[Less can be more - drug therapy in the elderly]

Area of Science:

• Gerontology
• Clinical Pharmacology
• Public Health

Context:

• The elderly population frequently experiences multimorbidity and polypharmacy.
• Age-associated physiological changes complicate drug safety, increasing risks of interactions, side effects, and poor adherence.
• Clinical trial data for older, multimorbid patients is often limited.

Purpose:

• To highlight the challenges of drug safety in elderly patients with multimorbidity and polypharmacy.
• To discuss the limitations of current guidelines and interventions for managing complex medication regimens in older adults.
• To review the evidence on the feasibility and impact of deprescribing in this population.

Summary:

• Drug safety is compromised in elderly patients with multimorbidity due to altered pharmacokinetics/pharmacodynamics, drug-drug interactions, side effects, and adherence issues.
• Current guidelines often fail to address age-specific factors and multimorbidity, while interventions to reduce polypharmacy lack robust validation.
• Despite challenges, studies indicate that deprescribing is feasible and can enhance quality of life for older adults.

Impact:

• Informs healthcare providers about the specific risks associated with polypharmacy in the elderly.
• Highlights the need for evidence-based guidelines and validated interventions for medication management in older adults.
• Supports the implementation of deprescribing strategies to improve patient outcomes and quality of life.