Achieving appropriate medication for older adults: A multidimensional perspective

Achieving appropriate medication is a multidimensional process. Current research on polypharmacy mainly focuses on drug appropriateness, but little is devoted to what determines the ongoing challenge. The authors, with their diverse clinical, pharmaceutical and regulatory backgrounds, offer a narrative review on the causes of inappropriate polypharmacy and how to avoid it. Inappropriate polypharmacy may stem from the systematic exclusion of frail older patients from landmark randomised controlled trials, which has prevented the accurate establishment of the clinical benefits of a drug for that ever-growing group of patients. Nonetheless, what may determine the usefulness of a drug in a specific patient cohort is its design. Patient-centric drug product development must, therefore, account for older people's characteristics, so that drugs are better formulated from their inception. This novel drug development process has significant implications for industry and requires adequate regulation. Clinicians must understand and be part of drug development. Explicit criteria such as STOPP/START provide guidance on identifying opportunities and circumstances to review medication but achieving appropriateness is far more complicated. New healthcare technology may pave the way to better-tailored interventions at a healthcare system level, but patient and advocate voices, as well as communication and continuity of care, must remain at the core. In conclusion, inappropriate polypharmacy results from the combination of multiple factors. Achieving appropriate medication for older adults requires merging different disciplines and a focus on patients' needs and expectations.