Medication management in older adults

Older adults, the largest medication consumer group worldwide, are virtually excluded from participating in clinical trials that investigate the efficacy and safety of drugs. The consequent lack of robust evidence regarding the effects of medicines in the older population is concerning in view of the ever-increasing medication exposure and the high risk of adverse drug reactions (ADRs) in this group. Furthermore, a number of age-related alterations in pharmacokinetics and the inter-individual variability in homeostatic capacity suggest caution when translating the evidence from trials conducted in younger and healthier participants into the routine management of older patients. Several decision tools have been developed to prevent inappropriate prescribing and polypharmacy in older adults; however, additional research is warranted to justify their widespread clinical use. The role of traditional disease-centered end points, based on objective markers of response, might also need revisiting and complementation with measures of self-rated health, particularly in older patients who may also be frail or have a poor quality of life. This article provides an overview of medication management in older adults, particularly in relation with trends in prescribing, polypharmacy and inappropriate medication use, and the development of decision tools that might facilitate an individualized therapeutic plan in this group.