Farewell to the Geriatric Therapeutics Review series: the end of the beginning

The Geriatric Therapeutics Review series (originally Geriatric Therapeutics) began as a local publication at the Heidelberg Repatriation Hospital in Melbourne in 1986. Its aim was to raise awareness and educate physicians about the special considerations needed when prescribing for ‘geriatric’ patients, at a time when there were few guidelines and reference texts to guide prescribing for older people. Geriatric Therapeutics Review articles have been published in the Journal since 1991, expanding its audience to pharmacists and other readers. For many years, reprints were distributed to members of the Australian and New Zealand Society for Geriatric Medicine.

Nearly 40 years later, the landscape has changed. Geriatric medicine has become one of the largest medical specialties in Australia, and an area of specialisation for many Australian pharmacists working in hospitals, residential care, and primary care. Information, guidelines, and professional development related to prescribing and medication management for older people are readily accessible.

The Geriatric Therapeutics Review series, comprising 146 peer-reviewed articles covering many areas of therapeutics and medication management (Table 1), has made a significant contribution to increased awareness and knowledge, thus achieving its aim. And so, the time has come to draw the series to a close.

This issue of the Journal celebrates the Geriatric Therapeutics Review series by looking back at a selection of vintage and seminal articles. Each article is accompanied by an introduction and commentary from a past author or guest commentator. There are also two new articles to round out the series.

We start with a reprint of the first Geriatric Therapeutics article published in the Journal, in 1991, titled ‘Problems associated with drug use in the elderly’.¹ This article was written by Dr David Fonda, the first geriatrician appointed at the Heidelberg Repatriation Hospital (in 1983). David has also written the accompanying introduction and commentary, in which he reflects on the state of geriatric medicine in the 1980s, the origins of the Geriatric Therapeutics series, and how medication use has changed since he wrote his original article more than 30 years ago. Although much has changed, many of the problems addressed in David's original article remain relevant today.

Next is a reprint of an article on diabetes from 1991, written by the late Dr Mario De Luise.² The introduction and commentary are written by Dr Tilenka Thynne, clinical pharmacologist and endocrinologist. Tilenka's commentary reflects on the limited treatment options that were available in the 1990s and the huge advances in diabetes therapeutics that have occurred since. As therapeutic options for diabetes evolved over the years, the Geriatric Therapeutics Review series published additional articles on this topic, including one co-authored by Tilenka in 2016 on sodium-glucose cotransporter-2 receptor inhibitors.³

We then have a reprint of the first Geriatric Therapeutics article on Alzheimer's disease, written by Dr Malcolm Hopwood and Dr Philip Morris.⁴ This article was published in 1994, at a time when no effective therapeutic options were available for dementia, and the first cholinesterase inhibitor (tacrine) was about to hit the market. The introduction and commentary for this article are by Associate Professor Michael Woodward. Michael was the second geriatrician to be appointed at the Heidelberg Repatriation Hospital (in 1988), and was chair of the Journal's Geriatric Therapeutics editorial committee from c1990–2014. Michael has spent much of his career contributing to Alzheimer's disease clinical trials. In his commentary, he reflects on the long, challenging and, at times, frustrating journey of drug development for Alzheimer's disease.

The fourth reprint is Michael Woodward's seminal 2003 paper titled ‘Deprescribing as a means for achieving better health outcomes for older people through reducing medications’.⁵ This was the first ever use of the word ‘deprescribing’ in the published literature. In the accompanying commentary, Professor Ian Scott, an eminent deprescribing researcher and clinician, reflects on the evolution of deprescribing research and practice over the last 20 years, noting that ‘deprescribing’ has now become part of the medical lexicon and is embraced as a vital aspect of clinical practice for improving medication safety and patient health, especially for older people.

Together these four reprints and their commentaries highlight how therapeutics has developed over the last four decades. Continuing that theme, the fifth and final reprint is an article that I wrote with Michael Woodward in 2016, on the 30th anniversary of the Geriatric Therapeutics Review series. In this article we described changes in therapeutics over the decades for diseases that were the subject of multiple articles in the series, including chronic pain, congestive heart failure, depression, epilepsy, osteoporosis and more. The article highlights how the number and type of medicines (and how they are used) has changed dramatically over the years, making therapeutics and medication management far more complex today.⁶ The article is introduced by Robyn Saunders, who, as a pharmacist at the Heidelberg Repatriation Hospital in the 1980s, conceived the Geriatric Therapeutics series and contributed to the Geriatric Therapeutics editorial committee for 28 years.

We finish off this issue, and the Geriatric Therapeutics Review series, with two new articles, addressing topics that have not been covered in the series until now. The first article, from Sara Yeganeh and Arron Sparkes, addresses mediciation management for older people living with human immunodeficiency virus (HIV). This is a topic of increasing relevance and importance, given the increased life expectancy of people with HIV.⁷ The second article is a review of the prevention, diagnosis, and management of vitamin B₁₂ deficiency, which is a common but often under-recognised problem in older people that may have serious consequences if left untreated.⁸ Fittingly, this final article is written by Heidelberg Repatriation Hospital aged-care pharmacist Nadia Mouchaileh.

The mix of contemporary and historical articles, and guest commentaries in this special issue provides a flavour of the vision and scope of the Geriatric Therapeutics Review series that made it so successful. The series would not have been possible without the foresight of pharmacists Robyn Saunders and Geoff Sussman, the hard work and dedication of the editorial committee (especially Michael Woodward, who led the committee for over 20 years, and Robyn Saunders), the Journal's managing editors (especially Jenny Johnston and Benafsha Khariwala), and the many authors and peer reviewers.⁶ It also would not have happened without the support of the Journal's editors-in-chief and the Society of Hospital Pharmacists of Australia.

For me personally, it has been a great privilege to contribute to this series over the last 24 years, as an editorial committee member, author, and editor. It is pleasing to see how physicians' and pharmacists' interest, awareness, and knowledge in geriatric medicine have developed over this period, along with excellent references, guidelines, and education programs to help clinicians care for older people. There is, however, still much to be done to ensure optimal medication management for older people, because inappropriate and unnecessary prescribing and adverse medication outcomes remain prevalent.⁹ So, although the Geriatric Therapeutics Review series will be no more, this is not the end; but it is, perhaps, the ‘end of the beginning’ for safe and appropriate therapeutics for older people.

Rohan A Elliot is an associate editor of the Journal of Pharmacy Practice and Research. He was excluded from editorial decision-making related to the acceptance and publication of this editorial.

The author received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Commissioned, not externally peer reviewed.