[Functional assessment and medication in older adults]

Comprehensive geriatric assessment (CGA) and targeted functional assessments have become indispensable tools for safe and effective pharmacotherapy in older adults. Chronological age alone is a poor predictor of drug response and adverse outcomes; in contrast, CGA reliably detects frailty, cognitive impairment, and motor dysfunction-key determinants of pharmacokinetic and pharmacodynamic changes, as well as vulnerability to delirium, falls, and functional decline. By integrating validated instruments (e.g., frailty indexes, neuropsychological tests, the Timed-Up-and-Go test, gait speed, and handgrip strength), CGA unmasks subclinical deficits and quantifies individual risk profiles that directly influence clinical decisions: initiation, dosing, choice of agent, and, in particular, deprescribing of high-risk medications (anticholinergics, benzodiazepines, and fall-risk increasing drugs [FRID]). There is a large body of evidence demonstrating that CGA-guided prescribing reduces serious adverse drug reactions, falls, hospitalisations, and mortality while improving quality of life. In an era of increasingly complex regimens, systematic functional assessment in older people is no longer optional-it is the cornerstone of personalised, evidence-based pharmacotherapy in geriatric medicine.