Medication-related problems in older people: how to optimise medication management

Older patients are at risk of medication-related problems because of age-related physiological changes and multiple medications taken for multiple co-morbidities. The resultant polypharmacy is frequently associated with inappropriate medication use, which in turn contributes to a range of adverse consequences, including geriatric syndromes (eg, falls, cognitive decline, urinary incontinence) and hospitalisation. In addition, medication non-adherence or discrepancies between the medications prescribed and those actually taken by patients, either intentional or unintentional, are prevalent and can lead to treatment failure. A large proportion of adverse drug events are preventable, and medication errors occur most commonly at the stages of prescribing and subsequent monitoring. There are a number of strategies to address these issues with the aim of ensuring safe prescribing. Furthermore, deprescribing with withdrawal of medications that are inappropriate or of minimal value for patients is increasingly emphasised for optimising medication management. In general, optimisation of medication management should be patient-centred, considering individual circumstances and preferences to determine the treatment goals or priorities for individual patients, and a multidisciplinary approach is recommended.