Ucarer, Gregory M Peterson, Colin M Curtain, Mohammed S Salahudeen","doi":"10.1007/s40266-026-01299-5","DOIUrl":"10.1007/s40266-026-01299-5","url":null,"abstract":"<p><strong>Background: </strong>Hospitalisation represents an opportunity to optimise medication therapy in patients at high risk of medication-related harm. Quality Use of Medicines (QUM) activities are typically incorporated into routine care, yet their impact as part of usual inpatient practice has not been comprehensively synthesised.</p><p><strong>Objective: </strong>The aims of this systematic review were to determine the extent to which hospitalisation serves as an opportunity for improving QUM in older adults receiving usual inpatient care, explore barriers and facilitators influencing the implementation and sustainability of QUM activities during hospitalisation, and identify which components of usual care most effectively improve medication appropriateness and safety.</p><p><strong>Methods: </strong>We conducted a systematic review of observational studies, identified using Medline, Embase, and International Pharmaceutical Abstracts, from January 2010 to May 2025. Eligible studies included older adults (≥ 65 years) admitted to hospital for at least 24 hours, where healthcare professionals delivered QUM-related activities as part of usual care during hospitalisation. Measurable changes in medications between admission and discharge using QUM indicators were reported. Methodological quality was assessed using the Joanna Briggs Institute (JBI) cohort checklist and findings were synthesised narratively.</p><p><strong>Results: </strong>Twenty-one studies met the inclusion criteria. Nineteen were rated as high quality and two as moderate quality. All studies evaluated changes in prescribing, most commonly using explicit tools such as the Beers criteria, Screening Tool to Alert to Right Treatment and guideline-based assessments of therapy. Ten studies showed usual care led to improvements in QUM indicators, including reduction in potentially inappropriate medicines (PIM) in settings with strong multidisciplinary involvement and structured medication reviews. However, 11 studies reported that QUM did not improve, with persistent or increased PIM use and polypharmacy at discharge. Factors contributing to ongoing QUM problems included limited clinician awareness, fragmented communication, inadequate documentation, constrained resources, poor integration of pharmacists, and variable use of QUM tools.</p><p><strong>Conclusion: </strong>Hospitalisation represents an important but inconsistently realised opportunity to optimise QUM in older adults. Inappropriate prescribing and polypharmacy frequently persist at discharge, indicating missed opportunities within usual care. System-level strategies embedding structured medication reviews, pharmacist involvement, explicit QUM tools, and robust documentation into routine practice may enhance medication safety.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"469-484"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}